Treatment of osteochondropathy

In addition to drug therapy, the patient is prescribed a course of physiotherapy: therapeutic massages, electrophoresis, paraffin applications, warming up, exercise therapy, shock wave therapy.

If conservative treatment methods are ineffective and serious complications develop, bone plastic surgeries are performed. The nature of the surgical intervention depends on the type of degenerative-dystrophic process in the bones, its severity, and the patient's age.

Treatment of degenerative-dystrophic process in bones requires a comprehensive approach. Medicines for osteochondropathy are selected by the attending physician, individually for each patient. The doctor takes into account the localization of the pathology, its stage, features and course and a number of other factors.

Painkillers

They relieve discomfort and acute pain. Very often, patients are prescribed complex action drugs, which, in addition to analgesic, have antipyretic and anti-inflammatory properties.

• Metamizole

A drug from the pharmacological group of NSAIDs of the pyrazolone series. It has analgesic, anti-inflammatory and antipyretic properties. Each capsule contains 500 mg of metamizole sodium. The active component blocks the synthesis of PG from arachidonic acid and reduces the severity of the inflammatory reaction. The analgesic effect is due to the blocking of the flow of pain impulses along the Goll and Burdach conducting bundles.

• Indications for use: pain syndrome of various origins and localizations, fever, infectious and inflammatory processes, insect bites.
• Method of administration: orally or parenterally 250-300 mg 2-3 times a day. A single dose should not exceed 1 g, the maximum daily dose is 3 g. The dosage for children is selected by a doctor, individually for each case.
• Side effects: oliguria, anuria, proteinuria, interstitial nephritis, allergic reactions. Local reactions, soft tissue infiltration.
• Contraindications: hypersensitivity to the components of the drug, history of broncho-obstruction, signs of hematopoiesis suppression, glucose-6-FDG deficiency, renal and/or hepatic insufficiency. Use during pregnancy and lactation is prohibited due to the pronounced hepatotoxic effect of the drug.
• Overdose: hypotension, tachycardia, hypothermia, nausea and vomiting, increased drowsiness, convulsions, tinnitus. Treatment consists of detoxification measures followed by symptomatic therapy.

Release form: tablets for oral administration with 10 capsules per package and ampoules of 1.2 ml with a colorless injection solution. There are also rectal suppositories, widely used in pediatric practice.

• Ketorolac

An analgesic, antipyretic and anti-inflammatory agent. Suppresses prostaglandin synthesis, prevents platelet aggregation.

• Indications for use: pain syndrome, postoperative pain.
• The method of administration and dosage depend on the form of the drug. For acute pain, take 30 mg 2-3 times a day. The maximum duration of treatment is no more than 5 days.
• Side effects: nausea, vomiting, abdominal pain, increased anxiety, headaches, sweating. Local reactions, stomatitis, liver dysfunction, skin allergic reactions, asthma attacks.
• Contraindications: intolerance to the components of the drug, erosive and ulcerative lesions of the gastrointestinal tract in the acute phase, impaired renal function, pregnancy and lactation, patients under 16 years of age.

Release form: tablets of 10 mg and injection solution in ampoules of 1 ml.

• Dexketoprofen

Contains the active ingredient - dexketoprofen trometamol. Has analgesic, anti-inflammatory and antipyretic properties. Belongs to the NSAID class.

• Indications for use: mild to moderate pain, musculoskeletal pain, toothache, dysmenorrhea.
• Method of administration: orally, the dosage depends on the severity of pain. For adults, 12.5 mg every 4-6 hours is recommended. The daily dose should not exceed 75 mg. The duration of treatment is determined by the attending physician.
• Contraindications: intolerance to dexketoprofen and other NSAIDs, bronchial asthma, bronchospasms, acute rhinitis, urticaria. Not used in case of bleeding or perforation in the digestive tract in the anamnesis, chronic dyspepsia, heart failure, liver dysfunction, in the last trimester of pregnancy and during lactation.
• Overdose: gastrointestinal disturbances, increased drowsiness and irritability, headaches, disorientation. Treatment is symptomatic, hemodialysis is effective.
• Side effects: neutropenia, thrombocytopenia, laryngeal edema, anaphylactic reactions, anxiety, sleep and appetite disturbances. Blurred vision, tinnitus, vertigo, tachycardia, various gastrointestinal disorders.

Release form: 10 tablets per blister, 1.3 blisters per package.

• Larfix

Non-narcotic analgesic with an active component from the oxicam group – lornoxicam. Effectively relieves pain and exhibits anti-inflammatory properties.

• Indications for use: moderate or moderately severe pain syndrome, pain in degenerative and inflammatory rheumatic diseases.
• Method of administration: orally, before meals, with plenty of liquid. For severe pain, take 4-8 mg 2-3 times a day, the maximum daily dose is no more than 16 mg.
• Side effects: ulcerative stomatitis, nausea, vomiting, dyspepsia, increased gas formation in the intestines, exacerbation of colitis and Crohn's disease, allergic reactions, cardiovascular disorders.
• Contraindications: intolerance to the components of the drug, thrombocytopenia, severe heart failure, hematological disorders, pediatric practice, peptic ulcer, tendency to bleeding, pregnancy and lactation.
• Overdose: development of cerebral syndromes, nausea, vomiting, ataxia, convulsions, comatose state, impaired blood clotting and liver function. There is no specific antidote, treatment is symptomatic.

