Nadkevych A. Clinico-pathogenetic substantiation of complex treatment with the inclusion of reflexotherapeutic methods at patients with vertebrogenic reflex lumbosacral pain syndromes and associated osteodieficency

The thesis deals with increasing of efficiency and substantiation of the offered complexes of treatment of the patients with vertebrogenic reflex lumbosacral pain syndromes and accompanying osteodeficiency on the basis of research of clinical-neurological condition, dynamics of parameters of cytokine status, endogenous intoxication, disturbances in nitric oxide system, oxidant-antioxidant system and bone tissue at 137 of these patients. According to densitometry data, among 137 studied patients, different-directional changes in bone mineral density were revealed: osteosclerosis - 40.9%, different degrees of osteopathy - from osteopenia at 33.6% of patients to osteoporosis - 10.9%. Osteodestructive changes significantly increased with age, onset and increase in the duration of menopause, with duration of pain, which significantly complicated the clinical course, accompanied by increased endotoxicosis and weakening of antioxidant protection of the enzyme and non-enzyme composition. Significant increase in levels of pro-inflammatory cytokines IL-1 and TNF-α and reduction of anti-inflammatory IL-10 in blood serum of such patients has been established, which correlated with the deepening of osteophytes and reduction of the level of nitrite anion. Reasonably higher efficiency of the proposed therapeutic program using the pharmacopuncture of meloxicam for the effect on pain syndrome and clinical indices in comparison with the accepted treatment in general was substantiated by 63.95% against 56.67%; on the indices of endotoxicosis, lipoxidation, antioxidant defense, cytokine profile, endothelial dysfunction (with an increase in the content of nitrite anion, respectively, by 24.37% vs. 20.22%, (p <0.05) and the parameters of osteodyphytes, the improvement was Z% - 5.19% vs. 0.20% (p1 <0.001), which led to a decrease in the depth of osteopenia from the II to the I grade. More significant positive dynamics of the pain syndrome at patients with inclusion in the treatment of acupuncture with standard treatment and the objective higher efficiency of homeosyniatry with Traumel S and Placenta compositum in the proposed scheme for the complex with acupuncture, as well as a higher level of efficiency in dynamics of the general condition parameters of the patients, endotoxicosis, oxidant-antioxidant systems, an increase in nitrite anion, which showed higher level of correction of endothelial dysfunctions towards increasing of vasodilation and improving microcirculation was established.