Грыжа диска
Для начала разберемся, что за грыжа и какого диска. Вопрос принципиален, поскольку он напрямую отражает понимание процессов, происходящих в позвоночнике.
Наиболее часто приходится слышать такие “термины”:
- Межпозвоночная грыжа. Само слово “межпозвоночная грыжа” означает, что эта грыжа чего-то между двумя позвоночниками. У сиамских близнецов, видимо. При всём при этом словосочетание “межпозвоночная грыжа” приходится слышать чаще всего!
- Грыжа межпозвоночного диска. И вновь аналогично: межпозвоночная означает между позвоночниками. А “грыжа межпозвоночного диска” означает, что между двумя позвоночниками есть какой-то диск.
- Позвоночная грыжа. Этот термин несколько ближе к правде, хотя словосочетание “позвоночная грыжа” подразумевает, что грыжевое выпячивание возникает в позвоночнике, хотя речь идет конкретно об одном диске.
- Грыжи дисков. Действительно, грыж обычно несколько, поэтому из всех “неофициальных терминов” словосочетание “грыжи дисков” наиболее оправдано.
И всё-таки единственный научный термин, который глубже всего отражает суть заболевания, звучит так:
Грыжа межпозвонкового диска
Грыжа диска: это страшно или нет?
Почти всегда это не страшно!
Разумеется, всё зависит от стадии и от месторасположения процесса. Как всё происходит, начиная с первых нарушений и заканчивая сформировавшимся грыжевым выпячиванием, вы узнаете по мере чтения этой веб-страницы.
I стадия. Разрушение пульпозного ядра межпозвонкового диска. Пульпозное ядро располагается в самом центре диска. Оно напоминает ртутный шарик, который перемещается внутри диска в зависимости от того, какую оно испытывает нагрузку. Самое важное то, что перемещения пульпозного ядра происходят таким образом, что на нижележащий позвонок вся нагрузка распределяется равномерно!
Вокруг ядра располагается многослойное фиброзное кольцо, которое удерживает ядро в центре и препятствует сдвиганию позвонков в сторону друг относительно друга за счет плотного с ними сращения.
В норме фиброзное кольцо образовано очень прочными волокнами. Необходимость столь прочной фиксации пульпозного ядра обусловлена тем, что в здоровом диске давление внутри него достигает 5-6 атмосфер, что позволяет достаточно эффективно амортизировать нагрузки. Для сравнения в автомобильной шине давление 1.8-2 атмосферы.
Ведущее свойство пульпозного ядра – это упругость. Главный компонент, обеспечивающий упругость – это вода. При недостатке чистой питьевой воды, при нарушениях кровоснабжения позвонков, при мышечных спазмах и малоподвижном образе жизни пульпозное ядро недополучает воду, теряет упругие свойства и становится ломким.
II стадия. Разрушения фиброзного кольца межпозвонкового диска.
Пульпозное ядро иссыхает и раскалывается на отдельные острые отломки. И оно становится похожим не на упругий шарик, а скорее на кучу битого стекла.
И вот при очередной перегрузке (а у человека в день эти перегрузки бывают десятки, если не сотни раз) один из фрагментов пульпозного ядра с силой упирается в фиброзное кольцо острым краем. Давление продолжается и острый осколок пульпозного ядра всё больше и больше прорезает фиброзное кольцо, выпячиваясь наружу.
III стадия. Протрузия межпозвонкового диска. Если выпячивание пульпозного ядра становится видимым снаружи, но пока не достигла достаточно выраженной формы, такое состояние называется протрузия межпозвонкового диска.
[спереди]
[сзади]
Наиболее податливы к разрывам задние и заднебоковые участки фиброзного кольца. Но ведь именно сзади располагается спинной мозг и отходящие от него спинномозговые нервы.
[спереди]
[сзади]
Плотная фиброзная ткань, устойчивая к растяжению, имеется только в переднебоковой области.
Для иллюстрации несколько цифр.
В покое нагрузка на диск составляет 30 кг.
Самый незначительный наклон вперед – нагрузка на диск становится 60 кг.
Если согнуться вперед под прямым углом – нагрузка на диск возрастает до 210 кг.
А теперь вспомните, из какого положения вы чаще всего поднимаете сумки или другие тяжести, моете полы, загружаете вещи в стиральную машинку? А ведь в таком случае 210 кг нагрузки на диск нужно еще увеличить в 2 – 3 раза, а может быть и больше!
Что происходит при наклоне туловища вперед: передние части соседних позвонков сближаются, а задние – расходятся.
Ядро диска в свою очередь смещается в освободившееся пространство, то есть назад. Вы помните, что задний участок фиброзного кольца наиболее подвержен разрывам, отсюда и классический случай “прострелов” в пояснице – наклонился вперед, из наклона попытался встать, поднять тяжесть или повернуться, после чего возникла резкая боль в пояснице.
