Included: Occupus hernia

Included:

• hernia aperture hole (esophageal) (sliding)
• equaline hernia

Excluded: congenital hernia:

• diaphragmal (Q79.0)
• diaphragm Ecoming Hole (Q40.1)

Included: Hernia:

• abdominal cavity refined Localization of the NCDR
• lumbar
• locked
• female outdoor genital organs
• rakr Trinky
• sedalish

Included:

• enterocele [Intestinal hernia]
• epiplocele [Gnug Seal]
• hernia:
  • BDA
  • interstitial
  • intestinal
  • intra-abdominal

Excluded: Vaginal Enterocele (N81.5)

In Russia, the International Classification of Diseases of the 10th Review (ICD-10) adopted as a single regulatory document for accounting for incidence, reasons for people's appeals to medical institutions of all departments, causes of death.

The ICD-10 has been introduced into the practice of health throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia from 27.05.97. №170

A new revision (ICD-11) is planned to be planned in 2017 2018.

With changes and additions to WHO.

Processing and transferring changes © MKB-10.com

K40-K46 hernia

• acquired hernia
• in the birth of hernia (except for daphragm or esophageal hole Daefragma)
• recurient hernia

Notification: Hernia with Gangren and obstruction is caught as a hernia with Hangene

• hangepid (one-sided) loaf: calling obstruction, disadvantaged, nefriever, stronger

• hergezha's Hernia (one-sided) without greasy: calling obstruction, disadvantaged, nefral, stronger

Spinal hernia on μb 10

The code of the intervertebral hernia of the spine on the ICD 10

Spinal hernia Code on MKB 10 gets in strict accordance with the type of damage to cartilage intervertebral discs and the location of their localization. So pathologies that are not involved in the trauma located in the cervical department are carried out in a separate unit and are indicated in the official medical documentation M50 code. This designation can be affixed in the diagnosis in a sheet of temporary disability, a sheet of statistical reporting, some types of directions for instrumental control methods.

Located in a chest, lumbar and sacralized department, intervertebral hernia in the ICD 10 is denoted by the M51 code. The designation M51.3 is found, which denotes the pronounced degeneration (nipping the hernia) of the cartilage disk without spinal syndromes and neurological signs. When radiculopathy and severe pain syndrome, during the exacerbation of hernia, it can be denoted by the M52.1 code. The code M52.2 is deciphered as pronounced degeneration (destruction) of a cartilage disc with instability of the position of the vertebrae sitting next to it.

The nodes or intervertebral hernia of the Schimorrich has a code on the ICD - M51.4. In the event that the diagnosis is not specified and additional differential laboratory diagnostics are required in official medical documents, the code M52.9 is affixed.

Special table is used to decrypt such data. It is usually an interest for workers medical institution, Social Insurance Department and Personnel Representatives Department. All the necessary information is in public domain and can be studied by any person who has interest in this. If you have any difficulties, you can contact our specialist. He will tell everything about the disease of the spine, which is encrypted as intervertebral hernia in the Code of the ICD 10.

Trubnikov Vladislav Igorevich

Candidate of Medical Sciences

Physician neurologist, manual therapist, rehabilitol, specialist in reflexotherapy, medical physical education and therapeutic massage.

Savelyev Mikhail Yuryevich

Doctor manual therapist higher category, has experience more than 25 years.

Owns methods of Aurikulo and corporate reflexology, pharmacopuncture, hirudotherapy, physiotherapy, physiotherapy, LFC. Perfection applies osteopathy both in adults and in children.

Signs of the dorsal hernia in the lumbar department

Intervertebral hernia is a degenerative disease of the intervertebral disc, characterized by a violation of its integrity and structure

The hernia of the lumbar spine is a fallout or fragments intervertebral disc in the vertebral channel. Code of the disease in the ICD - 10 # 8212; M51 (lesion of intervertebral discs of other departments). It occurs during injuries or osteochondrosis, leads to the compression of nerve structures.

The hernia in the area of \u200b\u200bthe lumbar department occurs with a frequency of 300: 100 thousand population, mainly in men from 30 to 50 years.

Localization of hernia - L5-S1 (mainly) and L4-L5. In rare cases of hernia of the lumbar spine, L3-L4 is found and with severe injuries of the upper lumbar drives.

Systematization (according to the degree of penetration into the vertebral channel):

By the location of hernia in the frontal plane: lateral, median, paramediable hernia.

Main clinical picture

At the very beginning of the disease, patients complain about lower back pain. The root and vertebral syndromes appear much later, in some cases "experience" pain counts for several years.

At this stage, the root compression and the formation of the hernia of the disc: Lambalgia (pain in the lumbar region). Initially - non-permanent and new. Over time, the severity of pain is growing, more often due to the stretching of the rear longitudinal ligament and overvoltage of the ligament and muscles. The patient feels the gain of pain in any muscle tension, cough, sneezing and lifting weights. For Lambalgia, repeated exacerbations are characterized by which for many years.

The hernia of the spine can occur almost on any site of the spine

1. the stress of the paravertebral muscles prevents the full strain straightening and causes pain;
2. limiting the mobility of the lumbar department;
3. smoothing lumbar lordosis (its transition to kyphosis is often observed);

With a median and paramediable hernia, scoliosis is observed, open in the sick side (less pulling the rear longitudinal ligament). With lateral hernia (reduction of the grinding of the nervous root), scoliosis is observed, open in the opposite direction.

Root syndrome (radiculopathy):

• paints occur in the innervation zone of one or several roots, spread to the buttock, and below - according to rides, rear (rear-line) surface of the lower leg and hips (Ishialia). According to nature, the pain happens or shooting;
• the pain most often arises due to injury, with an unsuccessful turn of the body or when lifting gravity;
• changes occur in the innervation zone of the nervous root;
• muscles become weak, hypotension is observed, atrophy develops (sometimes becyclation). The patient feels numbness, paresthesia arise;
• "Symptom of coughing push." When there is a sneezing (cough, sneezing) in the innervation zone of the siled roof, there is a tight pain or its sharp gain;
• there is a loss of proprioceptive reflexes.

1. the pain occurs even with a slight rise of the leg;
2. the pain appears in the lower back and in the dermatome of the affected root. The patient can feel numbness or "goosebumps" when picked up straightened legs up;
3. the pain is weakening (disappearing) when flexing the legs in the knee joint, but it is enhanced by the rear flexion of the foot.

The hernia of the spine of the lumbar department most often occurs on the background of osteochondrosis

Pathology of horse-tail (acute compression of roots):

• the reason: the median hernia of large sizes, pain occurs with a significant physical force and a large load on the spine (sometimes under the manual therapy session). Signs: urine delay (violation of sensitivity in the anogenital region), lower sluggish parapaprex.

Caudogenic mixing chromotype syndrome:

• there is pain when walking in lower limbs (due to the transient conchive tilt). The patient when driving is forced to stop often.

Diagnostic events

When diagnosis, it is important to take into account all the symptoms, "speaking" about the presence of hernia of the lumbar spine. The dorsal hernia is recognized in the following diagnostic methods:

• lumbar puncture (moderate protein increase);
• x-ray of the spinal column;
• MRI and myelography, sometimes - followed by high resolution CT;
• electromiography (the ability to retperine reimage neuropathy from the grinding of the root).

Differential diagnosis

It is important when differentiating from the lumbar hernia to exclude: tumors and metastases in the spine, Bekhterev's disease, tuberculous spondylitis, metabolic spondylopathy, circulatory disruption in the additional spinal artery of dererage-Gotteron, diabetic neuropathy.

In time, the diagnosis was diagnosed and the initiated treatment is capable of restoring the intervertebral disk completely. With late appeal, all therapeutic measures, unfortunately, are directed only to reduce the intensity of symptoms.

Dorsopathy and back pain

2. Degenerative dystrophic changes in the spine

Degenerative spinal changes are made up of three main options. This is osteochondrosis, spondylosis, spondyltrosis. Various pattomorphological options can be combined with each other. Degenerative-dystrophic changes of the spine to old age are celebrated by almost all people.

Osteocondritis of the spine

The cipher on the ICD-10: M42 is osteochondrosis of the spine.

Osteochondrosis of the spine is a decrease in the height of the intervertebral disk as a result of dystrophic processes without inflammatory phenomena. As a result, segmental instability is developing (excessive degree of flexion and extension, the sliding of the vertebrae is forwarded when flexing or backward during extension), the physiological curvature of the spine changes. The rapprochement of the vertebrae, and hence the articular processes, their excess friction inevitably lead in the future to local spondyltrosis.

Osteochondrosis of the spine is an x-ray, but not clinical diagnosis. In fact, the osteochondrosis of the spine simply states the fact of aging the body. Call back pain osteochondrosis - illiterately.

Spondylosis

CIFR on the ICD-10: M47 - Spondylosis.

Spondylosis is characterized by the appearance of edge bone expansions (on the upper and lower edge of the vertebrae), which on radiographs have the type of vertical spikes (osteophytes).

Clinically spondylosis will be not significant. It is believed that spondylosis is an adaptive process: edges (osteophytes), fibrosis of disks, ankylosis of the facet joints, thickening of bundles - all this leads to immobilization of the problem vertebral segment, expanding the support surface of the vertebral bodies.

Spondloarthrosis

Cipher on the ICD-10. M47 - Spondillas. Included: arthrosis or osteoarthritis of the spine, degeneration of facade joints.

Spondilotrosis is an arthrosis of intervertebral joints. It is proved that the processes of degeneration in intervertebral and peripheral joints do not differ in principle. That is, essentially spondyltrosis is a type of osteoarthrosis (therefore, drugs of chondroprotective series will be appropriate in treatment).

Spondilitrosis - SAMIA frequent cause Back pain in older people. Unlike discogenous pain in spondylotrosis, the pain bilateral and localizes paravertebrally; Strengthens with long standing and extension, decreases when walking and seat.

3. Protrusion and hernia disk

The cipher on the ICD-10: M50 is the defeat of the intervertebral discs of the cervical M51 is the defeat of intervertebral disks of other departments.