Release form: oral tablets, 10 pieces in a blister, in packs of 3, 10 blisters.

• Ibuprofen

An analgesic drug with anti-inflammatory and antipyretic properties. Contains the active ingredient - ibuprofen 200 mg.

• Indications for use: traumatic inflammation of soft tissues and the musculoskeletal system, rheumatoid arthritis, osteoarthrosis, bursitis, neuralgia, myalgia, radiculitis, ankylosing spondylitis. Complex therapy of ENT diseases, headache and toothache.
• Directions for use: 400-600 mg 3-4 times a day, maximum daily dose 2.4 g.
• Side effects: gastrointestinal disorders, headaches, increased anxiety and agitation, allergic reactions, gastrointestinal bleeding, bronchospasms, visual impairment.
• Contraindications: hypersensitivity to the components of the drug, erosive and ulcerative lesions of the gastrointestinal tract, ulcerative colitis, hematopoiesis disorders, patients under 6 years of age, optic nerve diseases, severe renal/liver dysfunction. Use during pregnancy and lactation is possible only on medical prescription.
• Overdose: abdominal pain, nausea, vomiting, increased drowsiness, headaches, metabolic acidosis, acute renal failure, bradycardia, respiratory arrest. Treatment is symptomatic.

Release form: film-coated tablets, 100 pieces per package. Each capsule contains 200 mg of active substance.

Anti-inflammatory

NSAIDs have an antirheumatic effect and, unlike analgesics, affect the joints. They are prescribed in combination with probiotics, since they negatively affect the gastrointestinal tract.

• Diclofenac

NSAID from the pharmacological group of phenylacetic acid derivatives. Contains the active component - sodium diclofenac. Has pronounced anti-inflammatory, antipyretic and analgesic properties. Reduces pain in the joints, reduces morning stiffness and swelling of the joints, increases their range of motion.

• Indications for use: inflammatory diseases of soft tissues and joints, injuries of the musculoskeletal system, rheumatism, rheumatoid arthritis, ankylosing spondylitis. Acute attack of gout, arthrosis, lumbago, radiculitis, primary dysmenorrhea. Postoperative pain syndrome.
• Method of administration: intramuscularly, the dosage is selected by the doctor, individually for each patient. Duration of treatment is 4-5 days.
• Side effects: dyspeptic disorders, erosive and ulcerative lesions and bleeding in the gastrointestinal tract, allergic reactions, increased drowsiness, headaches, irritability. Local reactions at the injection site, burning, abscess, necrosis of adipose tissue. Overdose is manifested by increased side effects, treatment is symptomatic.
• Contraindications: hypersensitivity to the components of the drug, gastric ulcer and duodenal ulcer, gastrointestinal bleeding, last trimester of pregnancy and lactation, urticaria, bronchial asthma, patients under 6 years of age.

Release form: injection solution in 3 ml ampoules. The package contains 5, 10 ampoules for injection.

• Indomethacin

Active nonsteroidal anti-inflammatory agent. Inhibitor of prostaglandin biosynthesis. Effectively relieves pain.

• Indications for use: rheumatoid arthritis, periarthritis, ankylosing spondylitis, gout. Inflammatory lesions of connective tissue and the musculoskeletal system, thrombophlebitis, nephrotic syndrome. Back pain, neuralgia, myalgia, traumatic inflammation of soft tissues and the musculoskeletal system. Diffuse diseases of connective tissue, algomenorrhea.
• Method of administration: orally, after meals. Initial dosage is 25 mg 2-3 times a day, increasing to 100-150 mg, divided into 3-4 doses per day. Maximum daily dose is 200 mg. Duration of treatment is up to 4 weeks. In acute pain, intramuscular administration of 60 mg 1-2 times a day is possible.
• Side effects: headaches and dizziness, increased drowsiness, nausea, vomiting, loss of appetite, stomach ulcers, gastrointestinal bleeding, allergic reactions.
• Contraindications: intolerance to the components of the medication, pregnancy and lactation, gastric ulcer and duodenal ulcer, bronchial asthma.

Release form: dragees and capsules of 25 mg, injection solution in ampoules of 1 ml, rectal suppositories.

• Nimesulide

NSAID from the sulfonanilide class. Contains the active substance nimesulide 100 mg. Has a pronounced anti-inflammatory, antipyretic and analgesic effect. Has antioxidant properties. The therapeutic effect develops within 20 minutes after taking the drug, which is very effective in acute pain attacks.

