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Application of scales, tests and questionnaires in the practice of an osteopathic physician 在骨科医生的实践中应用量表、测试和问卷
Pub Date : 2021-10-05 DOI: 10.32885/2220-0975-2021-3-85-94
A. F. Belyaev
The article attempts to systematize the scales, tests and questionnaires that are used in the practice of an osteopathic physician from the standpoint of the «patient′s model». The purpose of the scales using in the practice of an osteopathic physician is to objectify the patient′s diagnosis, assess the dynamics of her/his condition, the therapy results, the ability to demonstrate the treatment results to the patient and the professional community, and maintain continuity in the treatment process. The scales allow an osteopath to assess not only the dynamics of somatic dysfunctions (SD) during the treatment, but also to shift from a qualitative to a quantitative assessment of the patient′s clinical condition. In this case, it becomes possible to draw parallels, to determine the cause-and effect relationship between SD and the patient′s clinical condition.
本文试图从“病人模型”的角度系统化整骨疗法医生在实践中使用的量表、测试和问卷。在骨科医生的实践中使用这些量表的目的是使患者的诊断客观化,评估她/他的病情的动态,治疗结果,向患者和专业团体展示治疗结果的能力,并保持治疗过程的连续性。该量表使整骨医生不仅可以评估治疗过程中躯体功能障碍(SD)的动态,还可以从定性到定量评估患者的临床状况。在这种情况下,可以进行类比,以确定SD与患者临床状况之间的因果关系。
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引用次数: 0
Osteopathy as a method of correction and prevention of the formation of somatic dysfunctions of the musculoskeletal system in office workers 骨科作为一种矫正和预防办公室工作人员肌肉骨骼系统的躯体功能障碍形成的方法
Pub Date : 2021-10-05 DOI: 10.32885/2220-0975-2021-3-54-65
I. A. Aptekar, E. V. Abramova
Introduction. According to Russian and foreign studies, the frequency of musculoskeletal system pathology continues to grow. To improve the life quality and reduce the level of the musculoskeletal system diseases, an urgent task is to increase the volume of available non-drug methods of prophylaxis.The aim of the research was to develop measures to prevent the formation of somatic dysfunctions of the musculoskeletal system and their relapses in office workers using osteopathic correction.Materials and methods. In the period from 2016 to 2020, a prospective controlled randomized study was carried out on the basis of the ANO TIMM. The work is based on the results of osteopathic care in combination with a controlled change in the ergonomics of the workplace after the correction of somatic dysfunctions of the musculoskeletal system in office workers. The study involved 426 people who were divided into two comparable groups: the main and control groups of 212 and 214 people, respectively. All patients underwent osteopathic diagnostics before the start of the treatment, during therapy, and at its completion in accordance with the approved clinical guidelines. Patients of both groups received osteopathic care provided in accordance with the developed algorithm. The patients of the main group underwent correction of their workplaces ergonomics.Results. The study showed that office workers are characterized by the presence of somatic dysfunctions at the regional and local levels. Somatic dysfunctions of the spine, pelvis, abdominal and pelvic diaphragms were most often observed. As a result of osteopathic correction in combination with a change in the ergonomics of the workplace in patients of the main group, the frequency of recurrences of the somatic dysfunctions formation decreased significantly (p<0,05) compared with patients in the control group. It also was accompanied by a significant decrease in the pain syndromes recurrence.Conclusion. The use of osteopathic correction in combination with the workplace ergonomics change effectively contributes to the prevention of the formation of the musculoskeletal system somatic dysfunctions and their recurrence in office workers.
