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9После ортодонтического лечения была проведена имплантация и изготовлены конструкции.
Заключение
При выборе конструкции для восстановления отсутствующих зубов, впоследствии функции, оптимальной окклюзии, эстетики и ретенции после ортодонтического лечения целесообразно учитывать клиническую ситуацию, количество, состояние и месторасположение присутствующих зубов, возраст пациента и прогноз долгосрочности службы конструкции.
Литература
1. Проффит Уильям Р. Современная Орто-донтия (Новое издание)
2. Нанда Р., Урибе Ф.А. Атлас Клинической Ортодонтии // МЕДпресс-информ.
3. Митчелл Л. Основы Ортодонтии// ГЭОТАР-Медиа
4. Мелсен Б. Ортодонтия для взрослых. // Медицинская литература. Издательство: ГЭОТАР-Медиа, 2019 год, ISBN 978-5-9704-4943-1.
5. Ракоши Т., Грабер Т.М. Зубоальвеолярное и челюстно-лицевое ортодонтическое лече-ние//Стоматологическое издание
6. Нанда.Р. Биомеханика и Эстетика в Клинической Ортодонтии// МЕДпресс-информ Москва.
7. Экермен М.Б. Ортодонтическое лечение. Теория и практика//Медпресс-информ.Москва 2010
8. Daskalogiannakis Glossary of Orthodontie Terms// Quintessenz Verlags-GmbH (May 31, 2000)
9. Исааксон К.Г., Мюр Дж.Д, Рид Р.Т. Съемные ортодонтические аппараты// МедПресс-Ин-форм, 2014 г
10. Нетцель Ф., Шультц К. Практическое руководство по ортодоонтическое диагностике Львов: ГалДент, 2006. - 176 с., 264 ил.
EFFICACY OF KINESOTHERAPY IN THE TREATMENT OF PATIENTS WITH LUMBAR-SACRAL OSTEOCHONDROSIS OF THE SPINE
Vinnikova V., Kamyshna I.
I. Horbachevsky Ternopil National Medical University DOI: 10.5281/zenodo.6532857
ABSTRACT
The article is devoted to the study of the effectiveness of kinesitherapy in the treatment of lumbosacral osteochondrosis.
Keywords: kinesitherapy, physical rehabilitation, osteochondrosis, therapeutic physical culture.
Formulation of the problem.
One of the most common problems in Ukraine is the prevalence of musculoskeletal diseases [1], and about 3.5 million people are familiar with such a problem as osteochondrosis of the lumbosacral spine.
Osteochondrosis is a disease that is masked by the symptoms of other diseases, which greatly complicates the diagnosis. Disorders of the genitourinary system, sexual problems, and renal colic may indicate the presence of lumbar osteochondrosis.
Osteochondrosis leads to three pathologies:
- degenerative changes of intervertebral discs (hernias);
- damage to the vertebrae themselves, which leads to the formation of osteophytes (bone growths on the vertebral bodies);
- disorders of the intervertebral joints (spondylarthritis).
Thus, osteochondrosis causes hernias, osteo-phytes, and spondylarthritis. Damaged elements of the spine irritate and compress the roots of the spinal nerves, muscles, and the spinal cord itself. This leads to compression and reflex syndromes, which are manifested by severe pain and spasms or muscle weakness.
Osteochondrosis can develop at almost any age and manifests itself in rapid fatigue, limited mobility, pain, and other symptoms. The disease develops slowly, gradually. Osteochondrosis most often affects the cartilage of the thoracic and lumbar spine, on which mechanical loads act most intensively, and the tissue of the joints and discs wears out much faster than anywhere else, and therefore disorders based on osteochondrosis, "lead" to the form of radiculitis (inflammation of the spinal cord), which should be treated after treatment of the spine [2, 3].
It should be noted that the provoking factors of osteochondrosis accompany a person throughout life, starting from birth (during childbirth, the cervical vertebrae may be displaced, which leads to nervous and vascular disorders), during weaning, refusal of breast milk, and others. Osteochondrosis impairs the function of the spine, which also impairs the function of the lower extremities, resulting in the varus or valgus position of the lower extremities. Later - insufficient mobility and physical training, wrong selected shoes lead to deformity of the foot, the formation of flat feet, kyphosis, lordosis, posture disorders. This can disrupt almost all body functions - gastrointestinal tract, respiratory, cardiovascular, excretory, and other systems [3].