• Indications for use: rheumatoid arthritis, arthrosis, myalgia, bursitis, pain syndromes of various origins.
• Method of administration: orally 100 mg 2 times a day, after meals. The maximum daily dose is 400 mg. The duration of treatment depends on the severity of the disease. The medicine in the form of a gel is applied to the affected tissues 2-4 times a day, gently rubbing into the skin. Use under a bandage is contraindicated.
• Side effects: headaches and dizziness, nausea, vomiting, increased sleepiness, oliguria, urticaria, anaphylactic shock, hematuria, gastralgia, changes in the blood picture. When applied externally, local allergic reactions, itching, irritation, changes in skin color, peeling are possible.
• Contraindications: hypersensitivity to the components of the drug, patients under 12 years of age, pregnancy and lactation, renal/hepatic insufficiency, ulcerative diseases and gastrointestinal bleeding.
• Overdose: nausea, vomiting, gastrointestinal bleeding, epigastric pain, drowsiness, acute renal failure, arterial hypertension, respiratory depression. There is no specific antidote, treatment is symptomatic.

Release form: tablets of 100 mg, granules for preparation of oral suspension, gel 0.1%.

• Meloxicam

A medicinal product from the oxicam group with the active component meloxicam. Provides a pronounced analgesic and anti-inflammatory effect.

• Indications for use: chronic polyarthritis, exacerbation of arthrosis, ankylosing spondylitis, rheumatoid arthritis.
• Method of administration: orally 1 tablet per day during meals. The injection solution is administered intramuscularly once a day. The duration of treatment depends on the severity of the disease.
• Side effects: changes in the blood system, headaches and dizziness, gastrointestinal disorders, increased blood pressure, tachycardia, impaired renal function, asthma attacks, allergic reactions.
• Contraindications: intolerance to the components of the drug, ulcers in the digestive system, gastrointestinal bleeding, pregnancy and lactation, patients under 15 years of age, heart failure, renal/hepatic failure, cerebrovascular bleeding.
• Overdose: nausea, drowsiness, abdominal pain, increased blood pressure. Treatment is symptomatic.

Release form: tablets of 15 and 7.5 mg, 20 pieces per package. Solution in ampoules for intramuscular injections of 1.5 ml, 5 ampoules per package.

• Aertal

NSAID with the active ingredient aceclofenac. Has anti-inflammatory, analgesic and antipyretic properties. Effectively relieves pain syndrome, morning stiffness and joint swelling in rheumatic diseases.

• Indications for use: pain syndrome, reduction of the intensity of the inflammatory process. Lumbago, scapulohumeral periarthritis, rheumatic diseases of soft tissues, toothache, osteoarthrosis, ankylosing spondylitis.
• Method of administration: orally, with a small amount of water. Daily dosage: 1 tablet 1-2 times a day. The duration of treatment is determined by the attending physician.
• Side effects: nausea, vomiting, bowel and digestive disorders, intestinal spasms, erosive and ulcerative lesions of the mucous membrane of the gastrointestinal tract, stomatitis. Headaches and dizziness, increased irritability, sleep and wakefulness disorders, emotional lability. Renal failure, edema, heart rhythm disturbances, anemia, allergic reactions.
• Contraindications: individual sensitivity to the components of the drug, pregnancy and lactation, ulcerative lesions of the gastrointestinal tract, gastric bleeding, impaired renal/liver function, hematopoiesis disorders, patients under 18 years of age.
• Overdose: headache and dizziness, abdominal pain, nausea, vomiting, hyperventilation with increased convulsive activity. There is no specific antidote, treatment is symptomatic.

Release form: film-coated tablets, 10 pieces per blister, 2, 6 blisters per package.

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Vasodilators

They normalize microcirculation processes in the affected limb, stimulate regeneration processes, including osteogenesis.

• Actovegin

Deproteinized hemoderivative from calf blood. Activates cellular metabolism by increasing the transport and accumulation of oxygen and glucose. Enhances their intracellular utilization. Accelerates the metabolism of adenosine triphosphoric acid, increases the energy resources of the cell.

• Indications for use: cerebral circulatory failure, craniocerebral trauma, peripheral circulatory disorders, vascular tone disorders. trophic disorders in varicose veins of the lower extremities, ulcers of various origins, bedsores, burns. Corneal and scleral damage, radiation skin lesions.
• Method of administration: orally take 1-2 pills 3 times a day before meals. Intravenously/intraarterially administer 10-20 ml 1 time per day. The gel is applied to cleanse and treat ulcers and open wounds. The duration of therapy is determined by the attending physician.
• Side effects: hives, increased sweating, increased body temperature, itching and burning in the area of application.
• Contraindications: hypersensitivity to the components of the drug. Use during pregnancy and lactation is possible only on doctor's prescription.

Release form: 100 dragees per package, injection solution in 2.5 and 10 ml ampoules, 10 and 20% infusion solution, 20% gel, 5% cream, 5% ointment, 20% eye gel.

• Solcoseryl

Cattle blood extract. Improves metabolic processes in tissues, accelerates regeneration processes.

• Indications for use: obliterating diseases of the vessels of the extremities, chronic venous insufficiency of the lower extremities, diabetic angiopathy, 2-3 degree burns, bedsores, macerations, erosions.
• Method of administration: intramuscularly, intravenously or locally in the form of ointment/jelly. The dosage is selected individually for each patient.
• Side effects: local allergic reactions that do not require discontinuation of therapy.

Release form: injection solution of 2.5 and 10 ml in ampoules, ointment and jelly in tubes of 20 g, eye gel of 5 g.