介绍。根据俄罗斯和国外的研究,肌肉骨骼系统病理的频率持续增长。为了提高生活质量和降低肌肉骨骼系统疾病的水平,当务之急是增加可用的非药物预防方法的数量。该研究的目的是制定措施,以防止肌肉骨骼系统的躯体功能障碍的形成及其复发,在办公室工作人员使用整骨矫正。材料和方法。在2016 - 2020年期间,基于ANO TIMM进行前瞻性对照随机研究。这项工作是基于在办公室工作人员的肌肉骨骼系统的躯体功能障碍矫正后,将整骨疗法护理与工作场所的人体工程学控制变化相结合的结果。这项研究涉及426人,他们被分为两个可比较的组:主要组和对照组,分别有212人和214人。所有患者在治疗开始前、治疗期间和治疗结束时均按照批准的临床指南进行骨疗法诊断。两组患者均按照制定的算法接受整骨疗法治疗。主组患者对其工作场所进行了工效学校正。该研究表明,办公室工作人员的特点是在区域和地方层面存在躯体功能障碍。最常观察到的是脊柱、骨盆、腹部和骨盆膈的躯体功能障碍。与对照组患者相比,主组患者在进行整骨矫正并改变工作场所的人体工程学后,躯体功能障碍形成的复发率显著降低(p< 0.05)。并伴有疼痛综合征复发率的显著降低。结合工作场所人体工程学的改变,使用整骨矫正有效地有助于预防肌肉骨骼系统躯体功能障碍的形成及其在办公室工作人员中的复发。
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引用次数: 1
Study of polysynaptic reflex excitability and somatosensory evoked potentials in patients with myofascial pain syndrome 肌筋膜疼痛综合征患者多突触反射兴奋性和体感诱发电位的研究
Pub Date : 2021-10-05 DOI: 10.32885/2220-0975-2021-3-31-40
A. A. Safiullina, G. I. Safiullina, R. A. Yakupov
Introduction. Myofascial pain syndrome (MFPS) is one of the most common pathologies of the musculoskeletal system that causes chronic pain. This type of pain reaches its peak in middle-aged people; women get sick 2,5 times more often than men. The disease leads to significant disability; it is not only a medical but also a social problem. Atthe same time, a number of authors still note the low clinical efficacy of the applied therapy regimens. In this situation there is in demand the further study of the MFPS pathogenesis, in particular, the clinical and electroneurophysiological characteristics of this pathology, in order to search for new, including pathogenetically proved, treatment methods.The aim of the research was to study the relationship between the indicators of the blinking reflex and somatosensory evoked potentials in patients with active and latent forms of MFPS.Materials and methods. In order to study the neurophysiological aspects of MFPS, a comprehensive clinical and electroneurophysiological examination was carried out in 92 patients of working age, including 78 women and 14 men, whose average age was 48,1±9,3) years, suffering from MFPS of the scapular area. The patients were subdivided into subgroups depending on the prevalence and severity of pain manifestations: the first subgroup — with an active form (58 people, 63 %), the second subgroup — with a latent form of MFPS (34 people, 37 %). The control group was formed from conditionally healthy volunteers in the amount of 35 people, comparable to the main group by age and sex.Results. The comparing of the study results, taking into account polysynaptic reflex excitability and the data of somatosensory evoked potentials, revealed the significant positive correlations of the indicators. The obtained results allowed to assess the excitability of spinal cord motor neurons as well as suprasegmental structures in MFPS, involved in the implementation of pain syndrome.Conclusion. The use of clinical electroneurophysiology methods makes it possible to assess the functional state of the CNS structures involved in the analysis of nociceptive afferentation. In the active form of MFPS, an increase in the excitability of stem and thalamic structures was mainly determined, which could potentially indicate the activation of adaptive processes on the one hand, and on the other hand, the predisposition of neuronal networks to a state of arousal. In the latent form of MFPS, a multidirectional change in reflex excitability was observed.
介绍。肌筋膜疼痛综合征(MFPS)是引起慢性疼痛的肌肉骨骼系统最常见的病理之一。这种类型的疼痛在中年人中达到顶峰;女性患病的几率是男性的2.5倍。该病导致严重残疾;这不仅是一个医学问题,也是一个社会问题。与此同时,一些作者仍然注意到应用治疗方案的临床疗效较低。在这种情况下,需要进一步研究MFPS的发病机制,特别是该病理的临床和神经电生理特征,以寻求新的,包括病理证实的治疗方法。本研究旨在探讨活跃型和潜伏型MFPS患者眨眼反射指标与体感诱发电位之间的关系。材料和方法。为了研究MFPS的神经生理方面,我们对92例工作年龄的肩胛骨区MFPS患者进行了全面的临床和神经电生理检查,其中女性78例,男性14例,平均年龄48,1±9,3)岁。根据疼痛表现的患病率和严重程度,将患者细分为亚组:第一亚组为活动性MFPS(58人,63%),第二亚组为潜伏性MFPS(34人,37%)。对照组由有条件健康的志愿者组成,数量为35人,在年龄和性别上与主组相当。将多突触反射兴奋性与体感诱发电位数据进行比较,结果显示两指标间存在显著的正相关关系。所获得的结果可以评估脊髓运动神经元的兴奋性以及MFPS的超节段结构,参与疼痛综合征的实施。使用临床神经电生理学方法,可以评估中枢神经系统结构的功能状态,参与分析伤害性传入。在MFPS的活跃形式中,主要确定了茎和丘脑结构兴奋性的增加,这一方面可能表明适应性过程的激活,另一方面可能表明神经元网络倾向于觉醒状态。在MFPS的潜伏形式中,观察到反射兴奋性的多向变化。
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引用次数: 1
Post-intensive care syndrome (PICS) in children 儿童重症监护后综合征(PICS)
Pub Date : 2021-10-05 DOI: 10.32885/2220-0975-2021-3-95-105
L. K. Karimova, V. Belash
The survival rate of children who require intensive care for life-threatening diseases or injuries has recently increased significantly. In pediatric intensive care, a decrease in mortality is accompanied by an increase in morbidity. This trend has led to a shift in focus of attention from reducing mortality to optimizing outcomes in critically ill patients. A broader approach and focus on outcome in critically ill survivors has been greatly facilitated by the development of a concept that integrates post-intensive care (PIC) diseases into Post Intensive Care Syndrome (PICS). The concept of PIC syndrome implies the occurrence of disorders in patients after IC in three main areas: mental health, cognitive functions and physical health, and also takes into account the state of the family of surviving patients, in particular, parents, who often have a deterioration in mental health. Diagnosis and treatment of this condition involves the work of a multidisciplinary team, in which it is desirable to include an osteopathic doctor in order to more effectively and timely diagnose and correct reversible functional disorders.