Osteochondrosis can cause complications due to displacement of the intervertebral disc and its destruction. The first complication is chronic pain, which occurs due to constant irritation of nerve endings. If you follow an orthopedic regimen and take medication, back pain goes away. But exacerbations of pain may recur. And each exacerbation indicates an additional displacement of the intervertebral disc.
The second complication of osteochondrosis is the displacement of the spine to the side. Muscle spasms are reflexes due to constant pain. Constant muscle spasm on one side slowly displaces the spine. Scoliosis occurs, physiological cervical or lumbar curvature is smoothed.
Over time, disc protrusion progresses - it penetrates the epidural space (the space between the dura mater and vertebrae). In such cases, the spinal roots and arteries are irritated. As a result, there is a radicular syndrome, which is manifested by pain along the affected nerve. Prolapse of the spinal disc has not only a mechanical effect on the nervous system. The disk consists of proteins. In this case, the nervous system perceives the disc as a foreign substance that must be destroyed. An outbreak of autoimmune inflammation develops when the immune system regards its protein as foreign. This is the stage of discogenic radiculitis. Discogenic radiculitis is manifested by severe and shooting pains when the head is tilted forward and the pain is aggravated by coughing or sneezing. As a rule, the radicular syndrome and signs of discogenic radiculitis appear unilaterally in relation to the side from which the disc protrudes.
The most severe complications occur when an intervertebral disc herniation compresses the local arteries. Nerves and soft tissues do not receive enough blood and nutrients. There are motor and sensory disorders. Muscle paresis or paralysis develops - partial or complete loss of strength. These disorders usually occur after a sudden movement of the arm or leg, followed by short-term and severe back pain.
The syndrome of "paralytic sciatica" is manifested by paralysis or paresis on the part of the lesion. The main symptom is dysfunction of the extensor muscles of the foot and toes. The gait changes: it becomes a "rooster".
Osteochondrosis can disrupt blood flow in the larger arteries that supply blood to the brain. In this case, the most serious complication may occur - acute cerebrovascular accident or stroke.
If osteochondrosis has already developed, there is nothing you can do about it, but it is possible to stop the further development of the disease and alleviate the pain. To do this, you need to work out the rules of life with osteochondrosis and follow them constantly, not when the pain is already haunting you at every turn [2, 4].
At all times (during work or rest) you should make sure that the spine is the least vulnerable, and make sure that the back is straight. The main rules are:
1) mode (sleep time, activity, regular change of classes, proper nutrition);
2) comfortable bed (mattress with orthopedic and anatomical effect, which provides comfortable and proper support to the spine);
3) the workplace should be anatomically comfortable and provide the correct posture and reflexes of the body for learning at the desk, working with a computer, driving a car, lifting and carrying heavy objects performed with a straight back;
4) every 20-30 minutes you should change your posture, and after 60 minutes you should get up and walk a little.
Great prospects for the clinical effectiveness of rehabilitation of patients with osteochondrosis are the use of kinesiotherapy.
The name kinesitherapy comes from the ancient Greek "kinesis" - movement + "therapy" - treatment. It is an independent rehabilitation discipline that is based on experience and is based on all other related disciplines and includes both theory and methodology of physical therapy. Kinesitherapy is carried out in the interaction between the patient and the therapist to treat, improve and maintain a healthy condition, prevent relapses and contribute to the achievement of psycho-physical comfort. This is an active method of treatment in which the patient takes an active part in the rehabilitation process.
Kinesiotherapy is also a scientific and applied activity, which combines knowledge: of medicine, pedagogy, anatomy, physiology, biochemistry, etc.
Kinesiotherapy is based on real clinical achievements, as well as the results of scientific studies of the human muscular system, its physiology and biochemistry of the process of muscle fiber contraction, and its effects on the musculoskeletal system [5].
The purpose of the study: is to substantiate the need for kinesiotherapy for the treatment of osteochondrosis of the lumbosacral spine.
