RU2386392C1 - Diagnostic technique for static skeleton disturbances in patients with vertebragenous pain syndromes - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, orthopaedics, and can be used for diagnostics of static skeleton deformations in the patients with vertebragenous pain syndromes. That is ensured by bitrochanterial, bicostal, anterior bispinal, biacromial, biaxillar, biscapular, posterior bispinal, bigluteal lining from both sides of the body. Then a laser range finder is used to measure the distance to the body points and plotting the lining projections. The derived chart is used to position the lines and an angle of turn of the lines relative to the frontal axis and each other and to consider the ventral or dorsal displacement of the trunk parts. Then vessels of a water balance are applied to the points of the trunk surface to measure the position of these points. Projections of the lines are plotted. The derived chart provides determining the relative asymmetry of the homo- and counterlateral points and the angle of turn of the lines relative to the horizontal axis. They are used to consider the lateral inclination of the separate trunk parts homolaterally or counterlaterally. Then spinous processes of vertebra are palpated to mark their position on the vertical axis. The projection position chart of the scoliotic arc vertexes is plotted on the frontal plane to consider the trunk deviation.

EFFECT: method allows for more precise and quantitative estimation of static body asymmetries and vertebral deformation, to get an evident graphic presentation.

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Description

The invention relates to medicine, in particular to neurology, orthopedics, traumatology, rehabilitation, and can be used for instrumental diagnosis of pathobiomechanical changes in the human musculoskeletal system.

Methods of an objective assessment of pathobiomechanical changes in the musculoskeletal system, based on various physical principles, are widely used in orthopedics, traumatology and manual medicine (Gamburtsev V.A. Goniometry of the human body. - M .: Medicine, 1973. - P. 6- 87; Popelyansky Y. Yu. Orthopedic neurology. Vertebroneurology. A guide for doctors. Volume 1. Syndromology. - Kazan, 1997. - 554 p .; Veselovsky V.P., Romanova V.M., Tretyakov V.P. Clinical and instrumental examination of patients with vertebrogenic diseases of the nerve th system: textbook for cadets. - L., 1982.- 46 pp .; Kogan OG, Vasilieva LF On the vertebral static component of the motor stereotype. Manual therapy in arthrovertebroneurology. Novokuznetsk. 1990. S. 18-25; Guide to orthopedics and traumatology. - M .: Medicine, t.1.1967, p.110-111, 170-199).

Most of these methods are based either on visual palpation assessments, or on measuring the linear-angular characteristics of individual parts of the skeleton in vivo (on live) or on radiographs.

As an analogue, we have chosen the "Method of computer optical topography of the human body and a device for its implementation." The authors propose a non-contact and remote determination of the shape of the dorsal surface of the body of the examined patient based on computer processing of digital images.

The patient is placed in front of the reference plane. Vertical stripes are projected onto his back with a projector located at an angle of 16-22 °. The image of the bands is deformed in proportion to the relief of the surface of the patient’s body and carries complete information about the shape of the examined surface. A camera is located at the same distance as the projector, but perpendicular to the patient’s back. With its help, the image is entered into the computer and processed using special algorithms.

The resulting digital model of the back surface has the form of a topographic map with clearly visible asymmetry of relief. From the reconstructed surface and the anatomical landmarks of the bone structures identified on it, numerous parameters are calculated that quantitatively describe the shape of the dorsal surface of the trunk and evaluate the deformation of the spine in three planes: frontal, horizontal and sagittal (Sarnadsky V.N., Sadovoy M.A., Fomichev N. D. Method for computer optical topography of the human body and device for its implementation Patent of the Eurasian Patent Organization No. EA 000111 B1 of 08/27/1998 M. Cl. A61B 5/103).

A significant disadvantage of this method is the complexity and high cost of the equipment necessary for its implementation. In addition, the method allows you to evaluate only the condition of the back muscles and curvature of the spine, there is no data on its use to detect pathobiomechanical disorders in the chest and abdomen.

As a prototype, “Method for the diagnosis of static disorders in patients with chronic muscle pain syndromes” (Vasilieva L.F., Schmidt I.R., Kogan OG, “Method for the diagnosis of static disorders in patients with chronic muscle pain syndromes”, application Patent RU No. 2134532, M. CL A61B 5/00, Bull. No. 23, 08.20.99).

The inventors propose to draw horizontal lines across the boundaries of the main regions of the body directly on the human body (it is possible to use photographs or radiographs): biauricular (connects the earlobes), biacromial (connects the acromial processes of both clavicles), bicostal (connects the ends of the last ribs), bicristiliac (connects iliac crests), posterior bispinal (connects the posterior iliac bones), biischial (connects the tuberosity of the ischial bones), bitubercular (connective hums large tubercles of the humerus), etc.

The researcher mentally compares the direction of these lines with the norm and, if their parallelism is violated, determines the direction of the angle that they form. All this allows us to judge the pathologically significant violations of the static component of the motor stereotype. The disadvantages of the method include its complexity, the subjective and descriptive nature of the produced visual assessments and the lack of accurate data on the linear-angular characteristics of the compared lines. The direction of rotation of the region is evaluated only visually.

In addition, the patient can receive a significant dose of x-ray when diagnosed by an x-ray.