The protrusion and hernia disk are not a sign of osteochondrosis. Moreover, the less expressed degenerative changes in the spine, the more the disk is active (that is, the more realistic the appearance of hernia). That is why the hernia disk is more common in young people (and even in children) than the elderly.

The sign of osteochondrosis is often considered to be a hernia of Schimor, which has no clinical value (there are no back pain). The hernia of Schimorl is the displacement of the disk fragments to the spongosis of the body of the vertebral body (intracorporeal hernia) as a result of the impairment of the body of the vertebrae during the growth process (that is, in fact, the hernia of the Schimor is a dysplasia).

The intervertebral disk consists of an outer part - this is a fibrous ring (up to 90 layers of collagen fibers); And the inner part is a pentuary pulpidic core. In young people, a pulpous core consists of 90%; In the elderly, a pulp nucleus loses water and elasticity, fragmentation is possible. The protrusion and hernia disk arise both as a result of dystrophic changes of the disc and due to repetitive high loads on the spine (excessive or frequent bends and extensions of the spine, vibration, injury).

As a result of the transformation of vertical forces into the radial pulpseed kernel (or its fragmented parts), shifted to the side, deflection of the dudder the fibrous ring - develops the disk protrusion (from the lat. Protrusum - push, push). Protrusion disappears as soon as the vertical load stops.

Perhaps spontaneous recovery if fibrotization processes apply to the pulp nucleus. Fibrous rebirth occurs and the protrusion becomes impossible. If this does not happen, then as the protrusion of the protrusions, the fibrous ring is increasingly promoted and finally bursts - this is a disk hernia.

The hernia of the disk can develop sharply or slowly (when the fibrous ring breaks in small portions of the fragments of the pulp nucleus). The hernia of the disk in the back and rear-side directions can cause the compression of the spinal root (radiculopathy), the spinal cord (myelopathy) or their vessels.

Most often, the hernia of the disk occurs in the lumbar spine (75%), then the cervical (20%) goes in frequency and chest department spine (5%).

• The cervical department is the most mobile. The frequency of hernia in the cervical spine - 50 cases per 100 thousand population. The most often disk hernia occurs in the C5-C6 or C6-C7 segment.
• The lumbar department carries the greatest load by holding the whole body. The frequency of hernia in the lumbar spine - 300 cases per 100 thousand population. The most often disk hernia occurs in the L4-L5 segment (40% of all hernias in the lumbar spine) and in the L5-S1 segment (52%).

The hernia of the disk must have clinical confirmation, asymptomic disk hernias, according to CT and MRI, are found in 30-40% of cases and do not require any treatment. It should be remembered that the detection of the hernia of the disk (especially small sizes) according to CT or MRI does not exclude another cause of the back pain and cannot be the basis of a clinical diagnosis.

The content of the Dorsilla and Back Pain:

Degenerate-dystrophic changes in the spine. Protrusion and disk hernia.

Excluded: Lumbar Radiculitis BDU (M54.1)

Lyumbago due to the displacement of the intervertebral disk

In Russia, the International Classification of Diseases of the 10th Review (ICD-10) adopted as a single regulatory document for accounting for incidence, reasons for people's appeals to medical institutions of all departments, causes of death.

The ICD-10 has been introduced into the practice of health throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia from 27.05.97. №170

A new revision (ICD-11) is planned to be planned in 2017 2018.

With changes and additions to WHO.

Processing and transferring changes © MKB-10.com

Spinal hernia on μb 10

Spinal hernia Code on MKB 10 gets in strict accordance with the type of damage to cartilage intervertebral discs and the location of their localization. So pathologies that are not involved in the trauma located in the cervical department are made in a separate division and are designated in the official medical records with the M50 code. This designation can be affixed in the diagnosis in a sheet of temporary disability, a sheet of statistical reporting, some types of directions for instrumental control methods.

Trubnikov Vladislav Igorevich

Candidate of Medical Sciences

Physician neurologist, manual therapist, rehabilitol, specialist in reflexotherapy, medical physical education and therapeutic massage.

Savelyev Mikhail Yuryevich

The doctor manual therapist of the highest category has experience more than 25 years.

Owns methods of Aurikulo and corporate reflexology, pharmacopuncture, hirudotherapy, physiotherapy, physiotherapy, LFC. Perfection applies osteopathy both in adults and in children.

Signs of the dorsal hernia in the lumbar department

Intervertebral hernia is a degenerative disease of the intervertebral disc, characterized by a violation of its integrity and structure

The hernia of the lumbar spine is a fallout or protrusion of an intervertebral disk fragments to the vertebral channel. Code of the disease in the ICD - 10 # 8212; M51 (lesion of intervertebral discs of other departments). It occurs during injuries or osteochondrosis, leads to the compression of nerve structures.

The hernia in the area of \u200b\u200bthe lumbar department occurs with a frequency of 300: 100 thousand population, mainly in men from 30 to 50 years.

Localization of hernia - L5-S1 (mainly) and L4-L5. In rare cases of hernia of the lumbar spine, L3-L4 is found and with severe injuries of the upper lumbar drives.

Systematization (according to the degree of penetration into the vertebral channel):

By the location of hernia in the frontal plane: lateral, median, paramediable hernia.

Main clinical picture

At the very beginning of the disease, patients complain about lower back pain. The root and vertebral syndromes appear much later, in some cases "experience" pain counts for several years.

At this stage, the root compression and the formation of the hernia of the disc: Lambalgia (pain in the lumbar region). Initially - non-permanent and new. Over time, the severity of pain is growing, more often due to the stretching of the rear longitudinal ligament and overvoltage of the ligament and muscles. The patient feels the gain of pain in any muscle tension, cough, sneezing and lifting weights. For Lambalgia, repeated exacerbations are characterized by which for many years.

The hernia of the spine can occur almost on any site of the spine

1. the stress of the paravertebral muscles prevents the full strain straightening and causes pain;
2. limiting the mobility of the lumbar department;
3. smoothing lumbar lordosis (its transition to kyphosis is often observed);

when palpation of the paravertebral muscles and intermediate processes there is soreness;

there is a pronounced change in posture (forced position), to reduce pain;

"Call Symptom." The awakening of an interstilant gap that corresponds to the localization of hernia leads to a shot in the leg;

vegetative manifestations (skin marble, sweating).

With a median and paramediable hernia, scoliosis is observed, open in the sick side (less pulling the rear longitudinal ligament). With lateral hernia (reduction of the grinding of the nervous root), scoliosis is observed, open in the opposite direction.

Root syndrome (radiculopathy):

• paints occur in the innervation zone of one or several roots, spread to the buttock, and below - according to rides, rear (rear-line) surface of the lower leg and hips (Ishialia). According to nature, the pain happens or shooting;
• the pain most often arises due to injury, with an unsuccessful turn of the body or when lifting gravity;
• changes occur in the innervation zone of the nervous root;
• muscles become weak, hypotension is observed, atrophy develops (sometimes becyclation). The patient feels numbness, paresthesia arise;
• "Symptom of coughing push." When there is a sneezing (cough, sneezing) in the innervation zone of the siled roof, there is a tight pain or its sharp gain;
• there is a loss of proprioceptive reflexes.

1. the pain occurs even with a slight rise of the leg;
2. the pain appears in the lower back and in the dermatome of the affected root. The patient can feel numbness or "goosebumps" when picked up straightened legs up;
3. the pain is weakening (disappearing) when flexing the legs in the knee joint, but it is enhanced by the rear flexion of the foot.

The hernia of the spine of the lumbar department most often occurs on the background of osteochondrosis

Pathology of horse-tail (acute compression of roots):

• the reason: the median hernia of large sizes, pain occurs with a significant physical force and a large load on the spine (sometimes under the manual therapy session). Signs: urine delay (violation of sensitivity in the anogenital region), lower sluggish parapaprex.

Caudogenic mixing chromotype syndrome:

• there is pain when walking in the lower limbs (due to the transient compound of the horse-tail). The patient when driving is forced to stop often.

Diagnostic events

When diagnosis, it is important to take into account all the symptoms, "speaking" about the presence of hernia of the lumbar spine. The dorsal hernia is recognized in the following diagnostic methods:

• lumbar puncture (moderate protein increase);
• x-ray of the spinal column;
• MRI and myelography, sometimes - followed by high resolution CT;
• electromiography (the ability to retperine reimage neuropathy from the grinding of the root).

Differential diagnosis

It is important when differentiating from the lumbar hernia to exclude: tumors and metastases in the spine, Bekhterev's disease, tuberculous spondylitis, metabolic spondylopathy, circulatory disruption in the additional spinal artery of dererage-Gotteron, diabetic neuropathy.

In time, the diagnosis was diagnosed and the initiated treatment is capable of restoring the intervertebral disk completely. With late appeal, all therapeutic measures, unfortunately, are directed only to reduce the intensity of symptoms.

Dorsopathy and back pain

2. Degenerative dystrophic changes in the spine

Degenerative spinal changes are made up of three main options. This is osteochondrosis, spondylosis, spondyltrosis. Various pattomorphological options can be combined with each other. Degenerative-dystrophic changes of the spine to old age are celebrated by almost all people.

Osteocondritis of the spine

The cipher on the ICD-10: M42 is osteochondrosis of the spine.

Osteochondrosis of the spine is a decrease in the height of the intervertebral disk as a result of dystrophic processes without inflammatory phenomena. As a result, segmental instability is developing (excessive degree of flexion and extension, the sliding of the vertebrae is forwarded when flexing or backward during extension), the physiological curvature of the spine changes. The rapprochement of the vertebrae, and hence the articular processes, their excess friction inevitably lead in the future to local spondyltrosis.

Osteochondrosis of the spine is an x-ray, but not clinical diagnosis. In fact, the osteochondrosis of the spine simply states the fact of aging the body. Call back pain osteochondrosis - illiterately.

Spondylosis

CIFR on the ICD-10: M47 - Spondylosis.

Spondylosis is characterized by the appearance of edge bone expansions (on the upper and lower edge of the vertebrae), which on radiographs have the type of vertical spikes (osteophytes).

Clinically spondylosis will be not significant. It is believed that spondylosis is an adaptive process: edges (osteophytes), fibrosis of disks, ankylosis of the facet joints, thickening of bundles - all this leads to immobilization of the problem vertebral segment, expanding the support surface of the vertebral bodies.