患有危及生命的疾病或受伤需要特别护理的儿童的存活率最近显著增加。在儿科重症监护中,死亡率的降低伴随着发病率的增加。这一趋势导致关注的焦点从降低死亡率转向优化危重患者的预后。将重症监护后(PIC)疾病纳入重症监护后综合征(PICS)的概念的发展,极大地促进了对重症幸存者的更广泛的方法和对结果的关注。知情同意综合症的概念意味着知情同意后患者在三个主要领域出现疾病:心理健康、认知功能和身体健康,还考虑到幸存患者的家庭状况,特别是父母的状况,他们的精神健康状况往往恶化。这种情况的诊断和治疗需要一个多学科团队的工作,为了更有效和及时地诊断和纠正可逆的功能障碍,最好包括一名骨科医生。
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引用次数: 0
Study of the effectiveness of osteopathic correction in the complex treatment of patients with operated primary open-angle glaucoma 骨科矫正在原发性开角型青光眼手术综合治疗中的疗效研究
Pub Date : 2021-10-05 DOI: 10.32885/2220-0975-2021-3-66-76
O. V. Zubkov, E. Smirnova, V. V. Kramar, O. I. Kurbatov
Introduction. Glaucoma is a chronic eye disease characterized by a constant or periodic increase in intraocular pressure, a decrease of visual fields and visual acuity, and by a special form of optic nerve atrophy with excavation in the disc area. The reflection of this slowly fl owing atrophy is a disturbance in the visual field and a complete irreversible loss of visual function. The prevalence of the disease increases with increasing age. The main methods of treatment are medical and surgical. Non-penetrating operations are recognized as the safest methods of surgical treatment of glaucoma. The most common complications of such operations include: detachment of the choroid, small anterior chamber syndrome, hyphema, cicatricial changes in the filtration cushion. Based on the analysis of literature data, it can be assumed that the inclusion of osteopathic correction in the complex therapy of patients with operated glaucoma can increase the effectiveness of therapy.The aim of the research was to study the clinical efficacy of osteopathic correction in the complex treatment of patients operated on primary open-angle glaucoma.Materials and methods. The study involved 20 patients (20 eyes) aged 70 to 75 years with developed and advanced stages of primary open-angle glaucoma, who underwent surgical treatment. The main (10 people) and control (10 people) groups were formed by simple randomization. Participants in the main group received standard medical therapy and osteopathic correction, while participants in the control group received only medical therapy. Changes in the following clinical parameters were evaluated: visual acuity, visual fi eld, intraocular pressure, thickness of the retinal nerve fiber layer, and severity of pain syndrome. Indicators were recorded at the beginning of the study (2 weeks after surgery) and at the end of the study (2–3 months after surgery).Results. Patients receiving osteopathic correction as part of the complex therapy after surgery of primary openangle glaucoma are characterized by a statistically significant (p<0,05) decrease in the severity of pain syndrome, an increase in the magnitude of the visual field and of the thickness of the retinal nerve fiber layer.Conclusion. The obtained results suggest the effectiveness of the inclusion of osteopathic correction in the complex treatment of patients with operated on primary open-angle glaucoma. It is recommended to continue the study with a larger sample size.
