Клиническая характеристика больных поясничным остеохондрозом с нарушением двигательного стереотипа

Abstract

Вивчено ортопедичний статус 80 хворих на поперековий остеохондроз з порушенням рухового стереотипу і міотонічними реакціями м’язів попереково-тазової області у віці 22 – 44 (31,7 ± 4,4) року. При оцінці ортопедичного статусу встановлений асиметричний гіпертонус паравертебральних м’язів, а також несиметричне положення антропометричних орієнтирів правої і лівої, а також верхній і нижньої половини тулуба, яке збільшується при динамічних навантаженнях.

Lumbar pain and myotonic reactions lead to a change in the sequence of the inclusion of the muscles of the lumbar-pelvic area during daily loads. This is accompanied by an impairment of the control of active movements and can lead to the formation of pathological motor patterns. However, the factors that influence to the pathological motor stereotype formation so far not established. Objective: to study the features of the orthopedic status of patients with lumbar osteochondrosis with impaired motor stereotype. Methods. The material of the study is the protocols of a clinical and radiological examination of 80 patients with lumbar osteochondrosis with impaired motor stereotype and myotonic reactions of the muscles of the lumbarpelvic region. All patients were male at the age of 22–44 (31.7 ± 4.4) years. We randomized patients into two groups: the main group (n = 40) and the control group (n = 40). When assessing the orthopedic status, we took into account: 1) a position (symmetrical or asymmetrical) of the following paired anthropometric points: acromial ends of the clavicle, the anterior superior iliac spines, bottom corners of the blades, pelvic wings in a static position (when standing comfortably) and when performing a functional task (squat); 2) spinal configuration in the frontal and sagittal planes; 3) tone of the paravertebral muscles; 4) performing spinal movements (flexion, extension, lateral bending and rotation right and left); 5) the spine total mobility according to the results of the “fingers – floor” test, the thoracic and lumbar spine mobility according to the Schober method. The intensity of lumbar pain was determined on a 100 mm visual analogue scale (VAS). Results. The intensity of lumbar pain in VAS averaged (61.5 ± 7.8) mm in the main group and (64.0 ± 7.6) mm in the control groups. We found the prevalence of asymmetric location of the studied anthropometric landmarks in a static position (comfortable standing) in both groups. The different frequency of asymmetric position of the anthropometric landmarks of the upper and lower half of the body attracts attention. we noted the asymmetrical position of the right and left acromial ends of the clavicle in 57.5% of the observations in the main group and in 62.5% in the control group, whereas we recorded the asymmetrical position of the anterior superior iliac spines in 70.0% and 72.5% cases accordingly. The bottom corners of the blades were located at different heights in 75.0% and 70.0% of observations, respectively. Asymmetrical position of the pelvis wings, we observed in 67.5% of cases in each of the groups. When performing a functional task (squatting), the frequency of recording both the asymmetric position of the anthropometric landmarks of the front half of the body as a whole, and their different positions in the upper and lower halves of the body increased. At the same time, we observed a decrease in the frequency of occurrence of the asymmetric arrangement of the anatomical landmarks and the posterior half of the body, and in the upper and lower half of the body. When squatting the knee joints position was predominantly asymmetrical (72.5% in the main group and 70.0% in the control group). Conclusion. In patients with lumbar osteochondrosis with myotonic reactions of the muscles of the lumbarpelvic region, unfavorable trunk compensator patterns attitudes with muscular dysfunction develop, which are aggravated under the influence of dynamic loads.