• Nicotinic acid

A medicinal product with the active component - pyridinecarboxylic-3 acid. It takes part in oxidation-reduction processes in the body. It is used as an antipellagra agent. It improves carbohydrate metabolism, accelerates the healing of wound surfaces, and has a vasodilatory effect.

Nicotinic acid is taken orally and parenterally. The dosage and duration of therapy are determined by the attending physician. Side effects include allergic reactions, a feeling of blood flow to the head, paresthesia. The drug is contraindicated in hypertension and atherosclerosis. It is available in the form of tablets, powder, and injection solution.

• Nikoshpan

A vasodilator with the active substance drotaverine hydrochloride and nicotinic acid. It is used to treat and prevent spasms of the brain and peripheral vessels.

The drug is taken orally after meals, 1 tablet 1-3 times a day. For intramuscular administration, use 1-2 ml of solution 1-2 times a day. For peripheral circulatory disorders, the medication is slowly injected into the femoral artery, 1-2 ml at a time.

Side effects include allergic reactions, dizziness, increased heart rate, increased sweating. Nikoshpan is contraindicated in closed-angle glaucoma, prostatic hypertrophy. The drug is available in the form of tablets and ampoules with injection solution.

• Dipyridamole

Vasodilator, improves blood flow and supplies vessels with oxygen. Reduces systemic arterial pressure and improves cerebral circulation.

Indications for use: prevention of postoperative thrombosis, cerebrovascular accidents. Improvement of metabolic processes in the body. The drug is taken 25 mg 2-3 times a day. Side effects include allergic reactions, increased heart rate, and facial flushing.

Dipyridamole is contraindicated for intravenous administration in sclerosing atherosclerosis of the coronary arteries. It is available in the form of tablets of 25, 75 mg and as a 0.5% solution in ampoules of 2 ml.

Chondroprotectors and drugs modifying the structure of cartilage tissue

Restore articular cartilage and protect it from damage. Promote restoration of joint function, reduce clinical manifestations of joint pathologies, relieve pain.

• Alflutop

Contains an extract of sea fish. Has a chondroprotective effect, regulates metabolism in cartilage tissue. Has analgesic and anti-inflammatory properties. The composition of the drug includes the following components: hyaluronic acid, mucopolysaccharides, dermatan sulfate, chondroitin sulfate, creatine sulfate, polypeptides, amino acids, micro and macroelements, rosemary essential oil.

• Indications for use: osteochondrosis, osteoarthrosis, periarthritis, spondylosis, periodontopathy, fibromyalgia, traumatic dysostosis. Recovery period after joint surgery.
• Method of administration: intramuscularly 1 ml per day. The course of treatment consists of 20 injections. For intra-articular lesions, the drug is administered into the joint at 2 ml per injection for 3 days.
• Side effects: allergic reactions, itching, irritation at the injection site, reddening of the skin, arthralgia. Temporary increase in pain due to activation of metabolic processes. No cases of overdose have been recorded.
• Contraindications: hypersensitivity to the components of the drug, pregnancy and lactation. It is prescribed with special caution for the treatment of children and adolescents, since there is no clinical data confirming the safety of the drug for this age category.

Release form: injection solution in 1 ml ampoules, 10 ampoules per package.

• Artra

Combined chondroprotective agent with chondroitin sulfate, glucosamine hydrochloride. Promotes restoration of cartilage tissue and improves joint mobility. Reduces the severity of pain syndrome in degenerative-dystrophic diseases of the joints. In combination with glucosamine, it slows down degenerative processes, preventing the destruction of cartilage tissue.

• Indications for use: complex treatment of degenerative-dystrophic diseases of the musculoskeletal system, osteoarthritis of the joints of the spine and peripheral joints.
• Method of administration: orally, 1 tablet twice a day for 3 weeks. Duration of treatment is 4-6 months.
• Side effects: pain in the epigastric region, bowel disturbances, flatulence, dizziness, allergic reactions.
• Contraindications: intolerance to the components of the drug, impaired renal function, pregnancy and lactation. With special caution it is prescribed for patients with bronchial asthma, diabetes mellitus, tendency to bleeding and in pediatric practice.

Release form: film-coated tablets of 30, 60, 100, 120 pieces in polymer bottles.

• Teraflex

A combination product containing two active ingredients: glucosamine hydrochloride and sodium chondroitin sulfate. Slows down the processes of destruction of cartilage tissue. Reduces the activity of enzymes that contribute to degenerative processes in cartilage. Stimulates the regenerative processes of joint tissue.

• Indications for use: complex treatment of musculoskeletal diseases with degenerative-dystrophic changes in joint tissue. Osteoarthrosis, osteochondrosis, traumatic bone injury. Acceleration of regenerative processes and formation of bone callus.
• Directions for use: internally, from day 1 to day 21, 1 capsule 3 times a day, then 1 capsule twice a day. The course of treatment is at least 2 months.
• Side effects: dyspeptic disorders, allergic reactions. Overdose is manifested by the same symptoms. For treatment, dose adjustment or drug withdrawal is indicated.
• Contraindications: intolerance to the components of the drug, pregnancy and lactation, phenylketonuria.