The objective of the present invention is to comprehensively evaluate the static asymmetries of the body of a standing person, expand the possibilities of quantifying static asymmetries of the skeleton and increase its accuracy, due to the use of instrumental research methods.

The problem is solved by a method for diagnosing static skeletal deformities in patients with vertebrogenic pain syndromes, including the designation by lines of the boundaries of the regions of the body: the shoulder girdle, chest, pelvis, determining their spatial position in the frontal and horizontal planes passing through the center of gravity of the body, comparing the parallelism of lines between and an estimate of the angles formed by the lines in violation of parallelism.

A point is placed on the patient’s body in the center of the jugular fossa and it is assumed that the frontal plane passes through it and the body’s center of gravity. On both sides, points are applied to the projection of the large tubercles of the humerus - the bitrochanterial line, to the corners of the costal arches - the bicostal line, to the anterior superior iliac spine of the pelvis - the anterior bispinal line, to the clavicular-acromial joints - the biacromial line, to the highest points of the axillary folds between the axillary folds between the axillary folds and the scapula - a baxillary line, on the lower corners of the scapula - the biscapular line, on the posterior superior iliac spine of the pelvis - the posterior bispinal line, on the points in the lowest part of the arches of the lower gluteal folds - big yutealnaya line.

Determine the asymmetries of the body in the horizontal plane relative to the frontal plane. To do this, in the projection of the sagittal axis onto the support plane, draw a line from the vertical support at a distance of 2.5-3.0 m, where a digital laser range finder is mounted on a tripod. Measure the distance to points on the patient’s body, first with his back to the vertical support, on the ventral surface of the body to a point in the center of the jugular fossa and to projection points of the large tubercles of the humerus, angular points of the costal arches, points of the anterior superior iliac pelvis. Then, in the patient's position, facing the vertical support, the distance to the dorsal surface of the torso to the points of the clavicular-acromial joint, the highest points of the axillary folds between the shoulder and the shoulder blade, to the points of the posterior superior iliac spines of the pelvis is measured. The data obtained during the measurement are entered into tables and processed using the Microsoft Office Excel 2007 computer program, which constructs projections of the lines: bitrochanterial, bicostal, anterior and posterior bispinal, bacromial and baxillary onto a horizontal plane. The distance to the points located ventrally from the frontal plane has a “+” sign, and the distance to points located dorsally, has a “-” sign. According to the obtained schedule, the position of the lines and the angle of rotation of the lines relative to the frontal axis and relative to each other are determined and judged about the displacement of the parts of the body ventrally or dorsally.

The asymmetries of the body are determined in the frontal plane, relative to the horizontal plane, for which on the ventral surface of the trunk to the points of the anterior superior iliac spine of the pelvis, and on the dorsal surface of the trunk to the points of the clavicular-acromial joint, the points of the lower corners of the shoulder blades, the points of the posterior superior iliac pelvis, vessels of water scales are applied to the points of the lowest part of the arches of the lower gluteal folds. They measure the position of these points, process the data using a computer program that builds the projection of the lines: the anterior bispinal, biacromial, biscapular, posterior bispinal and bigluteal to the frontal plane. According to the obtained graph, the relative asymmetry of the homo- and contralaterally located points limiting these lines and the angle of rotation of the lines relative to the horizontal axis is found, and the lateral inclination of individual parts of the body is judged homolaterally or contlaterally.

The sizes of scoliotic curvatures of the spine are determined, for which the spinous processes of the vertebrae corresponding to the main and compensatory arch of scoliosis are palpated, their position on the vertical axis is noted. The thread of one plumb line is applied to the spinous process of C ₂ , the other to the top of the main scoliotic arch and the distance between the plumb threads is measured. Repeat measurement for compensatory scoliotic arch. Using a computer program, they plot the position of the projection of the vertices of the scoliotic arches on the frontal plane and judge the deviation of the body.

The novelty of the method.

- Put a point in the center of the jugular fossa and assume that the frontal plane passes through it. Dots are applied on both sides at the ends of the key lines of the body. It is believed that the frontal plane passes through the tragus of both ears (Nikolaev A.P. Guide to biomechanics as applied to orthopedics, traumatology and prosthetics. - Kiev, 1947. - 315 p.). In the usual type of standing, its position coincides with the center of gravity line (Fig. 4B), which is projected 4 cm anterior to the center of the ankle joint, 1 cm anterior to the center of the knee joints and 2 cm posterior to the center of the hip joints; then it passes through the bodies of the third and fifth lumbar vertebrae, anterior to the bodies of the upper lumbar, thoracic and cervical segments; the center of gravity of the head corresponds to the front arc of the atlas (Belenky V.E. Influence of body weight on the formation of functional bends of the spine. // Orthopedist, traumatol. - 1970. - N2. - P. 45-49 .; Gurfinkel BC, Kots Ya.M. , Shik M. L. Regulation of the human posture. - M., Nauka, 1965. - 256 pp .; Zatsiorsky V. M., Aruin A. S., Seluyanov V. N. Biomechanics of the human motor apparatus. - M., Physical education and sport, 1981. - 143 p .; Nikolaev AP A guide to biomechanics as applied to orthopedics, traumatology and prosthetics. - Kiev, 1947. - 315 p .; Uflyand Yu.M. Physiology of the human motor apparatus . - M .: Medicine, 1965. - 363 s).. Thus, to simplify the determination of the distance to the frontal plane by the laser range finder, it is justifiable to assume that the frontal plane passes in the immediate vicinity of the bottom of the jugular fossa (fossa jugularis). We also believe that other planes, namely horizontal and sagittal, pass through this point and the center of gravity of the patient’s body.

