Выпуск №5-22, 2023

Боль в пояснице: новая комплексная патогенетическая модель, подкрепляющая методы медицинской реабилитации

¹ Тезио Л.

¹ Итальянский Ауксологический Институт, IRCCS, Отделение нейрореабилитационных наук, Милан, Италия

РЕЗЮМЕ

Патогенез хронической боли в пояснице остается неясным. Она до сих пор считается «неспецифическим» состоянием, выра- женность которого слабо связана с анатомическими изменениями поясничного отдела позвоночного канала (например, грыжа диска, спинальный стеноз). Признаки и симптомы могут быть противоречивыми, например, боль, усиливающаяся в покое или при нагрузке на позвоночник, противоположные позы в поясничном отделе (сгибание или разгибание), принимаемые разными пациентами, и др. Руководства и обзоры колеблются между ограничительной моделью компрессии нерва и большим набором эпидемиологических факторов (от образа жизни до хронического поясничного стресса и генетических детерминант). Новая па- тогенетическая модель основана на вариабельном взаимодействии трех возможных детерминант: компрессии нервных окон- чаний в результате грыжи диска или артритных шпор, ущемления эпидурального (по Бэтсону) венозного сплетения и воспале- ния, вызванного очаговым тромбофлебитом и способствующего развитию фибринолитических дефектов. Отсюда возникло на- звание «компрессионно-венозно-воспалительная» (CoVIn) модель. Биологические и клинические исследования подтверждают наличие каждой из трех указанных детерминант. Комплексная модель объясняет многие «необъяснимые» характеристики боли в пояснице и дает обоснование для механических методов лечения, направленных на одну или несколько из трех детерминант.
Активное вытяжение поясницы (ауто-тракция), водные упражнения и упражнения Уильямса на сгибание выглядят в высшей степени соответствующими модели, что может объяснить их эффективность.

КЛЮЧЕВЫЕ СЛОВА: оль в спине, патогенетическая модель, эпидуральное венозное сплетение, активное вытяжение в поясничном отделе, бальнеотерапия, упражнения на сгибание

Источник финансирования: Авторы заявляют об отсутствии финансирования при проведении исследования.

Конфликт интересов: Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.

Для цитирования: Tesio L. Low Back Pain: a New Comprehensive Pathogenetic Model Supporting Methods of Medical Rehabilitation.
Bulletin of Rehabilitation Medicine. 2023; 22(5): 83-92. https://doi.org/10.38025/2078-1962-2023-22-5-83-92 

Для корреспонденции:  Luigi Tesio, E-mail: l.tesio@auxologico.it

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