Release form: capsules for oral administration, 30, 60 and 120 pieces per package.

• Structum

Chondroprotective drug with the active component - chondroitin sulfate sodium salt. Restores and maintains the normal structure of the cartilage matrix. Increases the anabolic activity of chondrocytes, stimulates the synthesis of proteoglycans. Stimulates the synthesis of hyaluronic acid, normalizes the viscosity of synovial fluid.

• Indications for use: complex therapy of degenerative-dystrophic diseases of the spine and joints, osteoarthrosis, intervertebral osteochondrosis.
• Directions for use: orally, 1 capsule 2 times a day. The course of treatment depends on the severity of the disease and is determined by the attending physician.
• Side effects: nausea, vomiting, dyspeptic disorders, allergic reactions. Overdose has similar signs, treatment is symptomatic.
• Contraindications: hypersensitivity reactions to the components of the drug, patients under 15 years of age, pregnancy and lactation.

Release form: capsules of 12 pieces in a blister, 5 blisters per package.

• Wobenzym

A combined medicinal product with enzymes of plant and animal origin. It has immunomodulatory, anti-inflammatory, fibrinolytic and anti-edematous properties. Improves the resorption of hematomas, normalizes blood viscosity and its microcirculation. Supplies tissues with oxygen and nutrients.

• Indications for use: rheumatoid arthritis, extra-articular rheumatism, obliterating thromboangiitis, thrombophlebitis, post-thrombotic syndrome, vasculitis, lymphedema. Urological and gynecological diseases. Treatment and prevention of postoperative complications, post-traumatic processes. Prevention of microcirculation disorders.
• Directions for use: orally 5-10 pills 3 times a day. The medicine is taken 30 minutes before meals with plenty of water.
• Side effects: allergic reactions, changes in stool consistency.
• Contraindications: intolerance to the components of the drug, hemophilia, thrombocytopenia. Use during pregnancy and lactation is possible only on doctor's prescription.

Release form: enteric-coated tablets of 40, 200 and 800 pieces per package.

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Products for restoring intestinal microflora, improving the absorption of beneficial microelements

1. Enterogermina

A medicinal product with 2 billion Bacillus clausii spores. Restores the normal qualitative and quantitative composition of intestinal microflora, normalizes endogenous synthesis of vitamins. Resistant to the action of antimicrobial drugs, so it can be used during antibacterial treatment.

• Indications for use: intestinal microflora disorders, endogenous vitamin imbalance disorders, digestive disorders due to intestinal microflora disorders.
• Method of administration: orally, for the preparation of suspension you can use water, juice, tea or milk. The dosage and duration of treatment is determined by the attending physician, for each patient individually.
• Side effects: skin allergic reactions, urticaria.
• Contraindications: intolerance to the components of the drug. No cases of overdose or adverse reactions have been identified. Use during pregnancy and lactation is permitted.

Release form: suspension for oral use in 5 ml vials, 10, 20 vials per package.

2. Bifidumbacterin

Dried live bifidobacteria with added lactose, i.e. bifidogenic factor. Exhibits antibacterial activity against a wide range of pathogenic and opportunistic microorganisms. Restores intestinal microflora, normalizes gastrointestinal tract function, has an immunomodulatory effect.

• Indications for use: disturbance of the normal intestinal microflora, intestinal dysfunctions. Sanitation of the genital tract during prenatal preparation.
• Method of administration: 3-5 doses of the medicine three times a day. The duration of treatment is determined by the attending physician.

Release form: powder for preparation of suspension in sachets of 5 doses, 5 sachets per package.

3. Bificol

Dried raw material of live bifidobacteria. Has antimicrobial properties, normalizes intestinal flora.

• Indications for use: dysbacteriosis, acute dysentery, colitis, enterocolitis, nonspecific ulcerative colitis, viral diarrhea associated with dysbacteriosis. Restoration of intestinal microflora.
• Directions for use: orally 30 minutes before meals. Take 1-5 doses per day, diluting the drug in boiled water (1 dose - 1 teaspoon of medicine). The course of treatment is 14 days.

Release form: ampoules and vials of 3 doses.

4. Symbiter acidophilus

A multiprobiotic in non-lyophilized form with a symbiotic association of 14-24 strains of bifidobacteria. It has a wide range of probiotic properties, exhibits antagonistic activity against pathogenic and opportunistic microorganisms. Activates specific and nonspecific immunity.

• Indications for use: normalization of intestinal microflora, improvement of digestion, normalization of stool and elimination of constipation. Strengthening the general condition of the body. Normalization of microflora after antibacterial therapy.
• Method of administration: orally, the contents of the sachet are diluted in 20 ml of water or boiled milk. The medicine is taken every 12 hours for 21-28 days.
• Contraindications: individual hypersensitivity to the components of the drug. Does not cause overdose symptoms and side effects. Approved for use during pregnancy and lactation.

Release form: 10 g sachets, 10 pieces per package.

Dimexide for osteochondropathy

A medicinal product with pronounced local anesthetic, anti-inflammatory and antimicrobial properties is Dimexide. Contains the active component - dimethyl sulfoxide 50/100 ml. Changes the sensitivity of microflora resistant to antibacterial drugs.