- Carry out the determination of the asymmetries of the body in the horizontal plane relative to the frontal plane. In the projection of the sagittal axis onto the support plane, a line is drawn from the vertical support to a distance of 2.5-3.0 m, where a digital laser range finder is mounted on a tripod and the distance to points on the patient’s body is measured on the ventral surface of the body, then on the dorsal, the obtained data is processed using a computer program that correlates them with the distance to the frontal plane, calculates their coordinates and builds a projection of lines on a horizontal plane. The distance to the points located ventrally from the frontal plane has a “+” sign, and the distance to points located dorsally, has a “-” sign. According to this graph, the position of the lines and the angle of rotation of the lines relative to the frontal axis and relative to each other are determined and judged about the displacement of the parts of the body ventrally or dorsally. Thus, precise measurements are carried out to determine the position of the points relative to the frontal plane and to make further graphical constructions of their projections on the horizontal plane, allowing to visualize the position of the lines of the body in space and more accurately estimate the angles formed by the lines of the body and the asymmetry of the body. The laser range finder provides measurement accuracy of ± 3 mm.

- Carry out the determination of the asymmetries of the body in the frontal plane relative to the horizontal plane. On the ventral surface of the body to the points of the ends of the lines apply vessels of water scales and find the difference in their position. Conduct computer processing of data and build a graph that reflects the position of the projections of the lines on the frontal plane. According to the graph, the relative asymmetry of the homo- and contralaterally located points that limit the lines and the angle of rotation of the lines relative to the horizontal axis is found, and the lateral inclination of individual parts of the body is judged homolaterally or contralaterally. These measurements make it possible to obtain accurate data on the position of points in a different plane, which makes it possible to more clearly reflect the existing asymmetries of the body and skeleton disturbances.

- The sizes of scoliotic curvatures of the spine are determined, for which the spinous processes of the vertebrae corresponding to the main and compensatory arch of scoliosis are palpated. Their position on the vertical axis is noted, the thread of one plumb line is applied to the spinous process of C ₂ , the other to the vertices of the main and then compensatory scoliotic arches, and each time the distance between the plumb lines is measured. Using computer processing, they plot the position of the projections of the vertices of the scoliotic arches on the frontal plane and judge the deviation of the body. This study supplements the data obtained using a laser range finder on the qualitative and quantitative deformations of the spine in the frontal plane.

The set of essential features of the invention allows you to make an objective comprehensive assessment of the asymmetries of the body of a normally standing person and deformations of the spinal column. The method is absolutely harmless to the patient, allows you to more accurately and quantitatively evaluate the static asymmetries of the body and spinal deformities, to obtain a clear graphic picture. All this makes it possible to choose the right treatment tactics for the patient, and with repeated examinations at individual stages of treatment, to monitor the effectiveness of the therapy. The method is characterized by low laboriousness and ease of execution; inexpensive, affordable equipment is used for execution.

The implementation of the method is illustrated by drawings and graphs presented in Fig.1-7.

Figure 1 shows the location of the points on the ventral and dorsal surfaces of the body.

Figure 2 shows the measurement of the distance to points on the ventral surface of the body with a laser range finder.

Figure 3 presents photographs of a patient examination using a water balance.

Figure 4, position A - the position of the main planes and axes of the body; position B - the ratio of the frontal plane to the elements of the musculoskeletal system.

In Fig. 5, position A is a photograph of the dorsal surface of the body of test G having a visible deformity of the spine; position B - a graph of the projection of key body lines on the horizontal plane of the same patient constructed after computer processing.

In figure 6, position A is a graph of the projection of key lines of the body of test subject G built on the frontal plane after computer processing; position B - a graph of the level and depth of the arches of scoliosis of the spine of the subject G. constructed after computer processing

In Fig.7, position A is a photograph of the ventral and dorsal surface of the body of test D; position B - a graph of the projection of key lines constructed after computer processing on the horizontal plane of this subject; position B - a graph of the projection of key lines constructed after computer processing on the frontal plane of test D.

The method is carried out in the following way.

The position of standard points on the human body is determined: the acromial ends of the clavicles, the large tubercles of the humerus, the lower angles of the shoulder blades, the posterior and anterior spine of the pelvis, lower gluteal folds, etc. in the frontal and horizontal planes using a laser meter and water scales, and also take into account the level, depth and relation to the pain syndrome of frontal deformities of the spine using a plumb line and visual palpation ratings.

The choice of the above standard guidelines, as well as in the prototype, is dictated by the fact that the lines drawn through the same points on both sides of the body form the boundaries of the main regions of the body: the shoulder girdle, chest, pelvis and reflect their spatial location. The state of each region characterizes several points and, accordingly, lines.