Spondloarthrosis

Cipher on the ICD-10. M47 - Spondillas. Included: arthrosis or osteoarthritis of the spine, degeneration of facade joints.

Spondilotrosis is an arthrosis of intervertebral joints. It is proved that the processes of degeneration in intervertebral and peripheral joints do not differ in principle. That is, essentially spondyltrosis is a type of osteoarthrosis (therefore, drugs of chondroprotective series will be appropriate in treatment).

Spondilitrosis is the most common cause of back pain in older people. Unlike discogenous pain in spondylotrosis, the pain bilateral and localizes paravertebrally; Strengthens with long standing and extension, decreases when walking and seat.

3. Protrusion and hernia disk

Cipher on μb-10: m50 -; M51 is the defeat of intervertebral disks of other departments.

The protrusion and hernia disk are not a sign of osteochondrosis. Moreover, the less expressed degenerative changes in the spine, the more the disk is active (that is, the more realistic the appearance of hernia). That is why the hernia disk is more common in young people (and even in children) than the elderly.

The sign of osteochondrosis is often considered to be a hernia of Schimor, which has no clinical value (there are no back pain). The hernia of Schimorl is the displacement of the disk fragments to the spongosis of the body of the vertebral body (intracorporeal hernia) as a result of the impairment of the body of the vertebrae during the growth process (that is, in fact, the hernia of the Schimor is a dysplasia).

The intervertebral disk consists of an outer part - this is a fibrous ring (up to 90 layers of collagen fibers); And the inner part is a pentuary pulpidic core. In young people, a pulpous core consists of 90%; In the elderly, a pulp nucleus loses water and elasticity, fragmentation is possible. The protrusion and hernia disk arise both as a result of dystrophic changes of the disc and due to repetitive high loads on the spine (excessive or frequent bends and extensions of the spine, vibration, injury).

As a result of the transformation of vertical forces into the radial pulpseed kernel (or its fragmented parts), shifted to the side, deflection of the dudder the fibrous ring - develops the disk protrusion (from the lat. Protrusum - push, push). Protrusion disappears as soon as the vertical load stops.

Perhaps spontaneous recovery if fibrotization processes apply to the pulp nucleus. Fibrous rebirth occurs and the protrusion becomes impossible. If this does not happen, then as the protrusion of the protrusions, the fibrous ring is increasingly promoted and finally bursts - this is a disk hernia.

The hernia of the disk can develop sharply or slowly (when the fibrous ring breaks in small portions of the fragments of the pulp nucleus). The hernia of the disk in the back and rear-side directions can cause the compression of the spinal root (radiculopathy), the spinal cord (myelopathy) or their vessels.

Most often, the hernia of the disk occurs in the lumbar spine (75%), then the cervical (20%) and the chest spine (5%) goes in frequency.

• The cervical department is the most mobile. The frequency of hernia in the cervical spine - 50 cases per 100 thousand population. The most often disk hernia occurs in the C5-C6 or C6-C7 segment.
• The lumbar department carries the greatest load by holding the whole body. The frequency of hernia in the lumbar spine - 300 cases per 100 thousand population. The most often disk hernia occurs in the L4-L5 segment (40% of all hernias in the lumbar spine) and in the L5-S1 segment (52%).

The hernia of the disk must have clinical confirmation, asymptomic disk hernias, according to CT and MRI, are found in 30-40% of cases and do not require any treatment. It should be remembered that the detection of the hernia of the disk (especially small sizes) according to CT or MRI does not exclude another cause of the back pain and cannot be the basis of a clinical diagnosis.

Spinal hernia on the ICD of the 10th revision

This disease is very dangerous and cunning, take care of yourself

The hernia of intervertebral discs is one of the most dangerous pathologies of the musculoskeletal system. This phenomenon is very common, especially among patients of 30-50-year-old age. With the hernia of the spine Code on the ICD 10 put in medical card patient. Why is it necessary? Turning to the hospital, the doctor immediately sees which diagnosis in the patient. The hernia of the intervertebral disc refers to the thirteenth class in which all pathology of bones, muscles, tendons, lesions of synovial shells, osteopathy and hondropathy, dorsopathy and systemic lesions are collected connective tissue. MKB 10 is a reference network developed for the convenience of doctors. Medical information directory has the following goals:

• formation of conditions for the purpose of comfortable exchange and comparison of data acquired in various states;
• so that the doctors and other medical staff were comfortable to keep information about patients;
• comparison of information in one hospital in different periods.

Thanks to the international classification of disease, it is convenient to count death, injuries. Also in the ICC of the 10th revision contains information about the causes of the appearance of the hernia of the spine, the symptoms, the course of the disease and pathogenesis.

Main types of protothes

The disk hernia is a degenerative pathology resulting from the absorption of the intervertebral disc and pressure on the spinal channel, as well as the nerve roots. The following types of hernia are distinguished depending on localization:

Most often there is a disease in the cervical and lumbar department, the pathology is somewhat less often affecting the chest department. The human spine consists of transverse and acute processes, intervertebral discs, rib joint surfaces, intervertebral holes. Each vertex department has a certain amount of vertebrae, between which intervertebral discs are located with the presence of a pulp nucleus inside. Consider the spine departments and the number of segments in each of them

1. The cervical department consists of Atlanta (1st vertebra), Aksis (2nd vertebra). Then the numbering continues from C3 to C7. There is also a conditional occipital bone, it is denoted by C0. The cervical part is very mobile, so hernia often amazes him.
2. The breast of the spine has in its composition 12 segments indicated by the letter "T". Between the vertebrae there are discs performing a depreciation function. Intervertebral discs distribute the load on the entire spine. In the ICD 10 it is indicated that in the thoracic hernia is more often formed between the T8-T12 segments.
3. The lumbar part consists of 5 vertebrae. The vertebrae in this area is denoted by the letter "L". Often the hernia amazes exactly this department. Unlike the cervical, it is more moving, it is more often injured.

Also isolated a sacral department consisting of 5 segments. Less frequently, the disease is found in breast and sacralized department. Each spine is associated with various patient bodies. This should be considered, the knowledge of knowledge will help to make a diagnosis.

How do you draw in the cervical examination on the patient's card? At work which organs affects the disease with this localization?

The ICB 10 code is set in accordance with the type of damage to cartilage intervertebral discs. With hernia in the cervical spine on the patient's medical card, the M50 code is set. The defeat of intervertebral segments on the international classification of disease is divided into 6 subclasses:

This diagnosis means temporary disability of the patient. With hernia in the cervical department, the patient arises the following symptoms:

• headache;
• worsening memory;
• hypertension;
• impairment;
• reduction of hearing;
• full deafness;
• pain in the shoulder muscles and joints;
• numbness of face and tingling.

As you can see, the degenerative disease affects the work of the eyes, pituitary, brain circulation, forehead, facial nerves, muscles, voice ligaments. In the absence of treatment of hernia, the neck department leads to complete paralysis. The patient remains disabled for life. For diagnosis, pathologists use X-ray, CT or MRI.

Classes with damage to intervertebral discs in breast, lumbar and sacrats

With a chest, lumbar or sacral hernia of the spine in the ICD, a class M51 is assigned. Under it is understood as the defeat of intervertebral discs of other departments with myelopathy (M51.0), radiculopathy (M51.1), Lyumbago due to the displacement of the intervertebral segment (M51.2), as well as clarified (M51.8) and unspecified (M51.9) defeat intervertebral disk. The code in the ICD is also found 10 m51.3. M51.3 is the degeneration of the intervertebral disk, flowing without spinal and neurological symptoms.

This table is usually necessary for doctors, nurses and other medical staff, employees of the Social Insurance Department and representatives of the personnel department. Information can receive any person, it is in the open access.

Symptoms of the disease in the breast, lumbar and sacral division in the form of a table

The spine of man has certain bends, in fact it is not a post, although in many sources you can meet the name "vertebral pillar". Physiological bends are not a sign of a pathological process in the body, there are certain norms and deviations in various pathologies. The hernia of the spine in the thoracic department causes a person to slouch, so the pain is less manifested, therefore, the appearance of kyphosis or lordosis is possible. For the disease does not lead to such complications, the symptoms of pathology should be recognized on time and consult a doctor. Let's consider signs of degenerative disease, depending on the location. In the table, everything is described in detail, even a non-saying person will be able to put a preliminary diagnosis to know what doctor to record.

The hernia of the spine in the sacral division most often occurs between the L5-S1 segments. At the same time, there is a pain that gives the buttocks, the lower limbs, the lumbar department, numbness in the foot, the absence of reflexes, the change in the sensitivity, the feeling of "goosebumps", tingling, "coughing push" (with the coughing or sneezing of the patient, is striking sharp pain).

How are SFORL nodes in official documents mean?

International Classification of Disease Indicates Hernia Schimor Code M51.4. Schorla nodes are to pry the cartilage tissue of the closure plates in the spongy bone of the segment. This disease disrupts the density of the cartilage of the intervertebral disc and mineral exchange. As a result, a decrease in the density of the vertebrae, the elasticity of intervertebral ligaments can occur. There is a deterioration in the depreciation properties, the growing of fibrous tissue at the location of the Schymno nodes and the formation of intervertebral pathology.

The hernia of the intervertebral disc

The hernia of the intervertebral disk is the morphofunctional state of the spine, in which the intervertebral disc goes beyond the fibrous ring. It is a sign of pronounced degenerative-dystrophic changes in the spine, may be a consequence of spinal spinal injury.

Many it is believed that the disk loss of less than 6 millimeters is a protrusion, while loss of 6 millimeters and more hernias.

The disk hernia itself cannot be considered as a separate independent disease and, rather, is the consequence of osteochondrosis, injuries. Consider the same hernia disc within various syndromes, which differ depending on the localization, involvement in the process of roots or the substance itself of the spinal cord.

More often than other localizations are the localization of intervertebral hernia at the LV-SI segment level. It is at this level that the transition of one mobile spine to another fixed and the load on intervertebral segments is the greatest.