• Indications for use: osteoarthrosis, sprains, arthropathies, Bechterew's disease, rheumatoid arthritis and other inflammatory lesions of the musculoskeletal system. Prescribed for bruises, inflammatory edema, purulent wounds and abscesses, osteomyelitis, nodular erythema, streptoderma. Effective for cervical osteochondrosis.
• Method of application: externally, in the form of 30-50% aqueous solutions for compresses. Dressings soaked in the medicine are applied to the affected areas, capturing a little healthy skin.
• In case of aseptic necrosis, Dimexide is diluted in a proportion of 1 part of 10% preparation and 9 parts of distilled water. It is recommended to cover compresses with wax paper or wrap them with a bandage on top, changing them every 5-10 minutes. The duration of the procedure should not exceed 10-15 minutes. The prepared solution can be used for 12 hours.
• Side effects: erythema, itching, peeling of the skin, dizziness, insomnia, dermatitis, bronchospasm, adynamia. Overdose is manifested by more pronounced side effects. Treatment is symptomatic, there is no specific antidote.
• Contraindications: individual intolerance to the components of the drug, pregnancy and lactation, patients under 12 years of age. Glaucoma, cardiovascular failure, liver and kidney disease, myocardial infarction and angina, stroke, atherosclerosis

Release form: liquid in 50 and 100 ml bottles.

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Vitamins

One of the mandatory components of the treatment of aseptic necrosis of any localization is multivitamin complexes. They are recommended to be taken during the period of active formation of the skeleton, that is, from 1 year to 25 years, as well as to increase the protective properties of the immune system.

1. Calcium

Of all the chemical elements in the body, calcium has the highest content. This microelement is involved in metabolic processes, promotes the transmission of impulses through nerve cells, and is also responsible for the healthy growth and regeneration of bone tissue. Partially blocks saturated fats in the gastrointestinal tract and reduces cholesterol levels in the blood.

• Calcemin is a mineral and vitamin complex containing calcium citrate, calcium carbonate, copper, cholecalciferol, zinc, manganese and other components. It is used to prevent diseases of the musculoskeletal system, dental pathologies. It replenishes the deficiency of vitamins and minerals in the body. It is recommended for children during periods of intensive growth, as well as during pregnancy and lactation.
• Calcium D3 Nycomed is a combination product containing calcium and cholecalciferol. Regulates phosphorus-calcium metabolism, replenishes calcium deficiency in the body. Regulates calcium absorption in the gastrointestinal tract and its distribution in the body. It is used in complex therapy and for the prevention of osteoporosis, calcium deficiency, cholecalciferol.
• Osteogenon - regulates phosphorus-calcium metabolism, stimulates osteoblasts and inhibits osteoclasts. Restores balance between bone resorption and bone tissue restoration processes. Contains ossein-hydroxyapatite complex. It is used to treat diseases of the musculoskeletal system, with dysplasia of joints and connective tissue, osteoporosis. Complex therapy of rachitic skeletal deformity, scoliosis.
• Vitrum Calcium+Vitamin D3 is a complex medicine for replenishing calcium deficiency in the body. Contains calcium carbonate from oyster shells, cholecalciferol. It is used for prevention, monotherapy and complex treatment of osteoporosis, to replenish calcium and cholecalciferol deficiency. It is effective during the recovery period after injuries and fractures, during pregnancy, lactation, menopause.

2. Precursors of the active form of vitamin D

Increases absorption of calcium and phosphorus from the gastrointestinal tract. Increases bone elasticity by improving protein synthesis.

• Alfaforcal is a precursor of the active metabolite of vitamin D3. Improves the absorption of calcium and phosphorus in the intestine, increases bone mineralization, reduces the level of parathyroid hormone in the blood. Restores calcium balance, reduces the incidence of bone fractures. It is used for osteoporosis, osteodystrophy, hyperparathyroidism, rickets, osteomalacia, Fanconi syndrome, psoriasis, renal acidosis.
• Oxydevit - normalizes phosphorus-calcium metabolism. It is used in osteopathic conditions, to correct phosphorus-calcium metabolism, in rickets and rickets-like diseases. It is effective in bone pathologies to improve bone nutrition and prevent its fragility.

3. B vitamins

They increase the functional capabilities of osteoblasts, improve protein synthesis in bone tissue and promote the penetration of magnesium into bones.

• Neurobion is a complex remedy, contains neurotropic vitamins: thiamine, cyanocobalamin, pyridoxine. It takes part in intermediate metabolic processes in the central nervous system as coenzymes. It is prescribed for trigeminal neuralgia, intercostal neuralgia, cervical-brachial syndrome, plexitis, lumbago, sciatica, radicular neuritis, prosoplegia, herpes zoster.
• Neurorubin – contains water-soluble B vitamins, which participate in the body’s metabolic processes. It is used for hypovitaminosis conditions, pain syndromes, polyneuritis, neuralgia, damage to nerve structures, and intoxications.

In addition to pharmacy vitamins, a balanced diet is very important for osteochondropathy. The patient's diet should include foods rich in calcium and phosphorus, as well as plenty of fluids.