介绍。青光眼是一种慢性眼病,其特征是眼压持续或周期性升高,视野和视力下降,并伴有视神经萎缩和椎间盘突出。这种缓慢流动萎缩的反映是视野的干扰和视觉功能的完全不可逆转的丧失。这种疾病的流行率随着年龄的增长而增加。主要的治疗方法是内科和外科。非穿透性手术是公认的最安全的青光眼手术治疗方法。此类手术最常见的并发症包括:脉络膜脱离、小前房综合征、前房积血、滤过垫瘢痕性改变。通过对文献资料的分析,可以认为在青光眼手术患者的综合治疗中纳入整骨矫正可以提高治疗的有效性。本研究旨在探讨骨科矫正在原发性开角型青光眼复杂治疗中的临床疗效。材料和方法。该研究涉及20例(20只眼睛)年龄在70至75岁之间,患有原发性开角型青光眼的发展和晚期,他们接受了手术治疗。采用简单随机分组法组成主组(10人)和对照组(10人)。主组参与者接受标准药物治疗和整骨矫正,而对照组参与者仅接受药物治疗。评估以下临床参数的变化:视力、视野、眼压、视网膜神经纤维层厚度和疼痛综合征的严重程度。在研究开始时(术后2周)和研究结束时(术后2 - 3个月)分别记录各项指标。原发性开角型青光眼术后接受骨科矫正作为综合治疗的一部分,患者疼痛综合征的严重程度降低,视野大小和视网膜神经纤维层厚度增加,具有统计学意义(p< 0.05)。结果表明,在原发性开角型青光眼手术患者的综合治疗中纳入整骨矫正是有效的。建议继续扩大样本量进行研究。
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引用次数: 1
Evaluation of the clinical effectiveness of the osteopathic correction in children with chronic bronchitis in a sanatorium 疗养院儿童慢性支气管炎整骨矫正的临床效果评价
Pub Date : 2021-10-05 DOI: 10.32885/2220-0975-2021-3-41-53
V. Belash, G. A. Khaibullina
Introduction. Possible causes of chronic bronchitis are anatomically incorrect location of internal organs, the presence of congestion, impaired blood circulation, impaired mobility level, disorders of innervation and metabolic processes in the respiratory organs, decreased mobility of the chest, tension of the thoracic diaphragm, imbalance of the myofascial system, diseases of the spine (osteochondrosis, scoliosis, etc.). These disorders and dysfunctions are extremely rarely taken into account in the prescription of conventional therapy regimens in children with chronic bronchitis. At the same time, it is known that many drugs and various therapeutic effects in some cases are not able to give long-term remission and recovery. This causes the need to search for new methods of treating chronic bronchitis in children, one of which could be osteopathic correction. At the same time, in the available literature sources, there is very little information on this problem, and the presented data are sometimes contradictory.The aim of the study is to evaluate the clinical effectiveness of osteopathic correction in the treatment of children with chronic bronchitis in a sanatorium.Materials and methods. The controlled randomized trial was conducted from June 2020 to April 2021. The study included 40 patients with chronic bronchitis at the age from 6 to 16 years, 24 boys, 16 girls, who were undergoing sanatorium-resort treatment in the children′s sanatorium «Raduga» (Sterlitamak). Depending on the applied treatment method, the patients were divided by simple randomization into two comparable groups (main and control) of 20 people each. All patients received sanatorium resort treatment, which included physical therapy, halotherapy, inhalations, phytotherapeutic procedures. Patients of the main group, in addition to the above-described therapy, received osteopathic correction. In total, 2 sessions were carried out with an interval of 7 days. All patients, regardless of the group, before the start of treatment, as well as after the completion of the therapy course, underwent an assessment of the osteopathic status, chest excursion and respiratory function.Results. During the treatment with inclusion of osteopathic correction, in patients of the main group, there is a significant decrease in the frequency of detection of somatic dysfunctions (global rhythmogenic disorder, neck region, chest region), as well as a significant positive dynamics of indicators characterizing the external respiration function (chest excursion, forced vital capacity of lungs, peak exhalation rate), compared with patients receiving only conventional therapy. Positive changes in the chest excursion and peak exhalation rate against the background of osteopathic correction persist reliably even 3 months after the completion of the therapy course, and it allows to suppose the prolonged effect of the therapy.Conclusion. The study showed that osteopathic correction increases the clinical effec