The study begins with a mark on the subject's body of standard points on the sides of the body. In Fig. 1, they are depicted by circles when measured by a laser rangefinder or by asterisks when measured by water scales, the homonymous points of the homo- and contralateral sides of the body are marked with the same numbers.

First, the patient is facing the researcher, along the midline in the deepest part of the jugular fossa on the skin, a marker is placed on the skin (figure 1, point 1). Assume that the frontal plane passes through this point 1. Then mark on both sides of the large tubercles of the humerus (Fig. 1, points 2.2); at the corners of the costal arches - they are usually located slightly lateral to the midclavicular line and correspond to the place of transition of the cartilaginous part of the rib to the bone (Fig. 1, points 3.3); on the anterior superior iliac spine of the pelvis (Fig. 1, points 4.4).

After this, the patient is turned with his back to the researcher and the position of the clavicular-acromial joints on both sides is noted (Fig. 1, points 5.5); the highest points of the axillary folds located between the shoulder and the shoulder blade (Fig. 1, points 6.6); note the lower angles of the blades (Fig. 1, points 7.7); note the posterior superior iliac spine of the pelvis (Fig. 1, points 8.8), mark the points located in the lowest part of the arches of the lower gluteal folds (Fig. 1, points 9.9).

To describe the orientation of the body in space through the center of gravity, it is customary to draw three main planes of the body: horizontal 10, sagittal 11 and frontal 12 (Fig. 4 A).

The center of gravity corresponds to the intersection point of these three planes. The sagittal axis 13 is located at the intersection of the sagittal and horizontal planes. Body points located ventrally from the frontal plane 12 are indicated by a “+” sign, and points located dorsally by a “-” sign. The vertical axis 14 is located at the intersection of the sagittal 11 and frontal 12 planes, and the horizontal axis 15 passes through the intersection of horizontal 10 and frontal plane 12. (Dubrovsky V.I. Fedorova V.N. Biomechanics: study guide for secondary and higher educational institutions. - M .: Publishing house VLADOS-PRES, 2003. - 672 p.)

It is believed that the frontal plane passes through the tragus of both ears (Nikolaev A.P. Guide to biomechanics as applied to orthopedics, traumatology and prosthetics. - Kiev, 1947. - 315 p.). In the usual type of standing, its position coincides with the center of gravity line (Fig. 4 B), which is projected 4 cm anterior to the center of the ankle joint, 1 cm anterior to the center of the knee joints and 2 cm posterior to the center of the hip joints; then it passes through the bodies of the third and fifth lumbar vertebrae, anterior to the bodies of the upper lumbar, thoracic and cervical segments; the center of gravity of the head corresponds to the front arc of the atlas (Belenky V.E. Influence of body weight on the formation of functional bends of the spine. // Orthopedist. traumatol. -1970. - N2. - P. 45-49 .; Gurfinkel BC, Kots Ya.M. , Shik M.L. Regulation of the human posture.- M .: Nauka, 1965. - 256 p .; Zatsiorsky V.M., Aruin A.S., Seluyanov V.N. Biomechanics of the human motor apparatus.- M .: Physical education and sport, 1981.-143 pp .; Nikolaev A.P. Guide to biomechanics as applied to orthopedics, traumatology and prosthetics.- Kiev, 1947. - 315 pp .; Uflyand Yu.M. Physiology of the human motor apparatus .- M .: Medicine, 1965.- 363 p.). Thus, to simplify the determination of the distance to the frontal plane 12 by the laser range finder, it is justifiable to assume that the frontal plane passes in the immediate vicinity of the bottom of the jugular fossa (fossa jugularis).

To study the asymmetries of the body in the horizontal plane relative to the frontal plane, the test subject in a normal stance - the body and head are straightened, arms are extended along the body, body weight is symmetrically distributed on both legs, heels together (Dubrovsky V.I. Fedorova V.N. Biomechanics: training manual for secondary and higher educational institutions. - M .: Publishing house VLADOS-PRES, 2003. - 672 p.) - first set with your back to the wall or other vertical support. To exclude involuntary swaying of the body, the shoulder blades and buttocks should touch the surface of the wall. On the floor in the projection of the sagittal axis 13 on the support plane, draw a line from the support at a distance of 2.5-3.0 m with chalk. At the end of this line, a three-legged photographic tripod with a height of about 1.5 m is installed. Its front unpaired support is located on the line, and two others are equidistant from her right and left. A laser distance meter is attached to the threaded mount of the tripod, Fig.2. In our case, it was a PROFESSIONAL DLE-50 digital laser rangefinder from Bosch (Germany) with a maximum systematic error of not more than ± 3 mm.

The point of the laser beam is combined with one of the points printed on the patient's body; in accordance with the instructions attached to the device, the distance to it from the rangefinder case is measured in millimeters.

First, the distances to the points on the ventral surface of the body are measured. In figure 1, these points are marked with white circles and have the following numbering: 1; 2.2; 3.3; 4.4, then the subject turns to face the wall, touching the forehead of its surface, and measures the distance to the points on the dorsal surface of the body (Fig. 1), point 5.5; 6.6; 8.8. The results are entered into a special computer database. After entering the measurement data of distances from the laser rangefinder to the above points (Fig. 3) into the computer, using standard procedures, the program "Microsoft Office Excel 2007" performs automatic calculations (Sergeev A. Using Microsoft Office Excel 2007.- M .: Dialectics , 288 p.)