Physiotherapy treatment

Complex therapy of aseptic necrosis includes physiotherapeutic methods of treatment. Physiotherapy is aimed at:

• Improving blood supply to the affected area.
• Reduction of pain syndrome.
• Acceleration of regeneration processes.
• Reduction in the severity of dystrophy.
• Reduction of bone tissue demineralization.
• Restoration of joint functions.

Let's look at the most popular physiotherapy procedures for osteochondropathy of various localizations:

1. Laser therapy is one of the effective and safe methods of treatment. The course consists of 12-20 sessions, conducted every other day. The procedure is contraindicated in blood diseases, tumors, infectious pathologies, hyperthyroidism, heart attack, bleeding.
2. Thermal procedures – this category includes paraffin therapy, ozokerite, mud therapy. They improve blood circulation in the damaged area, promote penetration of biologically active substances through the skin, and improve metabolic processes. The treatment is contraindicated in acute inflammatory processes, oncological diseases, blood and kidney diseases, bleeding, and purulent lesions of the body.
3. Decompression of the affected bone - a puncture is made in the bone tissue using a large needle. This allows for increased blood supply to the area by increasing the growth of blood vessels inside the puncture. Intraosseous pressure is also reduced, thereby reducing pain.
4. Manual therapy is performed if necrosis is caused by a pinched joint during an injury or blow. Massage improves blood circulation, improves tissue condition, and warms up. The procedure is contraindicated in cases of elevated body temperature, active joint inflammation, blood diseases and a tendency to bleeding, thrombosis, various neoplasms, and severe skin lesions in the treated area.
5. Hirudotherapy - treatment with medicinal leeches for aseptic necrosis is aimed at improving metabolic processes, increasing tissue elasticity and the body's immune properties. The enzymes secreted by leeches dissolve blood clots and improve blood circulation.

In addition to the above-mentioned physiotherapy procedures, patients may be prescribed pain-relieving methods (UV irradiation, diadynamic therapy), trophic stimulating, reparative-regenerative and defibrosing methods (electrophoresis, radon and sodium chloride baths).

Exercises for osteochondropathy of the spine

In degenerative-dystrophic processes in the bones of the spine, treatment consists of a complex of different methods. Particular attention is paid to exercises that are aimed at:

• Improving blood supply to the spinal column.
• Restoration of metabolic processes in the vertebrae.
• Reduction of pain.
• Restoring the functionality of the back muscle corset.

Features of exercise therapy for osteochondropathy:

• When compiling a treatment complex, the degree of expression of degenerative changes is taken into account. In case of severe curvature, preparatory exercises aimed at muscle relaxation are performed before gymnastics. Before and after exercise therapy, a massage can be performed, which improves blood supply in the spinal column.
• In addition to therapeutic gymnastics, patients are recommended to wear an orthopedic corset. It is prescribed from the 2nd degree of curvature. Exercises are performed in between wearing corrective underwear.
• When treating pediatric patients, not only exercise therapy and corseting are prescribed, but also traction.
• Strength exercises for kyphoscoliosis of 1, 2 degrees are not effective. Increased physical activity can cause serious complications. It is better to replace the gym with swimming, which strengthens the muscular frame of the back well.
• In case of degenerative changes of 3, 4 degrees, exercise therapy is used to prevent further progression of the disease. But the main emphasis in treatment is on conservative methods.

Exercises for osteochondropathy of the thoracic spine are aimed at the dynamic (muscular system) or stable component (bone-joint system) of the disease. Changes in muscles and ligaments without pronounced vertebral disorders (1, 2 degrees) require active gymnastics. Static changes (3, 4 degrees) are difficult to correct and require surgical intervention.

Treatment complex for aseptic necrosis of 1st and 2nd degree:

• Leg swings upward and circular movements clockwise and counterclockwise from a standing position. Raise your legs no higher than 45°. Do 10-12 repetitions for each limb in three sets.
• In a lying position, lift your legs up one by one, bending them at the knee joint and pressing them to your chest. During the exercise, the other leg should be pressed to the floor. Perform 10 repetitions in 2-3 sets.
• Raise the foot of your right leg to your left knee and gradually move it to the left and right in a bent position. Do the same on the other leg. Repeat the exercise 10 times in 2 sets.
• Lying on your back, place your feet shoulder-width apart. Raise your legs one by one, slowly bringing the other one down. 10-15 times in 2-3 sets.
• Lying on your stomach, clasp your hands behind your head, spread your elbows to the sides. Raise your body up, bending your knees slightly and return to the starting position. Do 5-10 repetitions in 2 sets.

An orthopedist is involved in the development of a comprehensive therapeutic exercise program. The doctor gives recommendations regarding the load and frequency of classes. Massage and a contrast shower are recommended before and after physical education.

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Folk remedies

Another way to combat the degenerative-dystrophic process in bones is folk methods of treatment. Alternative therapy is used in the early stages of aseptic necrosis and only as an auxiliary method. Let's consider effective recipes for pain relief.