Objectives of the study:
1. To determine the features and dynamics of os-teochondrosis of the lumbosacral spine in the example of middle-aged people.
2. To develop an algorithm of kinesiotherapy methods for middle-aged people with osteochondrosis of the lumbosacral spine.
Particular attention in osteochondrosis is paid to gymnastic exercises aimed at unloading the spine and reducing the pressure on the intervertebral discs. It is necessary to perform carefully and systematically those exercises that are the most difficult to perform, first with a small amplitude and sharpness, then gradually increasing their intensity and volume.
The basis of dosing exercises is an individual approach. Sometimes 15 minutes is enough to perform them, and sometimes much more, you should repeat the exercises several times a day. In the morning, after sleep, simple exercises are performed lying in bed to restore joint mobility. However, the main thing for the success of the treatment of any disease of the spine is a timely study of the musculoskeletal system (regardless of the patient's age) and planning (with a doctor!) Preventive measures for the future [4].
The special motor activity involves several types of exercises.
1. Hanging, pulling up, stretching the spine along the vertical axis, which reduces the pressure on the vertebrae, improves their nutrition, and more. Exercises should be performed up to three times a day, especially after static and compression exercises.
2. Increasing the strength of the muscles around the spine, which increases its ability to withstand the mechanical effects of the environment and the usual workload. There are special exercises for the muscles of the neck, chest, and lower back.
3. Removal of tension from the body by respiratory (static and dynamic) movements, pulling, and swinging movements. This relieves muscle fatigue, relaxation, and pressure on nerves and blood vessels. Exercises should be short, with intervals between 30-and 40 minutes.
4. Increasing the elasticity of muscles, ligaments, and capsules of joints, which improves their nutrition, restores mobility, and flexibility of the spine.
5. Mobilization exercises of gymnastic nature: turns, inclines, circular rotations, twisting to maintain the required minimum of feeding processes, prevention of stagnation.
6. Reduction of excess body weight (running, walking, exercise bike lasting 25 minutes).
7. Swimming, combining several separate exercises.
8. Correction of human behavior, which involves the creation of appropriate body positions during sleep, work, rest, lifting and moving, etc., which do not pose a risk of negative changes in the spine. If long-term static body positions are necessary, provided by the mode of operation, then every 30-90 minutes you need to pause with the use of moving exercises, elements of psychotraining.
9. Hardening of the body.
10. Strengthening the body's stress resistance.
11. Unloading and dietary therapy, medical fasting, saunas 1-4 times a month
12. Passive tension relief from muscles and joints using various methods of classical massage
13. Manual therapy, the effect of which is to eliminate the reflex effects of functional blocks (due to vas-ospasm, smooth muscles of internal organs, skeletal
muscles), pain, and autonomic dysfunction. Chiropractic is contraindicated in inflammation, tumors, and spinal injuries.
Since the health and preventive effect of exercise is associated with increased physical activity, strengthening the functions of the musculoskeletal system, and increased metabolism, physical therapy in combination with physiotherapy is a good way to restore a person's ability to work. If there is acute pain in the spine, then therapeutic exercise is performed in a supine position to unload the spine and reduce the load on the cardiovascular system. After 10-12 days, when the person's condition improves, they start exercising on the shoulder girdle, then on the lower extremities, and later on the torso muscles. Later, when the pain subsides, prescribe very carefully and gradually exercise shells (gymnastic sticks, dumbbells, balls) and exercises aimed at increasing the amplitude of the spine (forward, backward, sideways) to strengthen the muscles of the back and abdomen. They use games, especially with a ball (volleyball). First, the duration of classes - is 5-10 minutes, then - 25-30 and gradually increases to 40 minutes. After treatment, for those who are recovering, it is recommended to perform some special exercises, including skiing and swimming.
Conclusions:
Thus, we state that the use of exercise for the therapeutic purpose of osteochondrosis is based on the widespread use of movement as the basis of the biological function of all living organisms. Health-improving and preventive effects of health-improving physical culture are connected with increased physical activity, strengthening of functions of the musculoskeletal system, and activization of a metabolism. Systematic use of therapeutic exercise greatly increases the effectiveness of drugs, reduces the duration of treatment, reduces the patient's stay in bed, and reduces the time between clinical and functional recovery.
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