Information for doctors. In ICD 10, there are several ciphers under which it is customary to encode discogenous spinal lesions. Under the M50.0 code, the lesion of cervical intervertebral disks is encrypted. Under the code M51.1, the localization of hernia in the lumbar, thoracic departments is encrypted. The third digit zero means the presence of myelopathy, 1 - radiculopathy, 2 is another refined lesion, 3 - other degeneration of disks.

Symptoms

Symptoms of the disease depends on the localization of the process, the size of the hernia, its localization directly in the intervertebral segment. Thus, the hernia of the disc, which dropped out the kepent, cannot lead to the infringement of the root, nor to squeeze the spinal cord and proceeds asymptomatic. Whereas hernia, pinching spinal cord root can lead to radiculopathy. Then the symptoms of hernia will be weak in the leg or hand, a violation of sensitivity in it, convulsions, limiting the limb movements. In the later stages of radiculopathy, muscle hypotrophy develops.

Large hernias can lead to a spinal cord. In the case of localization in the lumbar-sacral division, patient may develop pelvic disorders, caudogenic chromium syndrome. Also, the compression of the spinal cord threatens the development of myelopathy, in which the neuromuscular transmission is disturbed, the ways of conducting nerve pulses from the head to the spinal cord are disturbed.

Disability in hernias is determined in patients with pronounced violations of functions. Thus, the disability can be assigned to a person with radiculopathy, patients after a neurosurgical surgery, with myelopathy.

Diagnostics

Diagnose the hernia can only be diagnosed when conducting a highly solid neurovalizing study. Such studies are MSCT or MRI. It should be noted that MRI as a whole, especially conducted on the devices recent generations (3 Tesla and more) Much more accurately. MSCT does not always determine the presence of hernia with localization in the cervical department.

Determine the hernia disk "Hands", with the help of ordinary x-ray research It is impossible. One can only assume the likely presence of the lesion of the intervertebral disc.

Neurological examination allows you to identify signs of tension of spinal roots, reveal the reflex muscle spasm. Also, the loss of reflexes, a change in the sensitivity of the root type, the decrease in the strength of the muscles of the limbs suggests the idea of \u200b\u200bthe presence of radiculopathy.

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Treatment

All treatment of hernias of intervertebral discs can be divided into several stages - conservative treatment, Conducting blockade, neurosurgical treatment.

At the first stage, a standard for vertebrogenic pain syndromes is a drug treatment. Non-steroidal anti-inflammatory drugs, the muscle relaxants of the central action, the vitamins of the group V. are often treated with vazoactive drugs (for example, Trental). With a protracted pain syndrome with evidence-effectiveness, the use of anticonvulsants, such as pregabalin, Gabapentin, is considered.

In the presence of a radiculopathy, additional neuroprotective therapy (tioktic acid preparations) can be used. Also additionally use such medication toolsAs prozero, contributing to the improvement of the nervous impulse.

Sometimes, especially in cases of moderately pronounced pain, protracted characteristics of the process, emotional changes in the patient are resorted to antidepressant therapy. Many drugs are used as an antidepressant, the choice is carried out on the basis of the financial capabilities of the patient, the availability of somatic pathology and other criteria.

In addition to drug treatment, manual impacts, physiotherapy, LFC, common-profile recommendations are used. Massage in a light pace as additional means The removal of muscle spasm and pain can be assigned to almost all patients, subject to the lack of direct contraindications to the massage. The question is less unequivocal, the question of manual therapy.

Manual therapy can be appointed only in a small number of cases. Contrary to popular belief, the manual therapy is unable to "correct" the intervertebral hernia and save the patient from the ailment. I myself love very manual therapy, resorting to various manual techniques with very many situations, but it is impossible to remove the hernia. In order to understand why it simply should be closely familiar with the process pathogenesis. Fingers to the place of localization of hernia do not get there, "to improve" the intervertebral disc will not be released, too, as well as "to shave" a fibrous ring. But once again to shift the hanieu, causing additional compression of the roots or directly spinal cord. Therefore, in the threat of such a process, during the localization of hernia at the cervical level, manual therapy is contraindicated.

From physiotherapeutic influences, in the absence of contraindications, DDTs are most often used, electrophoresis with various drugs, magnetotherapy. Currency treatment must, at least 5-10 procedures.

LFC classes are better held after consulting an instructor on the exercise. Specific exercises during the localization of the process at a certain level are shown in the section Rehabilitation, a subsection of the LFC. To strengthen the muscular corset, removal of spasm, the prevention of exacerbations is recommended regular (and perfect - daily) execution.

With the ineffectiveness of all of the above treatment methods, they switch to the next stage - the blockade method. Blocages are mainly divided into the following types: paravertebral, epidural, blockadic joints. Paralertebral - the simplest of all blockades - in fact, are intramuscular introduction into the long muscles of the back medicinal preparations. The doctor finds the most painful points and introduces various drugs that reduce pain.

The blockade of faceted joints is rarely used for disk hernias. They are directed to reduce pain in spondyloarthrosis of the arcotted intervertebral joints. Epidural blockades are a way of delivering a medicinal substance to the epidural spinal cord space and have a pronounced anti-inflammatory and painkillers. The blockade course usually consists of three procedures, the most commonly used drugs such as Kenalog, Diprosspan in combination with local anesthetics, vitamin B12.

In case of insufficient effectiveness of the above treatments, severe muscle hypotrophy under radiculopathic conditions, pelvic disorders, manifestations of myelopathy, and in the threat of the development of caudal interspersed chromium syndrome, neurosurgical intervention is shown. Laminectomy intervention is usually used with the removal of the disc hernia, the strengthening of the hernia can be carried out with transficuous fixation. The patient after surgery is not recommended to sit for 3-6 months, due to the high load on the vertebrae in the sitting position.

Also, all patients show the observance of general-rated events. These include: restriction of raised gravity, work in the tilt. When using elevators, public transport is recommended to be leaning back to the wall to reduce possible loads due to acceleration. It is necessary to sleep on a solid bed, preventing uncomfortable provisions.

The code of the intervertebral hernia of the spine on the ICD 10

Spinal hernia Code on MKB 10 gets in strict accordance with the type of damage to cartilage intervertebral discs and the location of their localization. So pathologies that are not involved in the trauma located in the cervical department are made in a separate division and are designated in the official medical records with the M50 code. This designation can be affixed in the "Diagnosis" field in a sheet of temporary disability, a sheet of statistical reporting, some types of directions on the instrumental control methods.

Located in a chest, lumbar and sacralized department, intervertebral hernia in the ICD 10 is denoted by the M51 code. The designation M51.3 is found, which denotes the pronounced degeneration (nipping the hernia) of the cartilage disk without spinal syndromes and neurological signs. When radiculopathy and severe pain syndrome, during the exacerbation of hernia, it can be denoted by the M52.1 code. The code M52.2 is deciphered as pronounced degeneration (destruction) of a cartilage disc with instability of the position of the vertebrae sitting next to it.

The nodes or intervertebral hernia of the Schimorrich has a code on the ICD - M51.4. In the event that the diagnosis is not specified and additional differential laboratory diagnostics are required in official medical documents, the code M52.9 is affixed.

Special table is used to decrypt such data. It is usually an interest for workers of a medical institution, employees of the social insurance department and representatives of the personnel department. All the necessary information is in public domain and can be studied by any person who has interest in this. If you have any difficulties, you can contact our specialist. He will tell everything about the disease of the spine, which is encrypted as intervertebral hernia in the Code of the ICD 10.

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Description and Treatment of Hernia Disc MKB 10

The most severe and dangerous diseases of the musculoskeletal system include the hernia of the intervertebral disc. According to the international classification of illness 10 reviews (ICD-10), they have the M51 code. The disease is diagnosed with each 3 of 1000 people. The flutters of men are usually diagnosed with the hernia of the ICC10 disk. Children's hernia are associated with congenital spinal pathology.

Description

When hernia is formed, the disks of the spine fall (prolapse) or protruded (protrusion), and the nerve endings of the spinal cord root occur. In the first place is the hernia, which are formed when moving the mobile spine to the stationary. The next frequency comes the hernia L3-4 disks. The hernia of the intervertebral disk of the upper lumbar spine is most rare. Usually they arise in patients who have suffered severe injuries.

Determine the presence of hernia in a patient, according to the results of neurological examination, it is impossible.

And, since the symptoms of the intervertebral hernia of the disk of the lumbar separation depend on the location of the localization, the size and stage of the disease, the only correct way to form a diagnosis is MRI or MSCT.

Symptoms of the disease

At the initial stage of the disease, while the intervertebral hernia of the disk has small sizes, the root of the root does not occur, and the patient does not experience severe pain. Usually, at this stage, pain is stupid and appears periodically:

In some cases, in the initial stage of the hernia, the disk is accompanied by the attacks of Lumbago. As hernia grows, the root of the spinal cord and the lesion of the intervertebral disks is observed. This leads to the manifestation of vertebral and root syndromes. If there is no sharp breakthrough of the hernia of the disk of the lumbar department, then there are several years between the initial stage of the disease and the emergence of syndromes.

With a vertebral syndrome, the mobility of the lumbar spine is limited, with the paravertebral muscles all the time are tense, because of which the patient is experiencing severe pain and cannot straighten the back. In a patient, with such syndrome, scoliosis is often observed, and in some cases kyphosis. Patients are experiencing severe sweating, and the skin has a marble shade. When tapping at the place of localization of hernia, the patient is experiencing a sharp shooting pain in the leg.

With the root syndrome shooting and it's a dull pain Puts to the buttock and thigh, and in some cases and in the shin. As the disease develops, the patient is experiencing numbness of the limbs, strong weakness of muscles, which, without proper treatment, goes into atrophy. Usually pain occurs with a sharp movement of the body, fall. One of the symptoms of the root syndrome of the lumbar department is a sudden strong pain that occurs during sneezing or cough.

Patients with intervertebral hernias of the lumbar department are painful when picked up the leg even on a small height, while the pain decreases or passes when the legs bended in the knee and becomes stronger when flexing the foot.

Sometimes even quite large hernias may not cause pain. If the loss occurred in front, then the root of the root does not occur. However, even the small hernia of the disk when pinching the spinal cord root can cause severe pain. In the median hernia, the disk can occur with chairs, incontinence or urine delay, impotence.