介绍。慢性支气管炎的可能原因有:内脏器官解剖位置不正确、充血、血液循环受损、活动水平受损、呼吸器官神经支配和代谢过程紊乱、胸部活动能力下降、胸横隔膜紧张、肌筋膜系统失衡、脊柱疾病(骨性软骨病、脊柱侧凸等)。这些疾病和功能障碍在儿童慢性支气管炎的常规治疗方案处方中很少考虑到。同时,我们知道,在某些情况下,许多药物和各种治疗效果都不能给予长期的缓解和恢复。这导致需要寻找治疗儿童慢性支气管炎的新方法,其中之一可能是整骨矫正。与此同时,在现有的文献资料中,关于这个问题的信息很少,而且所提供的数据有时是相互矛盾的。本研究的目的是评估骨科矫正在疗养院治疗儿童慢性支气管炎的临床效果。材料和方法。该对照随机试验于2020年6月至2021年4月进行。该研究包括40名6至16岁的慢性支气管炎患者,24名男孩,16名女孩,他们在儿童疗养院«Raduga»(Sterlitamak)接受疗养胜地治疗。根据应用的治疗方法,将患者简单随机分为两组(主要组和对照组),每组20人。所有患者均接受疗养胜地治疗,包括物理治疗、雾化治疗、吸入治疗和植物治疗。主组患者除上述治疗外,还接受整骨矫正。共进行2个疗程,间隔7天。所有患者,不论分组,在治疗开始前和治疗结束后,均进行了骨科状态、胸部偏移和呼吸功能的评估。在包含整骨矫正的治疗过程中,与仅接受常规治疗的患者相比,在主组患者中,躯体功能障碍(整体心律失常,颈部区域,胸部区域)的检测频率显着降低,以及表征外部呼吸功能指标(胸部偏移,肺用力肺活量,呼气峰值率)的显着积极动态变化。在整骨矫正的背景下,胸部偏移和呼气峰值率的积极变化在治疗过程完成后甚至持续3个月,这允许假设治疗的长期效果。研究表明,骨科矫正增加了传统方法的疗养胜地治疗儿童慢性支气管炎患者的临床疗效。这允许推荐在疗养院的这组患者的复杂治疗方案中包含整骨疗法的矫正方法。
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引用次数: 1
Changes in the characteristics of perception channels in the process of mastering the discipline «Osteopathy» 在掌握“整骨疗法”的过程中,知觉通道特征的变化
Pub Date : 2021-10-04 DOI: 10.32885/2220-0975-2021-3-19-30
P. V. Fisenko, Y. Potekhina
Introduction. Perception is a holistic reflection of objects and phenomena. A person has all the channels of perception — auditory, visual, kinesthetic. Only the expression degree of each channel in the overall structure of perception is different. Psychologists studied the specific weight of perception channels in its overall structure in a single-stage «slice». There is no reliable data on changes in perception in one group of subjects over a long period of time. Osteopathic researches have examined the development of touch during learning process. At the same time, there have not been studied the dynamics of perception as a whole system.The goal of the study is to research the changes of the perception channels among students of the cycle of professional retraining in the specialty «Osteopathy» in the process of 4-year education and to compare it with the perception channels characteristics of teachers of the cycle.Materials and methods. From 2018 to 2021 a cohort, prospective study was conducted. The study involved persons enrolled in a long (3,5 years) cycle of professional retraining in the specialty «Osteopathy» from I to IV courses — 63 people (35 men, 28 women, age from 26 to 52 years, median 36,5 years), and also teachers of osteopathy with at least 5 years of work experience — 20 people (14 men, 6 women, age from 31 to 55 years, median 48 years). An annual survey was conducted based on the questionnaire of S. A. Efremtseva «Diagnostics of the dominant perceptual modality», which consists of 48 questions aimed at identifying the predominant (dominant) channels of perception in three directions: auditory, visual or kinesthetic. The maximum score for each of the three modality channels is 16, the minimum is 0. The survey was anonymous. In the questionnaire, the participants provided only data on their gender, age, study group number, and the date of the study.Results. The general structure of the students′ perception underwent changes