Главное правило безопасности для позвоночника:
Никогда ничего не поднимайте из наклона!!!
Так НЕЛЬЗЯ:
Присядьте, и с прямой спиной поднимите тяжесть. Пусть вся нагрузка придется на ноги!!!
НУЖНО так:
“Если вы просто исключите наклоны вперед и подъем тяжестей из этого положения, вы уже сведёте вероятность образования межпозвонковой грыжи практически к нулю!”…
Подробнее о вредных и безопасных для позвоночника позах вы узнаете из статьиЗабота о спине днём и ночью.
IV стадия: Грыжа межпозвонкового диска. В чем разница между протрузией и грыжей? Лишь в размере грыжевого выпячивания.
У меня болит спина! О чем это говорит?
Это говорит о том, что процесс разрушения дисков у вас продолжается уже не один год, а возможно и не одно десятилетие. Вероятнее всего, по незнанию вы пренебрегали всеми рекомендациями, которые касаются заботы о своем позвоночнике или о своем здоровье в целом. На момент появления первых острых болей в спине вертикальные размеры пораженных дисков уже значительно уменьшились. На рентгеновских снимках уменьшение высоты диска до одной трети относительно нормы описывается как первая стадия остеохондроза, до половины – вторая, больше половины – третья, четвертая стадия характеризуется полным сращением тел двух позвонков – диск уже отсутствует как таковой.
Поскольку высота диска уменьшается, верхний позвонок опускается на нижний, и кости, которые не должны соприкасаться, теперь трутся друг о друга. Из-за этогопроцессы разрушения хряща начинаются и в фасеточных суставах. Посредством этих суставов выше- и нижележащий позвонок соединяются друг с другом.
Чтобы уберечь сустав от полного разрушения рефлекторно развивается мышечный спазм, который наощупь чувствуется как очень плотный валик различных размеров, от горошины до длинного тяжа вдоль всего позвоночника. У каждого человека таких мышечных уплотнений на спине довольно много. В это время организм прилагает все усилия для того, чтобы хоть как-то зафиксировать полуразрушенный диск в участке между позвонками и не допустить грыжевого выпячивания.
Казалось бы – заболела спина, в позвоночнике и дисках уже такие серьёзные нарушения, всё так безнадежно?
И вновь мы говорим СПАСИБО нашему организму. Его компенсаторные возможности настолько велики, что в принципе для активной жизни человека ничего страшного еще не произошло.
Допустим, что вчера фрагмент ядра настолько проник в трещину фиброзного кольца, что у вас заболела спина.
Прислушайтесь к своему телу, что оно просит?
А тело в этот момент просит покоя и неподвижности. Так дайте это своему телу! Если просто в момент болей в спине значительно снизить свою активность, а еще лучше – придерживаться постельного режима, то через 2 – 3 недели всё будет в порядке даже с диском!
Разорвавшиеся волокна и находящаяся в трещине часть ядра станут единым целым. Фрагмент прорастает рубцовой тканью, которая плотно свяжет его с фиброзным кольцом.
Иначе будет, если выпить обезболивающих и продолжить свою обычную деятельность. Тогда фрагмент ядра под напором ваших усилий продолжит разрывать фиброзное кольцо, что в конечном итоге приведет к его полному разрыву. И… Грыжа обеспечена!
“Распознать грыжу несложно: обычно к боли в пояснице присоединяется боль в ноге. Может быть слабость в ноге вплоть до невозможности на нее наступать”…
Появление боли в ноге говорит нам о том, что часть ядра попала в позвоночный канал и грыжа придавила нервный корешок.
Срединная (медианная) грыжа
Обычно грыжей поражаются нижние сегменты поясничного отдела позвоночника, а жалобы человека будут зависеть от того, в какую сторону произошло грыжевое выпячивание и на каком уровне оно произошло.
Наиболее часто выпавший диск в поясничном отделе позвоночника сдавливает корешок в позвоночном канале по средней линии.
Это так называемые срединные или медианные грыжи. При таких грыжахбольной не может разогнуться назад, в постели лежит на спине, приподнимает голову подушкой, сгибает ноги в коленях. При ходьбе туловище больного наклонено вперёд, иногда до 90 градусов.
Ключевую роль в направлении грыжевого выпячивания играет ширина задней продольной связки. Если она достаточна широка, то грыжа “пойдёт” в срединном направлении.
Околосрединная (парамедианная) грыжа
На уровне нижних сегментов поясничного отдела происходит сужение задней продольной связки, поэтому грыжа будет занимать пространство по бокам от нее. В таком случае грыжа будет называться околобоковой (парамедианной) или заднебоковой.
Лечение межпозвонковой грыжи
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