Methods of treatment

Depending on the stage of the disease and the size of the hernia, the treatment is carried out by a conservative or operational method. The operational treatment of the hernia of the intervertebral disk is resorted only in the inefficiency of conservative, strong muscular weakness, or in emergency cases during acute compression of the spinal cord root.

The traditional methods of treating the hernia disk include:

• pulling of the spine;
• novocaine or lidocaine blockade;
• reception of anti-inflammatory drugs and vitamins;
• physiotherapy;
• massage.

With intervertebral hernia, the disk of the lumbar department does not recommend manual therapy.

How to cure joints and forever get rid of back pain - Home Method

Have you ever tried to get rid of joint pain yourself? Judging by what you read this article - the victory was not on your side. And of course you do not know what: it is:

• with pain and creak bending legs and hands, turn, bend.
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• to any change of weather to suffer from what turns and turns the joints
• forget what free movement is and every minute there's another attack of pain!

Intervertebral hernia

Intervertebral hernia (the hernia of the intervertebral disk, the Code of ICD 10 M51.2) is the terminal stage of the spinal osteochondrosis, which is a degenerative-dystrophic disease. Recently, the frequency of occurrence of this pathological state is becoming higher.

The intervertebral hernia is called such a disease in which the intervertebral disc from the dust or knutrice is made from the spinal column due to the instability of the ligament and other fixing structures.

The symptoms of the intervertebral hernia are primarily determined by the presence of the grinding of nerve roots as a result of the seats of the intervertebral disc and reduce the gaps between the vertebrae. Therefore, the main clinical manifestations of intervertebral hernia are the following:

• Pains that can be permanent or periodic, and they are enhanced by changing the position of the human body (sloping to the side, for example)
• Symptoms of irritation of nervous roots that manifest increased sensitivity, pain along the nerve, feeling tingling and crawling goosebumps
• Chronic squeezing of the nervous root can lead to atrophy of the skin and muscles in the zone of its innervation, since the nervous tissue is inherent in the trophic function
• Violation of motor activity and sensitivity with the loss of certain innervation zones with a loss of its self-service ability.

The most reliable causes of the development of intervertebral hernia are finally not established. Allocate a number of predisposing factors that increase the likelihood of developing this disease. These include the following:

Thus, the main mechanism for the development of intervertebral hernia is to exceed the compensatory-adaptive mechanisms of the locking apparatus above the load that the spine is experiencing.

Diagnostic search with suspected intervertebral hernia includes the following studies:

• X-ray study that allows you to see the protrusion between certain vertebrae
• Computed tomography (MRI, PET, YMRR)
• Electronomyography, which allows you to estimate the degree of involvement of a nervous root in the pathological process.

The absence of timely treatment of intervertebral hernia can lead to the development of certain complications, which are reflected on the quality of the patient's life. These include the following:

• Pares and paralysis
• Chronic pain syndrome
• Implanting urine and feces and some others who are associated with the squeezing of nerve roots responsible for the innervation of internal organs.

The treatment of intervertebral hernia can be both operational and conservative. However considering that this last stage Osteochondrosis, conservative therapy has low efficiency. The operation pursues the goal to restore normal anatomical structure And strengthen the spine to prevent the repeated protrusion of the intervertebral disk.

Physiotherapeutic treatment has a certain efficiency. These techniques allow you to improve microcirculation in the connective tissue, which is somewhat strengthening the vertebral pole.

The risk group includes the following categories of patients:

• With burdened heredity
• With excess body
• Professional activities that are related to severe physical labor (for example, weightlifters, movers).

Preventive measures are aimed at eliminating predisposing factors. If the patient is in a higher risk group, it is necessary to undergo prophylactic inspections of the neurologist, including the mandatory passage of the X-ray or tomographic study of the spine. In addition, it is recommended to adhere to the following recommendations:

• Apply dosage physical exertion
• Eliminate overeating and hypodynamine.

• Avoiding excessive physical exertion
• Wearing a special orthopedic corset
• Regular observation at the neurologist
• Power has practically no restrictions, in addition to using high-calorie food, since overweight leads to the progression of the disease.

• Spin hurt
• Hurts loins
• hurts the loin nims
• pain in the lower back
• pain in the upper spins
• pain in the lumbar region
• pain in the lower back is intensified with inclons, lifting and twisting of the body.
• Pain in the bottom of the back

Included: Occupus hernia

Included:

• equaline hernia

Excluded: congenital hernia:

• diaphragmal (Q79.0)

Included: Hernia:

• lumbar
• locked
• rakr Trinky
• sedalish

Included:

• enterocele [Intestinal hernia]
• hernia:
  • BDA
  • interstitial
  • intestinal
  • intra-abdominal

Excluded: Vaginal Enterocele (N81.5)

In Russia, the International Classification of Diseases of the 10th Review (ICD-10) adopted as a single regulatory document for accounting for incidence, reasons for people's appeals to medical institutions of all departments, causes of death.

The ICD-10 has been introduced into the practice of health throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia from 27.05.97. №170

A new revision (ICD-11) is planned to be planned in 2017 2018.

With changes and additions to WHO.

Processing and transferring changes © MKB-10.com

MKB-10: K40-K46 - Hernia

Chain in classification:

The diagnosis with the code K40-K46 includes 7 clarifying diagnoses (CCM-10 columns):

Contains 6 blocks of diagnoses.

Included: Packing hernia bubonocele :. BDU. straight. bilateral. Indirect. sinking scrotal hernia.

With a median and paramediable hernia, scoliosis is observed, open in the sick side (less pulling the rear longitudinal ligament). With lateral hernia (reduction of the grinding of the nervous root), scoliosis is observed, open in the opposite direction.

Root syndrome (radiculopathy):

• paints occur in the innervation zone of one or several roots, spread to the buttock, and below - according to rides, rear (rear-line) surface of the lower leg and hips (Ishialia). According to nature, the pain happens or shooting;
• the pain most often arises due to injury, with an unsuccessful turn of the body or when lifting gravity;
• changes occur in the innervation zone of the nervous root;
• muscles become weak, hypotension is observed, atrophy develops (sometimes becyclation). The patient feels numbness, paresthesia arise;
• "Symptom of coughing push." When there is a sneezing (cough, sneezing) in the innervation zone of the siled roof, there is a tight pain or its sharp gain;
• there is a loss of proprioceptive reflexes.

1. the pain occurs even with a slight rise of the leg;
2. the pain appears in the lower back and in the dermatome of the affected root. The patient can feel numbness or "goosebumps" when picked up straightened legs up;
3. the pain is weakening (disappearing) when flexing the legs in the knee joint, but it is enhanced by the rear flexion of the foot.

The hernia of the spine of the lumbar department most often occurs on the background of osteochondrosis

Pathology of horse-tail (acute compression of roots):

• the reason: the median hernia of large sizes, pain occurs with a significant physical force and a large load on the spine (sometimes under the manual therapy session). Signs: urine delay (violation of sensitivity in the anogenital region), lower sluggish parapaprex.

Caudogenic mixing chromotype syndrome:

• there is pain when walking in the lower limbs (due to the transient compound of the horse-tail). The patient when driving is forced to stop often.

Diagnostic events

When diagnosis, it is important to take into account all the symptoms, "speaking" about the presence of hernia of the lumbar spine. The dorsal hernia is recognized in the following diagnostic methods:

• lumbar puncture (moderate protein increase);
• x-ray of the spinal column;
• MRI and myelography, sometimes - followed by high resolution CT;
• electromiography (the ability to retperine reimage neuropathy from the grinding of the root).

Differential diagnosis

It is important when differentiating from the lumbar hernia to exclude: tumors and metastases in the spine, Bekhterev's disease, tuberculous spondylitis, metabolic spondylopathy, circulatory disruption in the additional spinal artery of dererage-Gotteron, diabetic neuropathy.

In time, the diagnosis was diagnosed and the initiated treatment is capable of restoring the intervertebral disk completely. With late appeal, all therapeutic measures, unfortunately, are directed only to reduce the intensity of symptoms.

Dorsopathy and back pain

2. Degenerative dystrophic changes in the spine

Degenerative spinal changes are made up of three main options. This is osteochondrosis, spondylosis, spondyltrosis. Various pattomorphological options can be combined with each other. Degenerative-dystrophic changes of the spine to old age are celebrated by almost all people.

Osteocondritis of the spine

The cipher on the ICD-10: M42 is osteochondrosis of the spine.

Osteochondrosis of the spine is a decrease in the height of the intervertebral disk as a result of dystrophic processes without inflammatory phenomena. As a result, segmental instability is developing (excessive degree of flexion and extension, the sliding of the vertebrae is forwarded when flexing or backward during extension), the physiological curvature of the spine changes. The rapprochement of the vertebrae, and hence the articular processes, their excess friction inevitably lead in the future to local spondyltrosis.

Osteochondrosis of the spine is an x-ray, but not clinical diagnosis. In fact, the osteochondrosis of the spine simply states the fact of aging the body. Call back pain osteochondrosis - illiterately.

Spondylosis

CIFR on the ICD-10: M47 - Spondylosis.

Spondylosis is characterized by the appearance of edge bone expansions (on the upper and lower edge of the vertebrae), which on radiographs have the type of vertical spikes (osteophytes).

Clinically spondylosis will be not significant. It is believed that spondylosis is an adaptive process: edges (osteophytes), fibrosis of disks, ankylosis of the facet joints, thickening of bundles - all this leads to immobilization of the problem vertebral segment, expanding the support surface of the vertebral bodies.

Spondloarthrosis

Cipher on the ICD-10. M47 - Spondillas. Included: arthrosis or osteoarthritis of the spine, degeneration of facade joints.

Spondilotrosis is an arthrosis of intervertebral joints. It is proved that the processes of degeneration in intervertebral and peripheral joints do not differ in principle. That is, essentially spondyltrosis is a type of osteoarthrosis (therefore, drugs of chondroprotective series will be appropriate in treatment).

Spondilitrosis is the most common cause of back pain in older people. Unlike discogenous pain in spondylotrosis, the pain bilateral and localizes paravertebrally; Strengthens with long standing and extension, decreases when walking and seat.