• For severe pain, take a 0.5 l glass jar and pour pine buds into it. Mix the plant material with sugar and let it brew in a dark, warm place for a week. Strain the resulting syrup and take 2-3 teaspoons per day. Duration of treatment is 2-3 months.
• Take 50 g of mint, eucalyptus and a peeled aloe leaf. Grind everything thoroughly, pour 100 ml of water and put on medium heat. Boil until the mass has a uniform consistency. Apply the warm liquid to the sore spot as a compress, preferably before bed.
• Grind 3 ficus leaves, put them in a glass container and pour 500 ml of vodka or alcohol. The product should be infused in a dark place for 10-14 days. Then it is filtered and rubbed into the affected area.
• A tincture with meadowsweet has analgesic and blood flow enhancing effects. Take 50 g of dry grass and pour 1 liter of vodka, close the lid tightly and put in a dark place for a month. Strain the finished infusion and take 30 drops daily. The tincture can be rubbed into the skin.
• Take equal parts of pork fat and nutria fat. Melt the ingredients and mix until a homogeneous mass is obtained. Rub the remedy into the affected joint every evening. The course of treatment should be at least 30 days.

Before using traditional medicine methods, you should consult with your doctor. It should be taken into account that a positive effect will be achieved with long-term, continuous use of medicinal products.

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Herbal treatment

Alternative methods of treating aseptic necrosis include phytotherapy. Herbal treatment is aimed at:

• Restoration of metabolic processes in the body.
• Improving the absorption of micro and macroelements
• Acceleration of regeneration processes of damaged bone tissue.
• Pain relief and improved blood circulation.
• General toning and strengthening of the body.

For osteochondropathy, the following herbal treatment recipes can be used:

1. Take sleep-grass, woodruff and mugwort in a ratio of 1:1:2. Pour 500 ml of boiling water over the herbs and let it brew for 1 hour. Strain and take ¼ cup during the day. The infusion is suitable for the prevention of aseptic necrosis.
2. Take the following herbs in equal proportions: St. John's wort, common rape, calamus root, field pennycress and dandelion roots. Pour boiling water over the raw materials, at the rate of a tablespoon of herbs per glass of water. Infuse the remedy for an hour, after straining, drink in small sips throughout the day.
3. Take 1 part of mumiyo the size of a match head daily. The remedy should be taken before meals, twice a day for 3-4 weeks.
4. To normalize the absorption of calcium and silicon, which are responsible for bone strength, use infusions of geranium, horsetail and knotweed. The plants accelerate regenerative processes and promote the healing of fractures. Pour a tablespoon of herbs with a glass of boiling water and let it brew until it cools. Strain, take small portions throughout the day, make compresses.
5. Baths with infusion of horsetail, willow bark, hops, motherwort, and knotweed also help speed up the healing of fractures. A liter of infusion is diluted in bathing water and the bath is taken for 10-15 minutes. The procedures can be carried out 2-3 times a week.

In order for herbal treatment to be effective, you should consult a herbalist. The doctor will select medicinal herbs and give recommendations for their use.

Homeopathy

Another alternative method of treating bone and joint damage is homeopathy. Homeopathic preparations are aimed at relieving acute pain and activating metabolic processes. For aseptic necrosis of any localization, the following preparations can be prescribed:

• Abrotanum – rheumatic diseases, muscle rigidity, pain in the lower limbs.
• Arnica Montana – local circulatory disorders, trauma, inflammatory reactions, suppuration, acute pain.
• Calcium fluoratum – frequent fractures, increased bone fragility.
• Calendula – open, difficult to heal wounds, fractures, injuries.
• Hypericum perforatum – acute pain due to damage or irritation of nerves, trauma.
• Silicea Oligoplex – strengthens bone tissue, accelerates regenerative processes, used for poorly healing fractures.
• Symphytum Oligoplex – relieves pain, stimulates bone tissue restoration
• Symphytum Officinale – stabbing pains and increased sensitivity of the affected areas. Poorly healing fractures.

All homeopathic preparations can only be used as prescribed by a doctor. The homeopath selects the medicine and gives recommendations for its use, determines the duration of therapy.

Surgical treatment

If conservative treatment of osteochondropathy does not give the desired results, then surgical intervention is indicated. The operation can be prescribed both in the early stages of the disease and in severe forms of aseptic necrosis. Today, there are many effective treatment methods, let's consider the most popular ones:

1. Decompression – neat channels are drilled into the bone in areas where there is no blood flow. This improves blood supply due to the growth of new vessels in the created holes. The procedure reduces intraosseous pressure and effectively relieves acute pain.
2. Bone section transplantation – performed in cases of stage 1 and 2 necrosis. Quickly relieves pain, strengthens the affected bone, and improves blood supply. When strengthening the femoral head, a small part of the fibula is used.
3. Endoprosthetics is a complete replacement of deformed bone tissue with artificial ones. It is one of the most popular and effective treatment methods. About 90% of all operations are endoprosthetics. A special zirconium or titanium pin is inserted into the prepared joint cavity and fixed. A special bed for free movement of the joint is placed in the second part of the articular joint. The operation allows for complete restoration of the functionality of the lesion.

The most appropriate surgical treatment method is selected individually for each patient. The doctor takes into account the stage of the disease, symptoms and characteristics of the patient's body.