during their learning. The specific weight of the kinesthetic channel in the general structure of listeners′ perception grew annually and doubled in the IV year in comparison with the beginning of training. At the same time, the specific weight of other channels of perception decreased steadily. The expression of all channels of listeners′ perception in absolute numbers also increased (p<0,005). The kinesthetic channel showed the most stable positive dynamics. Its expression began to grow already in the second year of the learning (p<0,001), while the expression of the auditory and visual channels had a statistically significant difference only when comparing 3rd and 4th years of the learning (p<0,005). The perception channels among the teachers of osteopathy were characterized by high absolute indices with similar values for individual channels. In half of the subjects, the kinesthetic channel prevailed in the structure of perception, and in the second half the polymodal channel prevailed with a high rate o
介绍。知觉是对物体和现象的整体反映。一个人拥有所有的感知渠道——听觉、视觉、动觉。只是各个通道在感知整体结构中的表达程度不同。心理学家在单阶段“切片”中研究了其整体结构中感知通道的具体权重。没有可靠的数据表明一组受试者在很长一段时间内的感知变化。整骨疗法研究了学习过程中触觉的发展。同时,还没有将感知动力学作为一个整体系统进行研究。本研究的目的是研究骨科专业再培训周期学生在四年教育过程中感知通道的变化,并与周期教师的感知通道特征进行比较。材料和方法。从2018年到2021年进行了一项队列前瞻性研究。该研究涉及的人员参加了长周期(3.5年)的专业“骨科”专业再培训,从I到IV课程- 63人(35名男性,28名女性,年龄从26到52岁,中位数为36,5岁),以及至少有5年工作经验的骨科教师- 20人(14名男性,6名女性,年龄从31到55岁,中位数为48岁)。一项年度调查是基于s.a. Efremtseva的问卷“主导感知模式的诊断”进行的,该问卷由48个问题组成,旨在确定三个方向的主要(主导)感知渠道:听觉、视觉或动觉。三种模式通道的最高得分为16分,最低得分为0分。这项调查是匿名的。在调查问卷中,参与者只提供了他们的性别、年龄、研究组编号和研究日期的数据。学生感知的总体结构在学习过程中发生了变化。在听者感知总体结构中,动觉通道的权重逐年增长,在第4年比训练开始时增加了一倍。与此同时,其他感知渠道的权重稳步下降。听众感知各渠道的绝对表达数也有所增加(p< 0.005)。动觉通道表现出最稳定的正动态。其表达在学习的第二年就已经开始增长(p< 0.001),而听觉和视觉通道的表达只有在学习的第3年和第4年才有统计学差异(p< 0.005)。骨科教师的知觉通道具有绝对指数高、单项通道值相近的特点。在一半的受试者中,动觉通道在感知结构中占主导地位,而在另一半受试者中,多模态通道以高比率的动觉通道占主导地位。整骨学校学生在学习过程中各感知通道的表达逐渐接近整骨教师。在学习的第四年,学生与教师在感知通道指标的绝对值上没有统计学上的显著差异。整骨疗法学校的学生在学习过程中,所有知觉通道的表达都有规律的增加(p< 0.005)。动觉通道的表达增长最为迅速。在所有渠道中,最大的增长发生在学习的第四年。在学习的前三年,听者在感知通道表达方面逐渐向各通道指标均较高的教师靠拢。在第四年,学生和老师没有统计学上的显著差异。因此,骨科的初级培训应该持续至少3,5 - 4年,以形成一个高感知指数的骨科医生的感知。
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引用次数: 0
Kyphosis types of the spine cervical-thoracic junction 脊柱颈胸交界处的后凸类型
Pub Date : 2021-10-04 DOI: 10.32885/2220-0975-2021-3-8-18
A. Orel, O. Semenova
Introduction. The strengthening of thoracic kyphosis and forward head posture is one of the urgent problems of modern man. Such changes are most often detected for elderly and senile people. However, today these features are also detected for young people. Digital radiography can objectively assess the position of the cervical and thoracic vertebrae. However, the criteria for reliably registering the position of the vertebrae of the cervicalthoracic junction have not yet been developed.The aim of the study — to develop a method for assessing the position of the vertebrae of the cervical-thoracic junction according to digital radiographs; to develop a typology of the vertebra positions of the cervical-thoracic junction; to study the frequency of vertebral position types for the cervical-thoracic junction for different age groups.Materials and methods. Spine X-ray images in the sagittal plane for 141 adult patients with dorsopathies were studied. The selection of patients was random and there were four age groups: 32 persons aged 21 to 45, 32 persons aged 46 to 59, 50 persons aged 60 to 74 and 21 persons aged 75 to 88 year-old. The study was conducted on