3. Protrusion and hernia disk

The cipher on the ICD-10: M50 is the defeat of the intervertebral discs of the cervical M51 is the defeat of intervertebral disks of other departments.

The protrusion and hernia disk are not a sign of osteochondrosis. Moreover, the less expressed degenerative changes in the spine, the more the disk is active (that is, the more realistic the appearance of hernia). That is why the hernia disk is more common in young people (and even in children) than the elderly.

The sign of osteochondrosis is often considered to be a hernia of Schimor, which has no clinical value (there are no back pain). The hernia of Schimorl is the displacement of the disk fragments to the spongosis of the body of the vertebral body (intracorporeal hernia) as a result of the impairment of the body of the vertebrae during the growth process (that is, in fact, the hernia of the Schimor is a dysplasia).

The intervertebral disk consists of an outer part - this is a fibrous ring (up to 90 layers of collagen fibers); And the inner part is a pentuary pulpidic core. In young people, a pulpous core consists of 90%; In the elderly, a pulp nucleus loses water and elasticity, fragmentation is possible. The protrusion and hernia disk arise both as a result of dystrophic changes of the disc and due to repetitive high loads on the spine (excessive or frequent bends and extensions of the spine, vibration, injury).

As a result of the transformation of vertical forces into the radial pulpseed kernel (or its fragmented parts), shifted to the side, deflection of the dudder the fibrous ring - develops the disk protrusion (from the lat. Protrusum - push, push). Protrusion disappears as soon as the vertical load stops.

Perhaps spontaneous recovery if fibrotization processes apply to the pulp nucleus. Fibrous rebirth occurs and the protrusion becomes impossible. If this does not happen, then as the protrusion of the protrusions, the fibrous ring is increasingly promoted and finally bursts - this is a disk hernia.

The hernia of the disk can develop sharply or slowly (when the fibrous ring breaks in small portions of the fragments of the pulp nucleus). The hernia of the disk in the back and rear-side directions can cause the compression of the spinal root (radiculopathy), the spinal cord (myelopathy) or their vessels.

Most often, the hernia of the disk occurs in the lumbar spine (75%), then the cervical (20%) and the chest spine (5%) goes in frequency.

• The cervical department is the most mobile. The frequency of hernia in the cervical spine - 50 cases per 100 thousand population. The most often disk hernia occurs in the C5-C6 or C6-C7 segment.
• The lumbar department carries the greatest load by holding the whole body. The frequency of hernia in the lumbar spine - 300 cases per 100 thousand population. The most often disk hernia occurs in the L4-L5 segment (40% of all hernias in the lumbar spine) and in the L5-S1 segment (52%).

The hernia of the disk must have clinical confirmation, asymptomic disk hernias, according to CT and MRI, are found in 30-40% of cases and do not require any treatment. It should be remembered that the detection of the hernia of the disk (especially small sizes) according to CT or MRI does not exclude another cause of the back pain and cannot be the basis of a clinical diagnosis.

The content of the Dorsilla and Back Pain:

Degenerate-dystrophic changes in the spine. Protrusion and disk hernia.

Conservative therapy is the most preferred medical tactic With the hernia of the intervertebral disk. It is integrated. The drug component includes drugs to relieve pain syndrome (ketoprofen, ibuprofen, diclofenac, naproxen, meloxico, etc.), muscle relaxants for removing muscular-tonic syndrome (tolperizon hydrochloride) necessary to maintain the nervous tissue vitamin complexes (B1, B6, B12), anti-ethnic funds. In order to relieve the intensive pain syndrome, the local administration of corticosteroids and local anesthetics in the form of paravertebral blockades is used. In the initial stages, chondroprotectors (chondroitin sulfate, glucosamine, etc.) are effective.
Intervertebral hernia in the acute period is an indication for the assignment of UHF, ultrafonophoresis with hydrocortisone, electrophoresis. During the reconstruction period for the restoration of the parethous muscles, electromyism, reflexotherapy, mud, is applied. A good effect has tracting therapy, with which an increase in the intervertebral distance occurs and a significant reduction in the load on the affected disk, which provides conditions for stopping the progression of hernia protrusion, and in the initial stages can contribute to some recovery of the disc. Manual therapy is able to replace the stretch of the spine, but, unfortunately, in practice it has a large percentage of complications, therefore it can be carried out only by an experienced manual therapist.
The most important role in the treatment of intervertebral hernia is given to therapeutic physical education. Specially selected exercises can be achieved and the stretching of the spine, and the strengthening of its muscular framework, and the improvement of the blood supply to the affected disk. Regular exercises make it possible to strengthen the muscles that hold the spine that the recurrence of hernia or its appearance in other vertebral column departments is practically excluded. Well complements the LFC coursework massage, as well as swimming.
Surgical treatment is necessary only to patients who comprehensive application Conservative therapy turned out to be unsuccessful, and the existing heavy complications (unknown more than 1-1.5 months. pain syndrome, discogenous myelopathy, a vertebral artery syndrome with TIA) tend to progression. Given the possible postoperative complications (Bleeding, damage or infection of the spinal cord, injury to the spinal root, the development of spinal arachnoiditis and so on), should not be in a hurry with the operation. Experience has shown that surgery is really necessary about 10-15% of cases of an intervertebral disk hernia. 90% of patients are successfully treated with a conservative way.
The purpose of the operation can be the decompression of the spinal canal or the removal of hernia. In the first case, laminectomy is produced, in the second - open or endoscopic discectomy, microdiskomics. If during the intervention is carried out full removal Disk (discectomy), then for the stabilization of the spine, the B-Twin implant is installed or the spinal fixation. New methods of surgical treatment are laser vaporization, intranious electrothermal therapy. In the postoperative period, the most important is the gradual extension of the motor load with anatomically right fulfillment All movements. In the restorative period, the LFK is required.

CATAD_TEMA Surgical Diseases - Articles

Standard medical care Patients with disadvantaged hernia

On November 26, 2007, the Ministry of Health approved the protocols for the diagnosis and treatment of the disadvantaged hernia.

Strangulated hernia (ICD - 10 K40.3 - to 45.8) - a sudden or gradual compression of hernia contents at its gate.

Infringement is the most frequent and dangerous complication of the hernia. Patients' mortality increases with age, varying between 3.8 and 11%. Necrosis of the damned organs is observed at least in 10% of cases.

Forms of infringement are different. Among them are distinguished:
1) elastic infringement;
2) Caluing infringement;
3) clothes infringement;
4) retrograde infringement;
5) Lithra hernia (infringement of the meckel diverticula).

The frequency of occurrence is observed:
1) infrigious inguinal hernias
2) infrained femuric hernias;
3) infrained nuclear bumps;
4) infrained postoperative ventral hernias;
5) infrained hernia of a white abdomen;
6) infrained hernia rare localizations.

The disadvantaged hernia may be accompanied by acute intestinal obstruction, which proceeds through the mechanism of the strange intestinal obstruction, the severity of which depends on the level of the strategy.
With all the types and forms of the disadvantaged hernia, the severity of disorders has a direct dependence on the time factor, which determines the urgent nature of therapeutic and diagnostic measures.

Protocols for the diagnosis of infrainment of hernia in the emergency medical department (OEMP)

Patients enrolled in the OEMP with complaints of abdominal pain, symptoms of acute intestinal obstruction, should be purposefully examined for the presence of hernia protrusions in the places typical.

Based on complaints, anamnesis of a clinical picture and data of an objective examination, patients with infringent hernias should be divided into 4 groups:
1 group - uncomplicated disadvantaged hernia;
2 Group - complicated disadvantaged hernia

With complicated disadvantaged hernia, 2 subgroups are distinguished:
a) the disadvantaged hernia complicated by acute intestinal obstruction;
b) The disadvantaged hernia, complicated by the phlegmon hrying bag.
3 Group - improved thickened hernia;

Uncomplicated disadvantaged hernia;

Criteria for the diagnosis of uncomplicated disadvantaged hernia in the OEMP:

The disadvantaged uncomplicated hernia is recognized by:
- suddenly coming pains in the region of the previously aftered hernia, the nature and intensity of which depends on the type of infringement, the affected organ and the age of the patient;
- the impossibility of the right of the previously frightened hernia;
- increasing in the volume of hernial protrusion;
- voltage and soreness in the field of hernia protrusion;
- the absence of a "cough push";

No symptoms and signs of acute intestinal obstruction with uncomplicated disadvantaged hernia.

Laboratory research:
- clinical analysis blood
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

- ECG

Consultation therapeuts

Protocols for preoperative preparation with uncomplicated disadvantaged hernia in the OEMP

Protocols of surgical tactics with uncomplicated disadvantaged hernia.