After processing, the computer program “Microsoft Office Excel 2007” builds projections of the lines: bitrokhanterialny 2-2, bicostalny 3-3, front 4-4 and back 8-8 bispinal, bacromial 5-5 and baxillary 6-6 on a horizontal plane in the form of a graph . According to this graph, the position of the lines and the angle of rotation of the lines relative to the front axis and relative to each other are determined. The graph makes it possible to determine the angles between the received lines and the front axis. According to the graph, the displacement of the parts of the body is judged ventrally or dorsally.

When the points are located on the ventral surface of the body, the distance to the given point is subtracted from the distance to fossa jugularis corresponding to the position of the frontal plane. When the selected points are located on the dorsal surface of the body, on the contrary, the distance to the frontal plane is subtracted from the distance to this point.

In both cases, if the difference is positive, it means that the studied point is displaced ventrally from the frontal plane, and if it is negative, then it is dorsal.

Based on the data obtained, a graph is built. On it homonymous and contralateral to a pain syndrome points are connected by straight lines. Thus, the graph shows the relationship of the bacromial line 5-5, bitrochanterial line 2-2, biaxillary line 6-6, bicostal line 3-3, anterior 4-4 and posterior 8-8 bispinal lines to the frontal axis. In General, this graphical interpretation gives an idea of the torsion of individual segments of the body relative to each other and the frontal axis in the horizontal plane (Fig. 5 B; 7 B).

To study the asymmetries of the body in the frontal plane relative to the horizontal plane, water scales are used (Levit K., Zahse I, Yanda V. Manual medicine / transl. From German. - M .: Medicine, 1993. - 510 p.). In our case, for this purpose, we used cases from two syringes with a capacity of 10 ml connected by a flexible vinyl chloride tube with a length of 35-30 cm. The whole system is filled with water (Fig. 3).

Since the position of the liquid in the upstream syringe is lower, then its indicator in milliliters is lower than on the opposite side. To correct this systematic error, the available values are subtracted from 10.0 (in the case of a 10-gram syringe). The difference obtained by multiplying by the conversion factor (for each type of syringe it is determined individually) is converted to millimeters. Then, the smaller value is subtracted from the larger value, which allows you to determine the relative asymmetry of the points of the same name on the right and left sides. According to the data thus transformed, graphs are constructed that allow one to judge the lateral inclination of individual parts of the body relative to each other and the horizontal axis in the frontal plane (Fig. 6 A, 7 B).

In the position of the subject facing the vertical support, the researcher applies the upper sections of the syringes to the same points of the homolateral and contralateral dorsal side of the body, in Fig. 1 these points are marked with dark asterisks and have the following numbering: 5.5; 7.7; 8.8 and 9.9, and in the position with the back to the vertical support, the level of points of the 4.4 ventral side of the body is examined. Data on the position of water levels, according to the divisions on the syringes, are also entered into the database and processed on a computer by the previously specified program. The computer program constructs a graph depicting the projection of the lines: the anterior bispinal 4-4, the bacromial 5-5, the biscapular 7-7, the posterior bispinal 8-8, the bigluteal 9-9 on the frontal plane. According to the graph, the relative asymmetry of the homo- and contralaterally located points bounding the lines and the angle of rotation of the lines relative to the horizontal axis is estimated. The data obtained allow us to judge the lateral tilt of individual parts of the body homo- or contralaterally.

At the end of the study, the position and size of the scoliotic curvatures of the spine are revealed, if they are visually noticeable. Using well-known landmarks (Veselovsky VP, Romanova VM, Tretyakov VP Clinical and instrumental examination of patients with vertebral diseases of the nervous system: Method, recommendations. - L., 1982. - 46 p.) Determine the vertebrae corresponding to the position of the main and compensatory arches of scoliosis. Then they take two plumb lines, one of them is combined with the spinous process of C ₂ , the other with the vertices of the main and then compensatory scoliotic arches. The distances between the plumb lines are each time measured with a ruler. The obtained data, as well as information on the ratio of arches of scoliosis to pain, are homo- or contralaterally entered into the database, they are also processed by a computer program and a graph is plotted to project the position of the vertices of the scoliotic arches on the frontal plane and judged on the deviation of the body (Fig.6B).

Example 1. Subject G., 25 years old (Fig. 5 A), turned to a specialist in manual therapy on 07/16/08. with complaints of pain in the lumbar region and in the right buttock, exacerbation of 2 weeks. He was treated in the clinic at the place of work - without effect.

A similar exacerbation was 5 years ago, then it was successfully treated with blockades and acupuncture in a private medical center. 2 years ago suffered a myocardial infarction. Currently, the state of the cardiovascular system is satisfactory.

On the presented lumbar spondylograms:

- Full symmetrical lumbarization S ₁

- Spina bifida S ₁

- Reducing the height of the discs in segments L _4-5 ; L ₅ -S ₁ ;

- Retrolisthesis at these levels

Objectively. The lumbar lordosis is straightened. Scoliosis with a bulge to the left, an apex in the lower lumbar spine. The knee reflex is reduced on the right. Achilles reflexes are reduced on both sides. There are no clear sensitive disorders. There are signs of hypesthesia in the L ₅ dermatome _{on the} right. The most painful and widened interspinous gap L _4-5 .

