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№2' 2015

ORTHOPEDICS

MODERN APPROACHES TO CLINICAL DIAGNOSIS AND TREATMENT OF STATIC DISORDERS OF THE SPINE AND JOINTS

R. O. MALANCHUK

Kharkiv Medical Academy of Postgraduate Education, Ukraine

Modern data of leg length discrepancies diagnosis and structure in patients with hip asymmetry are presented in the article. Musculoskeletal diseases (MSВ) are as a rule caused by a number of factors. In studying the pathogenesis of MSD derivatives of the factors are of great interest, they create unfavorable background and underlay in the development of the pathology. The study of pathological states connected with the so−called short leg syndrome or leg length inequality −− LLI−syndrome, also known as leg length discrepancies −− LLD−syndrome is important. Static musculoskeletal disorders are diagnostically rather difficult because visual estimation is used, which is difficult to objectify, analyze biochemically as well as define the role of these violations in pain syndromes appearance. Computer optical topography (COT) is the most perspective estimation procedure of static musculoskeletal disorders. Noninvasiveness, absolute safety, precise dimensional analysis, possibility of functional research are positive properties of this method. According to various researchers 4 mm leg length discrepancy is found in 81.2 % patients with lower lumbar pain, 10 mm and more −− in 43.5 %, from 15 mm and more in 17.8 %. In this case all patients demonstrated warps of various intensity and hip asymmetries. The most widespread effects of LLI−syndrome are hip rotations in sagittal and frontal planes. Hip warps to 22 mm are most common compensation reactions of leg length discrepancy. Irrespective of the cause, rotation moment in hip bones appears while walking in patients with this syndrome, which gradually leads to twisted hip and lateral curvature in the lumbar part of the vertebra on the side of longer leg. Under 4−6 mm leg length discrepancy S−shaped thoracolumbar scoliosis is formed. The article comprises the results of clinical studies and perspective analysis of the results of examination of 251 patients presented with chronic pain in the lower lumbar area and/or lower extremities, in which asymmetries of lower extremities and hip were found with the help of clinical tests and instrumental methods. The parameters allowing to exclude vertebra pathology which can be cause of hip warp were studied additionally. For this purpose the angle of the arc of curvature lateral asymmetry (LA) similar to Cobb angle diagnosed under x−ray study and rotation angle in the arc of curvature apex (RA) were investigated. Besides general clinical examination all patients underwent segment measurement of lower extremities length with the help of a measuring tape. All patients were additionally done hip symmetry estimation with the help of COT method of human body relief worked out in Novosibirsk SRITO. Leg length discrepancy was found in 176 (70.1 %) patients with hip asymmetry including 125 (49.8 %) where it was due to anatomic lower extremity shortening; 13 (5.2 %) had the history of the hip or shank fractures; in 56 (22.3 %) it was connected with knee joint and/or foot deformations. In other 83 cases (33 %) hip asymmetries can be connected with functional leg shortening due to hypertone of hip and/or over−hip muscles which was proved by presence of various myofascial pain syndromes. Treatment of patients with chronic pain syndromes in the back, hip and lower extremities was directed to pain syndrome elimination by muscular spasm decrease and injured area trophic improvement. Besides traditional ways of pain syndrome treatment, methods of static musculoskeletal asymmetries with orthopedic correction with the help of orthopedic girdles, posture correctors, bandages, insoles and socks were used. Decrease of specific weight of medications for pain syndrome elimination is an important principle of the treatment. With this purpose we preferred the use of local therapy with the help of modern methods including extracorporeal shock wave therapy (ESWT). This method allowed in short terms to decrease or absolutely eliminate pain sense and restore the function of the injured segment.

Key words: leg length inequality syndrome, myofascial pain syndrome, pelvic asymmetry, computer optical topography of the body, extracorporal shock−wave therapy.

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