Kudrin A. DIAGNOSIS AND TREATMENT OF THORACALGIA IN PATIENTS WITH THORACIC SPINE OSTEOCHONDROSIS IN COMBINATION WITH CARDIOVASCULAR DISEASES

The dissertation is devoted to solving an urgent scientific problem - to improve the results of rehabilitation complex treatment of patients with pain syndrome in osteochondrosis of the thoracic spine combined with cardiovascular pathology. To achieve this goal, we retrospectively analyzed data from 434 medical records and personally examined and treated 147 patients with complaints of chest pain. Analyzing the results of the retrospective study, it was found that 86.2% of patients reported a positive effect of treatment. As for the negative results of treatment, a thorough study of them showed a connection with the presence of concomitant pathology in patients, and the total cardiac component was 4.6%. Among the treatment measures received by patients, drug therapy prevailed (58.3%), followed by physiotherapy (38.2%) and manual therapy (3.5%). The complete absence of therapeutic exercises and other methods of kinesiotherapy in the complex of treatment measures is noteworthy. In a prospective study, the main complaint at presentation was thoracalgia (147 patients). Characterizing the pain syndrome, we note that pain occurred more often when changing body position and during inhalation (23.1%) with a pronounced reaction to stress (28.6%). The localization was in the chest (45.6%) and behind the sternum (26.8%), and the nature was aching (48.3%) and compressive (19.3%). Long-term pain (39.5%) was more common than short-term pain (25.2%) with radiation to the left side of the chest. Changing body position increased pain in 85.7% of cases. NSAIDs improved the situation in 51% of cases, and nitroglycerin in 20.4%. Such indicators make it possible to differentially diagnose pain syndrome (vertebrogenic or cardiovascular pathology). According to the results of the examination, all patients were divided into 3 main groups with cardialgia (30) and thoracalgia (75) and a group with mixed symptoms and signs of pain (42). To further clarify the clinical picture, patients underwent a series of clinical and instrumental studies: MRI, RTG, ECG, echocardiography, goniometry, dynamometry, bicycle ergometry, and questionnaires. It was determined that MRI and ECG play the most important role in the differential diagnosis of pain syndrome. Given the above data, the author proposed a rehabilitation program for the rehabilitation treatment of pain in the thoracic spine, which, compared to the results of a retrospective study, would include a much larger proportion of therapeutic exercises and a decrease in the use of drug therapy. According to the results of the treatment measures carried out under the developed program, patients in both groups had reduced (52.3%) or completely disappeared (4.6%) chest pain. According to the Roland-Morris and ODI questionnaires, the level of vital activity (15%) and the number of patients with low levels of situational (2.4%) and personal anxiety (4.8%) increased. Based on the data of instrumental studies, there was an increase in the functional capacity of muscles, their strength, according to dynamometry, and spinal mobility, according to goniometry. Studies in the dynamics show that the good results of treatment were maintained for 3 months. Data obtained during the follow-up of 145 patients 3 months after treatment confirm the effectiveness of the developed measures and the reduction in the number of exacerbations (87.2%).