Diagnosis. Lumbar osteochondrosis in the abnormal spine (lumbarization, spina bifida S ₁ ). The clinically relevant lesion level is L _4-5 , presumably an acute crack of the disc with its edema and elastic protrusion at this level. Signs of root irritation are L _4,5 on the right and S ₁ on both sides. Syndrome of discogenic lumbago IY severity of clinical manifestations with reflex disturbance of posture.

The patient underwent a biometric examination, according to the above method. Primary measurement data obtained using a laser rangefinder, water balance, topographic palpation and plumb are presented in tables 1, 2, 3, respectively.

After computer processing of the primary material, the following data were obtained for graphing (Tables 4, 5).

Based on the data received, the program automatically builds graphs (Figs. 5, 6).

In Fig. 5 B, it is especially striking that the baxillary line 6-6 (reflects the position of the shoulder girdle) and the anterior bispinal line 4-4 (reflects the position of the pelvis) are at an obtuse angle to each other, and the bicostal line 3-3 ( reflects the position of the lower chest) forms sharp corners with two previous lines.

All this says that the shoulder girdle is rotated clockwise relative to the front axis by 36 °. The lower sections of the chest are rotated counterclockwise relative to the frontal plane by 15 ° and form an angle of 25 ° with the shoulder girdle. At the same time, the pelvis is rotated counterclockwise by 38 ° relative to the frontal plane, forming an angle of 23 ° with the chest and 70 ° with the shoulder girdle.

On figa it is seen that the ends of the bacromial 5-5 and biscapular 7-7 lines, reflecting the position of the shoulder girdle, raised 2.1 mm homolateral pain syndrome, forming an angle of 3 ° with the horizontal plane. At the same time, the ends of the anterior 4-4 and posterior 8-8 bispinal lines, as well as the bigutheal line 9-9, reflecting the position of the pelvis, are raised 4.2-2.1 mm in the contralateral pain syndrome, forming angles of 3 with the horizontal plane ° -7 °.

On figb shows that the top of the main arc of scoliosis corresponds to L ₃ vertebra and has a depth of 25 mm, and the top of the compensatory arch of scoliosis corresponds to Th ₆ and has a depth of 18 mm

Thus, the biometric study of the proposed method revealed the presence of a complex three-plane deformation of the body in the patient: the shoulder and pelvic girdles are rotated relative to each other within 70 °. At the same time, both belts are inclined to each other in a contralateral pain syndrome and fan-like diverge homolaterally, forming an angle of 30 ° -41 ° open between them, open homolaterally. In this case, the spine has an S-shaped scoliotic curvature with the apex of the main arch in the lumbar region L ₃ directed homolaterally to the pain syndrome, and the apex of the compensatory arch in the middle chest region Th ₆ directed counter-laterally.

The patient underwent a course of treatment, including epidural blockade in the interspinous space L _4-5 with diprospan, blockade on trigger points in the lumbar region and right leg, systemic acupressure.

After treatment, pain in the lower back regressed. The biometric signs of rotation of the shoulder girdle relative to the lower chest and pelvis are significantly reduced. The baxillary line 6-6, reflecting the position of the shoulder girdle, the bicostal line 3-3, reflecting the position of the lower chest, and the anterior bispinal line 4-4, reflecting the position of the pelvis, began to be located almost parallel to each other and form very small angles from the front the plane.

At the same time, it was noted that the biscapular 7–7, reflecting the position of the shoulder girdle, the anterior 4–4 and the posterior 8–8 bispinal and bigluteal 9–9, reflecting the position of the pelvis, the lines acquired an almost horizontal position.

Example 2. Subject D., 20 years old (Fig. 7 A), at the time of the study (07/18/08.) Complained of moderate pain in the lower lumbar region on the left. The patient has an athletically developed musculature of the body. When viewed from behind, there were no visible signs of scoliotic spinal deformities.

Palpation reveals the expansion and tenderness of the interspinous gap in the L ₅ -S ₁ segment, changes in reflexes and sensitive radicular disorders were not detected. Radiography of the lumbar spine was not performed.

The primary data of a biometric examination using a laser rangefinder and water scales are presented in tables 6, 7.

After computer processing of the primary material, the following data were obtained for plotting tables 8, 9.

On the constructed graphs (figb and 7B) it is seen that the lines reflecting the position of the shoulder and pelvic girdles in the frontal and horizontal planes are much more parallel with respect to each other than in the previous case.

Fig. 7B indicates that the bacromial line 5-5 practically coincides with the frontal plane, and the baxillary line 6-6 is somewhat dorsally displaced. They characterize the position of the posterior boundaries of the shoulder girdle, and the angle between them is only 7 °.

At the same time, the bitrochanterial line 2-2, reflecting the position of the anterior border of the shoulder girdle, is to be expected to be displaced ventrally and runs parallel to the frontal plane.

The bicostal line 3-3, reflecting the position of the lower sections of the chest, occupies an extreme ventral position, forming an angle of only 4 ° with the frontal plane.

