腰椎软骨病伴反射和压迫性椎体病综合征患者的临床和神经系统疾病

V. Smirnov, M. Savvova, Anna Lyudagovskaya, V. Smirnov
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摘要

对临床和神经系统结果的分析表明,椎间盘突出综合征和压迫综合征之间的主要区别是存在脱垂症状,表现为肌腱和骨膜椎间盘突出缺失以及节段型感觉和运动障碍的显著患病率。此外,以交感神经和血管痉挛紊乱形式向疼痛综合征侧化的自主神经营养紊乱在反射性脊椎型疼痛综合征中明显更常见(p<0.05),而在压迫性疼痛综合征,神经营养不良紊乱占主导地位。腰椎病变在男性中更为常见。主要危险因素是举重和运动不协调(分别为36%和11.5%)。压迫性神经根综合征的临床表现在腰椎中明显更常见(p<0.05)。同时,压迫综合征的临床表现更为严重,主要表现为疼痛、肌肉强直和稳态、自主神经和营养障碍。神经根压迫综合征的水平对应于病理形态学基质的水平。病理形态学基质的存在可能在很长一段时间内保持临床上的不显著性,并且只有在某些情况下才会表现出来(静脉淤滞、水肿、无菌性炎症)。
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CLINICAL AND NEUROLOGICAL DISORDERS IN PATIENTS WITH REFLEX AND COMPRESSION SPONDYLOGENIC SYNDROMES IN CASE OF LUMBAR OSTEOCHONDROSIS
An analysis of the clinical and neurological fi ndings showed that the main diff erence between refl ex spondylogenic syndromes and compression syndromes was the presence of prolapse symptoms in the form of signifi cant prevalence of the loss of tendon and periosteal refl exes as well as sensory and motor disorders of the segmental type. Moreover, autonomic-trophic disturbances with lateralization toward the pain syndrome in the form of sympathetic and angiospastic disturbances were defi nitely more frequent (p < 0.05) in refl ex spondylogenic pain syndromes, while in compressive ones, neurodystrophic disturbances prevailed. Lumbar spine pathology was signifi cantly more common in men. The leading risk factors were weight lifting and uncoordinated movement (36% and 11.5%, respectively). Clinical manifestations of compression radicular syndromes were defi nitely more frequent (p < 0.05) in the lumbar spine. At the same time, compression syndromes featured greater severity of clinical manifestations in the form of the predominance of pain, muscle-tonic and statodynamic, autonomic and trophic disorders. The level of radicular compression syndrome corresponds to the level of the pathomorphological substrate. The presence of the pathomorphological substrate may remain clinically insignifi cant for a long time and manifest itself only under certain conditions (venous stasis, edema, aseptic infl ammation).
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Manual Therapy
Manual Therapy 医学-康复医学
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