PC screen, without the patient′s presence. A single digital X-ray image of the spine for each patient in the sagittal plane was obtained. On the combined digital radiograph, the occipital vertical was drawn along all parts of the spine, starting from the external hillock of the occipital bone downwards, and the anteroposterior CV–TV axes of the vertebrae (r axes) were applied. At the points of intersection of the axes with the occipital vertical, the perpendiculars to the axis were restored, and the angles between the perpendiculars and the vertical — the angles of the anteroposterior axes of the vertebrae (r angles) — were measured. Statistical analysis was performed using the MS Offi ce Excel 2007 and Statistica 12 software packages.Results. It was found that the values of the anteroposterior axe angles r of CVII–TIII vertebrae can serve as criteria for determining the spatial position of the cervical-thoracic junction vertebrae. There are 4 types of the shape of the cervical-thoracic junction. Type I is a straightened kyphosis («giraffe neck»); type II is physiological («harmonious»); type III — enhanced kyphosis («bear withers»); type IV–hyperkyphosis («buffalo hump»). Types III and IV are accompanied by a forward displacement of the head. Straightened cervical-thoracic junction kyphosis — type I — was diagnosed in 21 (15 %) people, 52 (37 %) patients were assigned to type II, another 48 (34 %) patients had type III, and 20 (14 %) patients had type IV cervical-thoracic junction kyphosis. In young patients aged 21 to 45, as well as in middle-aged patients aged 46 to 59, the most common type was the harmonious type II of cervical-thoracic junction, in elderly patients aged 60 to 74 — type III and close to it in frequency was type III. In elderly patients aged 75 to 88, the IV type of the position
介绍。加强胸后凸和前倾头位是现代人亟待解决的问题之一。这种变化最常见于老年人和老年人群。然而,今天这些特征也可以在年轻人身上发现。数字x线摄影可以客观地评估颈椎和胸椎的位置。然而,可靠地记录颈胸交界处椎体位置的标准尚未得到发展。该研究的目的是开发一种根据数字x线片评估颈胸交界处椎骨位置的方法;发展颈胸交界处椎体位置的类型学;目的探讨不同年龄组颈胸交界处椎体体位类型的发生频率。材料和方法。本文对141例成人脊柱病变患者的脊柱矢状面x线图像进行了研究。患者随机选择4个年龄组:21 ~ 45岁32例,46 ~ 59岁32例,60 ~ 74岁50例,75 ~ 88岁21例。该研究在电脑屏幕上进行,患者不在场。获得每位患者矢状面脊柱的单个数字x线图像。在联合数字x线片上,沿脊柱各部位绘制枕骨垂直线,从枕骨外丘开始向下,并应用椎骨的前后CV-TV轴(r轴)。在轴与枕骨垂直的交点处,恢复轴与轴线的垂直线,并测量垂直线与垂直线之间的夹角——椎体前后轴的夹角(r角)。采用MS office office Excel 2007和Statistica 12软件包进行统计分析。我们发现CVII-TIII椎体的前后斧角r值可以作为判断颈胸交界椎体空间位置的标准。颈胸交界处有四种形状。I型是直型后凸(“长颈鹿颈”);II型是生理上的(“和谐”);III型-增强型后凸(“熊萎”);iv型-后凸畸形(“水牛驼峰”)。III型和IV型伴有头部向前移位。21人(15%)被诊断为I型颈胸交界处后凸,52人(37%)被诊断为II型,另外48人(34%)被诊断为III型,20人(14%)被诊断为IV型颈胸交界处后凸。在21 ~ 45岁的年轻患者以及46 ~ 59岁的中年患者中,最常见的类型是颈胸交界处和谐型II型,在60 ~ 74岁的老年患者中,最常见的类型是III型,频率接近III型。在75 ~ 88岁的老年患者中,颈胸交界处椎体位置以IV型居多。所提出的诊断方法允许为每个患者登记颈胸交界处的椎体位置类型。确定了颈-胸交界椎体的四种位置类型:“长颈鹿颈型”的直型后凸、“和谐型”的生理性后凸、“熊颈型”的增强型后凸和“水牛驼峰型”的后凸。增加的后凸和后凸过度伴有前倾的头部姿势。
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引用次数: 4
Terminology of injuries in osteopathy and other medical disciplines 骨科和其他医学学科损伤术语
Pub Date : 2021-07-03 DOI: 10.32885/2220-0975-2021-2-116-127
Y. Potekhina, A. A. Gurichev
There is presented a review of the literature on the concepts of «osteopathic damage», «somatic dysfunction», «trauma», «damage». The similarities and differences of these terms in osteopathy, traumatology and forensic medicine are shown. In order to achieve an interdisciplinary understanding in osteopathy, along with the original and new terminology, the use of the historically established terminology of classification of external damaging factors is proposed.