The anterior bispinal line 4-4, corresponding to the anterior border of the pelvic girdle, is located ventrally from the frontal plane, almost coinciding with the bitrochanterial line 2-2, the angle with the frontal plane is 5 °. The posterior bispinal line 8-8 occupies an extreme dorsal position, forming an angle of 4 ° with the frontal plane.

Fig.7B indicates that the bacromial line 5-5, reflecting the position of the shoulder girdle, is raised 6.3 mm homolateral to the pain syndrome, forming an angle of 8 ° with the horizontal. At the same time, both scapulae, the biscapular line 7-7, are located perfectly symmetrically.

The anterior 4-4 and posterior 8-8 bispinal lines corresponding to the pelvic girdle, opposite, are raised 4.2 mm counterlaterally, the horizontal angle is 7 °, and the lower gluteal fold is the bigutal line 9-9, again located 4.2 higher ° eponymous pain syndrome.

Thus, in this example, an almost perfect arrangement of the elements of the body relative to the frontal plane is observed. In the horizontal plane, the raising of the shoulder girdle to the homolateral pain syndrome is almost completely compensated by the opposite displacement of the pelvic girdle.

The patient underwent a course of treatment, including blockade of trigger points in the lumbar region and systemic acupressure. After treatment, the pain syndrome completely regressed.

According to laser measurements, no significant dynamics were observed in the deviations of the shoulder and pelvic girdles, since even before treatment they were almost parallel to the frontal plane.

The results of the study using a water balance showed that the shoulder and pelvic girdles became almost horizontal and parallel to each other, and their compensatory anti-slopes disappeared.

These examples prove that the proposed diagnostic method has sufficient sensitivity and accuracy; it allows you to identify and quantify pathobiomechanical disorders that are invisible in a conventional visual palpation study, and also reflects the dynamics of pathobiomechanical changes as a result of the treatment. With its help, it is possible to successfully control the effectiveness and feasibility of ongoing treatment and rehabilitation measures.

Table 1
Measurement data of the distance from the laser rangefinder to the studied points in the patient Measuring points The distance from the laser rangefinder to the point of interest (mm) Homolateral Pain Syndrome Contralateral Pain Syndrome Jugular fossa (fossa jugularis) point 1 1934 Clavicular-acromial articulation, points 5.5 1973 1965 Large tubercle of the humerus, points 2.2 1987 1906 The highest point of the axillary fold between the shoulder and shoulder blade, point 6.6 1994 1908 Edge arc angle, points 3.3 1967 1934 Anterior superior iliac spine of the pelvis, points 4.4 1978 1908 Posterior superior iliac spine of the pelvis, points 8.8 1985 1988

table 2
Measurement data using a patient’s water balance Measuring points Marks on syringe bodies in ml Homolateral Pain Syndrome Contralateral Pain Syndrome Clavicular-acromial articulation, points 5.5 6.5 7 The lower angle of the shoulder blades, point 7.7 6.5 7 Anterior superior iliac spine of the pelvis, points 4.4 7 6 Posterior superior iliac spine of the pelvis, points 8.8 7 6.5 The lowest part of the arc of the lower gluteal folds, point 9.9 7 6

Table 3
Data instrumental palpation studies of scoliosis parameters in a patient G-va Study Parameters Homolateral Pain Syndrome The ratio of the main arc of scoliosis to pain Homolaterally The top level of the main arc of scoliosis L ₃ Apex level of the compensatory arch of scoliosis Th ₆ Depth of the main (lumbar) arch of scoliosis (mm) 25 Depth is compensatory (thoracic) arch of scoliosis (mm) eighteen

Table 4
The coordinates of the displacement of the key lines of the body in the horizontal plane of the patient Key Torso Lines Homolateral Pain Syndrome Contralateral Pain Syndrome The coordinates of the bacromial line 5-5 39 31 The coordinates of the bitrochanterial line 2-2 -53 -53 The coordinates of the bicostal line 3-3 -33 0 Coordinates of the biaxillary line 6-6 60 -26 The coordinates of the anterior bispinal line 4-4 -44 57 Coordinates of the posterior bispinal line 8-8 51 54

Table 5
The coordinates of the displacement of the key lines of the trunk in the frontal plane of the patient Key Torso Lines Homolateral Pain Syndrome Contralateral Pain Syndrome The coordinates of the bacromial line 5-5 2.1 0 Coordinates of the biscapular line 7-7 2.1 0 The coordinates of the anterior bispinal line 4-4 0 4.2 Coordinates of the posterior bispinal line 8-8 0 2.1 The coordinates of the bigluteal line 9-9 0 4.2

Table 6 Measurement data of the distance from the laser rangefinder to the studied points in a patient Measuring points The distance from the laser rangefinder to the point of interest (mm) Homolateral Pain Syndrome Contralateral Pain Syndrome Jugular fossa (fossa jugularis) point 1 1685 Clavicular-acromial articulation, points 5.5 1680 1683 Large tubercle of the humerus, points 2.2 1631 1640 The highest point of the axillary fold between the shoulder and shoulder blade, point 6.6 1604 1620 The angle of the costal arch, points 3, 3 1539 1548 Anterior superior iliac spine of the pelvis, points 4.4 1641 1631 Posterior superior iliac spine of the pelvis, points 8, 8 1534 1538

