证实骨科矫正治疗穿刺后综合征的有效性

M. S. Krivenya, L. V. Gorobets
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摘要

介绍。穿刺后综合征(PPS)是脊髓麻醉或腰椎穿刺后1-2天出现的复杂症状,以头痛为主要症状。目前,还没有有效的非侵入性治疗PPS的方法。基于硬脑膜损伤在PPS发病机制中可能发挥的作用,我们有理由认为,对相应区域的躯体功能障碍进行识别和骨科矫正可能是治疗PPS患者的有效方法。该研究的目的是证实使用整骨矫正治疗患者穿刺后综合征的可能性。材料和方法。本研究涉及40例年龄在20 ~ 50岁的PPS综合征患者,他们在手术后使用脊髓麻醉住院。患者随机分为对照组(20例)和对照组(20例)。所有研究参与者都被规定卧床和中等饮酒(25-30毫升/公斤体重)方案。主组的参与者在术后第一天额外接受一小时的整骨矫正。所有患者在治疗开始时和治疗开始后第三天接受检查。采用视觉模拟评分(VAS, 0 - 10分)、PPS的严重程度和骨病状态评估疼痛的严重程度。PPS患者的特征是存在剧烈疼痛综合征(根据VAS评分为5-6分);他们的特点是在采取垂直姿势时头痛加重,并伴有头晕和恶心。这些患者的特征是在头部、硬脑膜、下肢和颈部(结构部分)区域存在生物力学障碍。采用整骨矫正后,疼痛综合征的强度、PPS症状的缓解以及大部分区域躯体功能障碍的检出率均有统计学意义(p< 0.05)的降低。根据所获得的结果,似乎有可能推荐将整骨矫正纳入PPS患者的综合治疗措施中。
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Substantiation of the effectiveness of osteopathic correction in the treatment of patients suffering from post-puncture syndrome
Introduction. Post-puncture syndrome (PPS) is a complex of symptoms that occurs 1–2 days after spinal anesthesia or lumbar puncture, and the headache is a leading symptom. Currently, there is no effective method of non-invasive treatment of PPS. Based on the possible role of dura mater damage in the PPS pathogenesis, it is reasonable to assume that the identification and osteopathic correction of somatic dysfunctions in the respective regions may be effective in the treatment of patients suffering from PPS.The aim of the study is to substantiate the possibility of using osteopathic correction in the treatment of patients suffering from post-puncture syndrome.Materials and methods. The study involved 40 patients with PPS syndrome aged 20 to 50 years who were hospitalized after surgery with spinal anesthesia using. Patients were randomized into two groups — control (20 patients) and main (20 patients). All study participants were prescribed bed and medium drinking (25–30 ml/kg body weight) regimen. Participants of the main group additionally received a single hour session of osteopathic correction on the first day after the operation. All patients were examined at the start of treatment and on the third day after the start of a treatment. The severity of pain was assessed using a visual analogue scale (VAS, from 0 to 10 points), the severity of PPS and the osteopathic status.Results. Patients suffering from PPS are characterized by the presence of intense pain syndrome (5–6 points according to VAS); they are characterized by a headache that worsens during taking a vertical position and is accompanied by dizziness and nausea. These patients are characterized by the presence of biomechanical disorders in the regions of the head, dura mater, lower extremities and neck (structural component). The use of osteopathic correction is accompanied by a statistically significant (p<0,05) decrease in the pain syndrome intensity, relief of PPS symptoms, and a decrease in the detection frequency of the most regional somatic dysfunctions.Conclusion. Based on the results obtained, it seems possible to recommend the inclusion of osteopathic correction in the complex of therapeutic measures for patients suffering from PPS.
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