1. The only method of treating patients with infringent uncomplicated hernia is an urgent operation, which should be started no later than 2 hours from the moment of the patient's admission to the OEMP. There are no contraindications to the operation with a strenuous hernia.
2. The main tasks of the operation in the treatment of uncomplicated disadvantaged hernia are:
- elimination of infringement;
- inspection of the disadvantaged authorities and the corresponding interventions on them;
- Plastic of the hernial gate.
3. The section of sufficient size is carried out in accordance with the localization of hernia. An opening of a hernia bag and fixation of the organ disadvantaged in it. Dissection of the infringerating ring until the junk bag is unacceptable.
4. When spontaneous to the abdominal cavity of the infringent organ, it should be extracted for inspection and evaluating its blood supply. If it fails to find and extract, the wound expansion (Herniolaparotomy) or diagnostic laparoscopy is shown.
5. After dissection of the infringerating ring, an assessment of the state of the disadvantaged organ. The viable intestine quickly takes a normal look, the painting of it becomes pink, serous shell Brilliant, peristalistic distinct, pulsa vessels pulsate. Before the intestine in the abdominal cavity, it is necessary to introduce 100 ml of a 0.25% solution of novocaine into its mesentery.
6. If there are doubtful in the viability of the intestine in its mesentery, 100-120 ml of 0.25% of the novocaine solution should be introduced and to warm up the dubious area with warm tampons moistened with 0.9% NaCl. If doubts in the viability of the intestine remain, the gut must be restected within healthy tissues.
7. Signs of intelligence of the intestine and undisputed testimony to its resection serve:
- dark color of the intestine;
- dull serous shell;
- Drying wall;
- no intestine peristals;
- no pulsation of vessels of her mesentery;
8. Resection is subject to, except for the disadvantaged area of \u200b\u200bthe intestine, all macroscopically modified part of the leading and discharge intestine plus 30 - 40 cm of the unchanged separation of the leading intestine and 15-20 cm of the unchanged segment of the removal intestine. The exceptions are resection near an ileocecal angle, where limitation of these requirements is allowed with the beneficial visual characteristics of the intestine in the zone of the intended intersection. In this case, control indicators are used to bleed from the wall vessels during its intersection and the state of the mucous membrane. It is also possible to use transyl aluminlation or other objective methods for assessing blood supply. When resection of the intestine, when the level of imposition of anastomosis falls on the most distal department of the ileum - less than 15 - 20 cm from the blind intestine, it should be resorted to the imposition of ieoassensto - or an ileotransnetsoanastomosis.
9. If there are doubts about the viability of the intestine, especially in its large extent, it is permissible to postpone the solution of the issue of resection using the programmed laparoscopy after 12 hours.
10. In cases of intricate infringement, the intestines should be made. The immersion of the changed area in the intestinal lumen is dangerous and should not be made, since it may be possible to discrepate the immersible seams, and the immersion of an extensive area within the limits of non-modified sections of the intestine can create a mechanical obstacle to the intestine.
11. Restoration of the continuity of the gastrointestinal tract after resection is carried out:
- with a large difference of the diameters of the lumen of the crosslinkable sections of the intestine by anastomosis "side in side";
- When the diameters of the lumen of the crosslides of the intestine can be used the anastomosis "end to the end".
12. When infringement of the gland, the testimony for resection is put in the event that it is eaten, has fibrinous raids or hemorrhages.
13. Operational intervention ends with plastic hernia gates depending on the localization of hernia.

Minutes of postoperative management of patients with uncomplicated disadvantaged hernia

2. An intramuscular administration of painkillers (analgin, ketarol) is prescribed to all patients 3 times a day for 3 days after surgery; Wide spectrum antibiotics (cefazoline 1 g x 2 p / day) within 5 days after surgery.

Complicated disadvantaged hernia

Disadvantaged hernia complicated by acute intestinal obstruction

Criteria for diagnosing disadvantaged hernia complicated by intestinal obstruction in the OEMP:

Symptoms of acute intestinal obstruction are joined to local symptoms of infringement:
- Catching pain in the area of \u200b\u200bhernia
- Thirst, dry mouth,
- Tachycardia\u003e 90 wt. in 1 min.
- periodically repeated vomiting;
- delay of gases;
- during the examination, the bloating is determined, the strengthening of the peristaltics; MB "Slot's noise";
- on the survey radiograph, cubebeer bowls and sublictic arches with transverse aperture are determined, perhaps the presence of a "insulated loop";
- under ultrasound examination, extended intestinal loops and the "pendulum-shaped" peristalistic are determined;

Survey Protocols in the OEMP

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

Tools:
- ECG
- Survey radiography of the organs of the chest
- overview radiography of the abdominal cavity.
- Abdominal ultrasound.

Consultation therapeuts

Protocols of preoperative preparation of the disadvantaged hernia complicated by intestinal obstruction in the OEMP

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.
2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.
3. The presence of pronounced clinical signs General dehydration and endotoxicosis serves as an indication for intensive preoperative preparation with a catheter formulation to the main vein and infusion therapy (intravenously 1.5 liters of crystalloid solutions, 400 ml reasberin, 10 ml in dilution by 400 ml of 5% glucose solution. Antibiotics in this case are entered 30 minutes before operation intravenously.

Protocols of surgical tactics in progressive hernia complicated by intestinal obstruction.

1. Operation on the complicated disadvantaged hernia is always carried out under anesthesia three-directional team with participation in the operation of the most experienced surgeon of the duty officer or a responsible duty surgeon no later than 2 hours from the moment the patient's admission to the OEMP.
2. The main tasks of the operation in the treatment of the disadvantaged hernia complicated by intestinal obstruction are:
- elimination of infringement;
- determination of the viability of the intestine and determining the indications for its resection;
- establishing the boundaries of resection of the changed intestine and its execution;
- determination of the testimony and method of drainage of the intestine;
- Sanitation and drainage of the abdominal cavity
- Plastic of the hernial gate.

3. The initial stages of the operation to eliminate the disadvantaged hernia, complicated by intestinal obstruction, correspond to the provisions set out in P.P. 5 - 12 surgical tactics with uncomplicated disadvantaged hernia.
4. Indication to drainage thin gut serves overflow content leading intestinal loops.
5. The preferred method of draining the small intestine is a nasogasorentestine intubation from a separate median laparotomy access.
6. Operational intervention ends with the drainage of the abdominal cavity and the plastic of the hernial gate, depending on the localization of hernia.

Minutes of postoperative management of patients with infringent hernia complicated by intestinal obstruction

1. Theent nutrition begins with the advent of intestinal peristaltics by introducing glucose-electrolyte mixtures to the intestinal probe.
2. The method of a namogasorentestinal drainage probe is carried out after the restoration of stable peristaltics and an independent chair for 3-4 days. The draining tube installed in the small intestine through the gastrostomy or retrograde on the vehicle is removed somewhat later - for 4 to 6 days.
3. The purpose of combating ischemic and reperfusion damage to the small intestine is carried out infusion therapy (intravenous 2-2.5 liters of cryptaloid solutions, 400 ml reasurerin, 10.0 ml in dilution by 400 ml of 0.9% sodium chloride solution, Trental 5, 0 - 3 times a day, conflict - 50,000 cells / day, ascorbic acid 5% 10 ml / day).
4. Aartibacterial therapy in the postoperative period should include either aminoglycosides II-W, generation cephalosporins III and metronideosol, or fluoroquinolones II generation and metronidozol.
5. For the prevention of the formation of sharp ulcers, the scicure of therapy should include antisecretory preparations.
6.complex therapy should include heparin or low molecular weight heparins for the prevention of thromboembolic complications and microcirculation disorders.
Laboratory studies are performed according to the testimony and before discharge. Extract with the uncomplicated flow of the postoperative period is made for 10-12 days.

Disadvantaged hernia complicated by phlegmon hrying bag

Criteria for the diagnosis of the disadvantaged hernia, complicated by the phlegmon of a junk bag in the OEMP:
- the presence of symptoms of severe endotoxicosis;
- the presence of fever;
- Herge-up swelling, hot to the touch;
- hyperemia of the skin and swelling of subcutaneous fiber, propagating far beyond the limits of hernia protrusion;
- It is possible to have attachments in the surrounding hernial tissue protrusion.

Survey Protocols in the OEMP

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

Tools:
- ECG
- Survey radiography of the organs of the chest
- overview radiography of the abdominal cavity.

Consultation therapeuts

Protocols preoperative preparation of the disadvantaged hernia, complicated by the phlegmon of a hernia bag in the OEMP

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.
2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.
3. Intensive preoperative preparation with the formulation of the catheter in the main vein and infusion therapy (intravenously 1.5 liters of crystalloid solutions, 400 ml reasberin,
4. Must with the introduction of a wide range of action (cephalosporins III III and Metronidozol) 30 minutes before operation intravenously.

Protocols of surgical tactics with a disadvantaged hernia complicated by the phlegmon hrying bag.

1. Operation about the complicated disadvantaged hernia is always carried out under anesthesia three-directional team with participation in the operation of the most experienced surgeon at the duty officer or a responsible duty surgeon no later than 2 hours from the moment of the patient's arrival in the OEMP.
2. Operative intervention begins with median laparotomy. When reducing the loop of the small intestine, it is carried out with the imposition of anastomosis. The question of the method of completing resection of the colon is solved individually. The ends of the intestine to be removed is sewn tightly. Then the brushless seam is superimposed on the peritoneum around the inner ring of the hernia gate. The intra-painting stage of the operation is temporarily terminated.
3. Hiniotomy is performed. The disadvantaged necrotic part of the intestine is removed through a herniotomic section with simultaneous tightening of the brush seam inside the abdominal cavity. At the same time, special attention is paid to the prevention of the inflammatory purulent-rotary exudate of the hernial bag into the abdominal cavity.
4. Primary plastic of the hernial gate is not performed. In the herniotomic wound, necratetomy is performed followed by its loose rubony and drainage.
5. According to the testimony, the detonation of the small intestine is performed.
6. The operation ends with the drainage of the abdominal cavity.

Protocols postoperative maintenance of patients with a disadvantaged hernia, complicated by the phlegmon of a junk bag.

1. Sea treatment of the herniotomic wound is carried out in accordance with the principles of treatment of purulent wounds. Dressing daily.
2. Seizoxication therapy includes intravenous administration 2-2.5 liters of crystalloid solutions, 400 ml reasperine, 10.0 ml in dilution by 400 ml of 0.9% sodium chloride solution, Trental 5.0 - 3 times a day, conficilla - 50000 U / day, ascorbic acid 5 % 10 ml / day.
3. Intibacterial therapy in the postoperative period should include either aminoglycosides II-w, generation cephalosporins III and metronideosol, or fluoroquinolone II of generation and metronideosol.
4. For the prevention of the formation of sharp ulcers, the trap therapy should include antisecretory drugs.
5. Complex therapy should include heparin or low molecular weight heparins for the prevention of thromboembolic complications and microcirculation disorders.
Laboratory studies are performed according to the testimony and before discharge.

Imbutable disadvantaged hernia.

Criteria for the diagnosis of undergoing infrained hernia OEMP:

The diagnosis "disadvantaged hernia, condition after infringement" can be delivered when there is clear indications of the patient himself on the fact of infringement of the previously repeated hernia, the time interval of its email and the fact of its independent return.

The enlightened disadvantaged hernia should also be considered a hernia, the fact of independently affecting which occurred (and recorded in medical documents) in the presence medical personnel (on the chipboard - In the presence of a medical staff ambulance, after hospitalization - in the presence of a duty surgeon Surgeon OEMP).