Table 7
Measurement data using a patient’s water balance Measuring points Marks on syringe bodies in ml Homolateral Pain Syndrome Contralateral Pain Syndrome Clavicular-acromial articulation, points 5.5 5 6.5 The lower angle of the shoulder blades, point 7.7 6 6 Anterior superior iliac spine of the pelvis, points 4.4 6 5 Posterior superior iliac spine of the pelvis, points 8.8 6 5 The lowest part of the arc of the lower gluteal folds, point 9.9 5 6

Table 8
The coordinates of the displacement of the key lines of the trunk in the horizontal plane of the patient D. Key Torso Lines Homolateral Pain Syndrome Contralateral Pain Syndrome The coordinates of the bacromial line 5-5 5 -2 The coordinates of the bitrochanterial line 2-2 54 54 The coordinates of the bicostal line 3-3 146 137 Coordinates of the biaxillary line 6-6 -81 -65 The coordinates of the anterior bispinal line 4-4 44 52 Coordinates of the posterior bispinal line 8-8 -150 -147

Table 9
The coordinates of the displacement of the key lines of the trunk in the frontal plane of the patient D. Key Torso Lines Homolateral Pain Syndrome Contralateral Pain Syndrome The coordinates of the bacromial line 5-5 6.3 0 Coordinates of the biscapular line 7-7 0 0 The coordinates of the anterior bispinal line 4-4 0 4.2 Coordinates of the posterior bispinal line 8-8 0 4.2 The coordinates of the bigluteal line 9-9 4.2 0

Claims (1)

A method for the diagnosis of static skeletal deformities in patients with vertebrogenic pain syndromes, including the designation by lines of the boundaries of the regions of the body: the shoulder girdle, chest, pelvis, determining their spatial position in the frontal and horizontal planes passing through the center of gravity of the body, comparing the parallelism of the lines with each other and assessing angles formed by lines in case of violation of parallelism, characterized in that a point is placed on the patient’s body in the center of the jugular fossa and it is assumed that the frontal plane the center of gravity of the body passes through it, points on both sides of the body are applied to the projection of the large tubercles of the humerus — the bitrochanterial line, to the corners of the costal arches — the bicostal line, to the anterior superior iliac spine of the pelvis — the anterior bispinal line, and the clavicular-acromial joints - the bacromial line, to the highest points of the axillary folds between the shoulder and the shoulder blade - the baxillary line, to the lower corners of the shoulder blades - the biscapular line, to the posterior superior iliac spine of the pelvis - the posterior bispinal line, to the points at the most the lower part of the arches of the lower gluteal folds - the bigluteal line; the asymmetries of the body are determined in a horizontal plane relative to the frontal plane, for which, in the projection of the sagittal axis on the support plane, a line is drawn from the vertical support at a distance of 2.5-3.0 m, where a digital laser range finder is mounted on a tripod and the distance to points on the body is measured the patient, first with his back to the vertical support, on the ventral surface of the trunk: to the point in the center of the jugular fossa and to the projection points of the large tubercles of the humerus, the points of the angles of the costal arches, the points of the anterior upper of the iliac pelvis, then in the patient’s position facing the vertical support, measure the distance to the dorsal surface of the trunk: to the points of the clavicular-acromial joint, the highest points of the axillary folds between the shoulder and the shoulder blade, to the points of the posterior superior iliac pelvis, process the data using a computer program "Microsoft Office Excel 2007", which builds the projection of the lines: bitrokhanterialnoy, bicostal, anterior and posterior bispinal, bacromial and baxillary on a horizontal plane, while The distance to the points located ventrally from the frontal plane has a “+” sign, and the distance to the points located dorsally, has a “-” sign, according to the obtained graph, the position of the lines and the angle of rotation of the lines relative to the frontal axis and relative to each other are determined and judge displacement of parts of the body ventrally or dorsally; determine the asymmetries of the body in the frontal plane relative to the horizontal plane, for which on the ventral surface of the trunk to the points of the anterior superior iliac spine of the pelvis, and on the dorsal surface of the trunk to the points of the clavicular-acromial articulation, to the points of the lower corners of the scapula, to the points of the posterior superior iliac spines of the pelvis , to the points of the lowest part of the arches of the lower gluteal folds, apply vessels of water scales, measure the position of these points, process the data using a computer a yuter program that builds projections of lines: the anterior bispinal, biacromial, biscapular, posterior bispinal and bigluteal to the frontal plane, according to the obtained graph find the relative asymmetry of the homo- and contralaterally located points that limit these lines and the angle of rotation of the lines relative to the horizontal axis, and judge about lateral tilt of individual parts of the body homolaterally or contralaterally; the scoliotic curvature of the spine is determined, for which the spinous processes of the vertebrae corresponding to the main and compensatory arch of scoliosis are palpated, their position on the vertical axis is noted, the thread of one plumb line is applied to the spinous process of C ₂ , the other to the top of the main scoliotic arch and the distance between the threads of the plumb lines is measured , repeat the measurement for the compensatory scoliotic arc, using a computer program build a graph of the position of the projection of the vertices of the scoliotic arches on the frontal plane and judge the deviation of the body.

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