本文对“骨科损伤”、“躯体功能障碍”、“创伤”、“损伤”等概念的文献进行了综述。指出了这些术语在骨科、创伤学和法医学中的异同。为了实现对骨病的跨学科理解,以及原始和新的术语,建议使用历史上建立的外部损伤因素分类术语。
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引用次数: 1
Study of the peculiarities of the osteopathic status in patients with planovalgus deformity of the feet in combination with a history of placement torticollis and without such a combination 足平外翻畸形患者合并放置性斜颈病史和无此类合并病史的骨科状态特点的研究
Pub Date : 2021-07-03 DOI: 10.32885/2220-0975-2021-2-41-51
Yu. R. Mukhammadieva, A. N. Alshina, I. I. Gainetdinov, R. F. Safin
Introduction. The relevance of the feet planovalgus deformity problem is caused by its prevalence and tendency to progression, insufficient knowledge of a number of aspects, and the complexity of treatment. Another urgent pediatric orthopedics problem is the placement torticollis in infants, and the possible relationship of this problem with feet planovalgus deformity. Among the least studied aspects of these diseases categories it is necessary to highlight the problem of the peculiarities of the osteopathic status in children with feet planovalgus deformity with a history of placement torticollis, and the dynamics of clinical manifestations during their osteopathic correction.The aim of the research was to study the features of the osteopathic status in patients with planovalgus deformity of the feet in combination with a history of placement torticollis and without such a combination, and to evaluate the clinical efficacy of complex therapy, including osteopathic correction.Materials and methods. The study involved 60 patients aged 7–14 years with planovalgus deformity of the feet. The study participants were divided into two groups. The first group included 30 patients with planovalgus deformity of the feet and a history of placement torticollis. The second group included 30 patients with planovalgus deformity of the feet, who did not have a history of torticollis. All study participants received complex therapy (orthopedic treatment and osteopathic correction). At the beginning and at the end of the course of osteopathic correction, the condition of the arch of the foot (the severity of fl at feet) and osteopathic status were assessed in all study participants.Results. In the first group there were prevailed somatic dysfunctions (SD) of the head region, the detection rate was 86%, the pelvic region (somatic component — C), 76 %, and the neck region (C), 13 %. Among the second group participants there were prevailed SD of the pelvic region (C) — the detection rate was 100 %, the lower extremities, 43 %, and the lumbar region (C), 13 %. The SD in the pelvic region was the most typical; however, more often (p<0,05) this dysfunction was detected in the second group. The number of regional SD in general was statistically significant (p<0,05) more in the first group. The participants in both groups were most characterized by local SD of the vertebrae (76 and 100 %) and fibula (20 and 56 %). There was a statistically significant (p<0,05) difference between patients in terms of the detection frequency of these musculoskeletal system dysfunctions. Among the local SD of the craniosacral system and organs of the head, intraosseous SD (90 and 17 %) and SD of the dura mater (40 and 23 %) prevailed. SD of the temporomandibular joint was detected only in the first group (23 %). There was a statistically significant (p<0,05) difference between the groups in terms of the detection rates of temporomandibular joint dysfunctions and intraosseous dysfunctions. Ac
介绍。足跖外翻畸形问题的相关性是由于其患病率和进展趋势,对许多方面的知识不足以及治疗的复杂性。另一个迫切的儿科骨科问题是婴儿斜颈的放置,以及这个问题与足平外翻畸形的可能关系。在这些疾病类别中研究最少的方面中,有必要强调有放置性斜颈病史的足跖外翻畸形儿童的骨科状况的特殊性,以及他们在骨科矫正期间的临床表现的动态。本研究的目的是研究足平外翻畸形合并放置性斜颈病史和不合并放置性斜颈病史患者的骨科状态特征,并评价包括骨科矫正在内的综合治疗的临床疗效。材料和方法。该研究涉及60例7-14岁的足平外翻畸形患者。研究参与者被分为两组。第一组包括30例足平外翻畸形和有放置性斜颈病史的患者。第二组包括30例无斜颈病史的足平外翻畸形患者。所有的研究参与者都接受了综合治疗(骨科治疗和骨科矫正)。在整骨矫正过程的开始和结束时,对所有研究参与者的足弓状况(足部浮肿的严重程度)和整骨状态进行评估。第一组以头部区躯体功能障碍(SD)为主,检出率为86%,盆腔区(躯体成分- C)检出率为76%,颈部区(C)检出率为13%。在第二组参与者中,骨盆区域(C)的SD患病率为100%,下肢为43%,腰椎区域(C)为13%。以盆腔区SD最典型;然而,第二组更常发现这种功能障碍(p< 0.05)。总体而言,第一组的区域SD数有统计学意义(p< 0.05)。两组参与者的主要特征是椎骨(76%和100%)和腓骨(20%和56%)的局部SD。在这些肌肉骨骼系统功能障碍的检测频率方面,患者之间的差异有统计学意义(p< 0.05)。在颅骶系统和头部器官的局部SD中,骨内SD占90%和17%,硬脑膜SD占40%和23%。仅在第一组(23%)检测到颞下颌关节的SD。两组患者颞下颌关节功能障碍和骨内功能障碍检出率比较,差异有统计学意义(p< 0.05)。根据治疗结果,第一组患者头部和盆腔SD发生率显著降低(p< 0.05),第二组患者盆腔和下肢SD发生率显著降低(p< 0.05)。研究参与者的平足严重程度在治疗前没有统计学上的显著差异。综合治疗结束时,两组患者足弓状态的改善均有统计学意义(p< 0.05)。各组受试者在局部功能障碍患病率和数量以及局部SD患病率上的差异,可能反映了置入性斜颈与足跖外翻畸形之间的关系。基于各组参与者之间平足严重程度的差异,可以假设放置性斜颈的病史本身与足平外翻畸形严重程度的加重无关。
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引用次数: 0
期刊
Russian Osteopathic Journal
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