Survey Protocols in the OEMP

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

Tools:
- ECG
- Survey radiography of the organs of the chest
- overview radiography of the abdominal cavity.

Consultation therapeuts

Protocols of preoperative preparation of the infringeable inclusive hernia in the OEMP

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.
2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.

Protocols of surgical tactics when improving the disadvantaged hernia.

1. When the infringement of the infringent hernia and the duration of the infringement of less than 2 hours shows the hospitalization on the surgical department with subsequent dynamic observation within 24 hours.
2. If, during dynamic observation, symptoms of deterioration of the overall state of the observed, as well as peritoneal symptomatics - is shown diagnostic laparoscopy.
3. With an independent refueling of the infringent hernia to hospitalization, if the fact of infringement does not cause doubt, and the duration of the infringement is 2 or more hours - the diagnostic laparoscopy is shown.

Protocols for the maintenance of patients when improving the disadvantaged hernia.

Postoperative maintenance of patients after diagnostic laparoscopy is determined by diagnostic finds and volume surgical intervention with them.

Infringed postoperative ventral hernia

Criteria for the diagnosis of infrainable postoperative ventral hernia OEMP:
- The clinical picture depends on its size, the type of infringement and the severity of intestinal obstruction. There are a wheelchair and elastic infringement.
- With a hidden infringement there is a gradual principle of the disease. The constantly existing pain in the area of \u200b\u200bhernia absorption increases, acquire a grapple-shaped character, subsequently join the symptoms of acute intestinal obstruction - there is vomiting, the delay of gases, the absence of a chair, the bloating of the abdomen. Herge-up protrusion in the lying position does not decrease, it acquires clear contours.
- Elastic infringement typically for hernia with a small hernial gate. There is a sudden beginning of pain syndrome due to the introduction of a large segment of the intestines in the hernial bag through a small defect of the front abdominal wall. In the subsequent pain syndrome, symptoms of intestinal obstruction are enhanced.
- The main symptoms of the disadvantaged postoperative ventral hernia are:
- pain in the field of hernia dummy;
- incorrect hernia;
- sharp soreness in palpation of hernia protrusion;
- With a long progress, clinical and radiological signs of intestinal obstruction are possible.

Survey Protocols in the OEMP

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

Tools:
- ECG
- Survey radiography of the organs of the chest
- overview radiography of the abdominal cavity.

Consultation therapeuts

Protocols for preoperative preparation of the infringent postoperative ventral hernia in the OEMP.

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.
2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.
3. With the presence of intestinal obstruction, an intensive preoperative preparation is shown with a catheter formulation to the main vein and infusion therapy (intravenously 1.5 liters of crystalloid solutions, 400 ml reasurerin, 10 ml in dilution by 400 ml of 5% glucose solution) for 1 hour or On the operating table, or in the OKR.

Protocols of surgical tactics in the infringeable postoperative ventral hernia.

1. The treatment of the infrainment postoperative ventral hernia is to perform emergency laparotomy within 2 hours from the moment of entering the hospital.
2. Supports of surgical treatment with a disadvantaged postoperative ventral hernia:
- a thorough revision of the hernia bag, given its multi-chamber and liquidation of the adhesive process;
- assessment of the viability of the organ stirred in hernia;
- With the presence of signs of non-viability of the disadvantaged organ - its resection.
3. In the infringement of large multi-chamber postoperative ventral hernias of the abdominal wall, the operation is completed by the dissection of all fibrous partitions and the ears of only skin with the subcutaneous tissue.
4. With an extensive hernial defect, more than 10 cm in diameter in order to prevent abdominal compartman-syndrome, it is possible to close the hernial gate with a mesh explant.

Minutes of postoperative maintenance of patients with infringeable postoperative ventral hernia.

1. Treatment of patients with infringent postoperative ventral hernia prior to stabilization of hemodynamics and restoration of independent respiration is carried out in OKH.
2. Therapeutic measures in the postoperative period should be directed to:
- suppression of infection by appointing antibacterial agents;
- fighting intoxication and violation of metabolic processes;
- treatment of complications from respiratory and cardiovascular systems;
- Restore the function of the gastrointestinal tract.

Disadvantaged hernia complicated by peritonitis

Criteria for the diagnosis of the disadvantaged hernia complicated by peritonitis in the OEMP:
- general condition is severe;
- Symptoms of heavy endotoxicosis: Consciousness confused, dry mouth, tachycardia\u003e 100 ° C. In 1 min., Hypotension 100 - 80/60 - 40 mm. Hg;
- periodic vomiting congestive or intestinal content;
- During the examination, the bloating is determined, the absence of peristaltics, a positive symptom of Shetkina-Blumberg;
- Multiple levels of fluid are determined on the survey radiograph;
- under ultrasound examination, extended intestinal loops are determined;

Survey Protocols in the OEMP

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

Tools:
- ECG
- Survey radiography of the organs of the chest
- overview radiography of the abdominal cavity.

Consultation therapeuts
Inspection of resuscitator

Protocols for preoperative preparation of the disadvantaged hernia complicated by peritonitis in the OEMP

1. Preoperative preparation and diagnostics are carried out in the conditions of OKR.
2. The gastric probe is set and the gastric content is evacuated.
Intensive preoperative preparation with the formulation of the catheter in the main vein and the implementation of infusion therapy (intravenously 1.5 liters of crystalloid solutions, 400 ml reastery, 10 ml in dilution by 400 ml of 5% glucose solution) for 1 hour or on the operating table, or in OKR.
3. Be sure to introduce antibiotics of a wide range of action (cephalosporins III of generation and metronideosol) 30 minutes before operation intravenously.
4. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.

Protocols of surgical tactics with a disadvantaged hernia complicated by peritonitis.
1. Operation on the complicated disadvantaged hernia is always carried out under anesthesia three-propelled brigade with participation in the operation of the most experienced surgeon on the duty officer or a responsible duty surgeon.
2. Operative intervention begins with median laparotomy.

Attempts to order a disadvantaged hernia are contraindicated.

The diagnosis of improved disadvantaged hernia can be delivered when there are clear indications of the patient himself on the fact of infringement of the previously aftered hernia, the time of its immediate disposition and the fact of its independent return. We should also consider the enjoyment of the infringent hernia, the fact of the independent return of which occurred (and recorded in medical documents) in the presence of medical personnel (at a pre-hospital stage - in the presence of ambulance, after hospitalization - in the presence of a duty surgeon Surgeon).

4 Group - Disadvantaged Postoperative Ventral Hernia

The infringement of postoperative ventral hernia is observed in 6 - 13% of cases. The clinical picture depends on its size, the type of infringement and the severity of intestinal obstruction. There are a wheelchair and elastic infringement.
In case of hidden infringement, there is a gradual principle of the disease. The constantly existing pain in the area of \u200b\u200bhernia absorption increases, acquire a grapple-shaped character, subsequently join the symptoms of acute intestinal obstruction - there is vomiting, the delay of gases, the absence of a chair, the bloating of the abdomen. Herge-up protrusion in the lying position does not decrease, it acquires clear contours.
Elastic reinforcement typically for hernia with a small hernial gate. There is a sudden beginning of pain syndrome due to the introduction of a large segment of the intestines in the hernial bag through a small defect of the front abdominal wall. In the subsequent pain syndrome, symptoms of intestinal obstruction are enhanced.

Survey Protocols in the OEMP

Laboratory research:
- clinical blood test,
- blood type and RH factor,
- blood sugar,
- Bilirubin,
- Coagulogram,
- Creatine,
- urea,
- Blood on RW,
- Clinical urine analysis.

Tools:
- ECG
- Survey radiography of the organs of the chest
- overview radiography of the abdominal cavity.
- ultrasound of the abdominal cavity and hernia protoration - according to the testimony

Consultation therapeuts
Anesthesiologist consultation (according to indications)

With the diagnosed diagnosis, the patient's disadvantaged hernia is immediately sent to the operating.

Protocols of preoperative preparation in the OEMP

1. Before the operation, the gastric probe is mandatory and the gastric content is evacuated.
2. The bladder is emptying and hygienic preparation of the area of \u200b\u200boperational intervention and the entire front abdominal wall.
3. With the presence of complicated disadvantaged hernia and severe patient's condition, the patient is sent to the separation of surgical resuscitation, where intensive therapy is carried out for 1-2 hours, including the active aspiration of gastric content, infusion therapydirected to the stabilization of hemodynamics and the restoration of the introductory and electrolyte balance, as well as antibiotic therapy. After preoperative preparation, the patient is sent to the operating room.

II. Protocols of the anesthesiological implementation of the operation

1. In addition to the infringement of inguinal and femoral hernia with small stages of infringement, with general satisfactory condition, the lack of symptoms of acute intestinal obstruction. Operational intervention can be started under local infiltration anesthesia for visual assessment of the viability of the organ.
2. Meeting of choice is endotracheal anesthesia.

III. Differential surgical tactics protocols

13. With infringent hernias complicated by subfickered obstruction, the detonation of the small intestine is performed using a nasorentestine probe.
14. At the phlegmon of a hernial bag, the operation is performed in 2 stages. The first stage is laparotomy. In the abdominal cavity, resection of the disadvantaged organ with the elimination of the hernial bag and its contents from the abdominal cavity is an acidic seam. The second stage is herniotomy with the removal of the infrained organ outside the abdominal cavity. Plastic of the hernial gate at the phlegmon of a junk bag is not performed.
15. Operational intervention is completed by plastic closure of the hernial gate. The character of plastics is determined by the localization and type of hernia. Plastic of the hernial gate is not performed with gigantic multi-chamber postoperative ventral hernias.

Vi. Protocols postoperative management of patients with uncomplicated flow

1. The overall blood test is assigned a day after the operation and before discharge from the hospital.
2. All patients are prescribed intramuscular administration of painkillers (analgin, ketarol) in 1 - 3 and a day after surgery; Wide spectrum antibiotics (cefazoline 1 g x 2 p / day) within 5 days after surgery.
3. The seams are removed by 8 - 10 days, the day before the patient discharge for treatment in the clinic.
4. Treatment of developing complications is carried out in accordance with their character.