oosteoqondropaTiebi steoqondropaTiebi bbavSvTa da … embolia sisxlis mimoqcevis Sem-dgomi moSliTE(53. 149. 178.)B paTologiuri procesis lokalizaciis mixedviT ganasxvaveben 20 - ze

pavle kasraZepavle kasraZe

osteoqondropaTiebi osteoqondropaTiebi

bavSvTa da mozardi bavSvTa da mozardi

asakis sportsmenebSi asakis sportsmenebSi

Tbilisi

2012

2

uak (UDC) 616 71-002 k-336

monografia exeba bavSvTa da mozard sports-

menTa Soris osteoqondropaTiebis diagnostikis

da kompleqsuri aRdgeniTi mkurnalobis (medikamen-

turi, fizikuri da sxv.) problemas, rac saqarTvelo-

Si pirveladaa Seswavlili, wignSi amomwuravadaa

ganxiluli aRniSnuli paTologiis Taobaze arse-

buli literaturuli monacemebi, rac did daxmare-

bas gauwevs yvela im profilis eqims, visac uxde-

ba am daavadebiT avadmyofebTan muSaoba. SromaSi

warmodgenilia avtoris mier mowodebuli osteo-

qondropaTiebis diagnostikisa da reabilitaciis

axali meTodebi, romelTa meSveobiT SesaZlebe-

lia bavSvTa da mozard sportsmenebis droulad

gankurneba da sportSi dabruneba, rac dRemde aseve

problemad iTvleba.

redaqtori: profesori romanoz svaniSviliromanoz svaniSvili

Остеохондропатии у спортсменов детского и юношеского возраста

Osteochondropathy in childrens and adolescent athletes

© gamomcemloba

,,georgika”

ISBN 978-9941-0-3842-6

Tbilisi - 2012

3

SinaarsiSinaarsi

Sesavali ............................................................................................. 4

osteoqondropaTiebi .............................................................. 8

osteoqondropaTiebis medikamenturi

mkurnaloba .................................................................................... 29

osteoqondropaTiebis aRdgeniTi mkurnaloba

fizikuri meTodebiT ........................................................... 60

osteoqondropaTiebis aRdgeniTi mkurnaloba

kinezoTerapiis meTodebiT ............................................ 78

osteoqondropaTiebis mkurnalobis dros

sakvebSi biologiurad aqtiuri danamatebis

gamoyeneba ........................................................................................ 89

sakuTari gamokvlevebi ....................................................... 95

daskvna-rekomendaciebi .......................................................169

gamoyenebuli literatura .......................................... 173

4

SesavaliSesavali

problemis aqtualoba: osteoqondropaTiebi,

romlebic bavSvTa da mozardTa asakis sports-

menebSi gvxvdeba, sakmaod xSiri paTologiaa,

romlebic iwveven gardamaval asakSi am sports-

menebis sakmaod xangrZlivi droiT sportisagan

CamoSorebas (zogierTi avtoris monacemebiT 2

wlamdec).

Tanamedrove moTxovnebis gaTvaliswinebiT

sportul moRvaweobaSi xangrZlivi pauza

TiTqmis SeuZlebelia, radgan SemTxvevaTa umrav-

lesobaSi es profesiuli karieris dasrulebis

tolfasia.

literaturul monacemebSi Zalze mwir-

ia informacia bavSvTa da mozardTa asakis

sportsmenebSi osteoqondropaTiebis Sesaxeb.

es paTologia naklebad aris Seswavlili am

asakis sportsmenebSi da ar aris Camoyalibe-

buli erTiani koncefcia aRdgeniTi mkurnalo-

bis meTodebis Sesaxeb, xolo rac arsebobs ar

Seesabameba Tanamedrove moTxovnebs.

aRsaniSnavia, rom sportsmenTa da miT um-

etes, mozard sportsmenTa mkurnalobis sakiTxi

5

gansakuTrebul midgomas saWiroebs. mkurnalo-

ba unda iyos maqsimalurad efeqturi, unda

moicavdes drois rac SeiZleba mokle periods

da rac mTavaria, SeZlebisdagvarad unda iqnes

acilebuli qimiuri samkurnalwamlo saSuale-

bebis arasasurveli gverdiTi efeqtebi.

bavSvTa da mozardTa asakis pirebSi,

romlebic sportSi arian Cambulebi, osteo-

qondropaTiebidan yvelaze xSirad gvxvdeboda

didi wvivis Zvlis borcvis osteoqondropaTia,

e.w. osgus-Slateris daavadeba; quslis Zvlis

borcvis osteoqondropaTia e.w. hagland-Sincis,

hagland-severis daavadeba; terfis naviseburi

Zvlis osteoqondropaTia e.w. keleris daavadeba

I, fexis II-III TiTis falangis proqsimaluri os-

teoqondropaTia e.w. keleris daavadeba II.

amasTan erTad unda aRiniSnos am daavadeb-

is diagnostikis Tanamedrove kvlevis meTodebis,

simwire, rac gamowveuli unda iyos klinikuri

diagnostikis sakmaod didi sarwmunoebiT, gan-

sakuTrebiT osgud-Slateris daavadebis, Tumca

daavadebis sxvadasxva simZimis diferenciaciis

obieqturi kriteriumebi TiTqmis ar arsebobs.

aseve, SeiZleba aRiniSnos, rom bavSvTa

6

asakis sportsmenebSi, romlebsac awuxebT esa

Tu is osteoqondropaTia, mkurnalobis ambula-

toriuli kursis damTavrebis Semdeg pirdapir

ebmebian sportuli wvrTvnis procesSi, rac sak-

maod xSirad recidivebiT mTavrdeba da umetes

SemTxvevaSi kidev ufro gamwvavebuli formiT

yalibdeba. erTi sityviT ar iyo SemuSavebuli

fizikuri reabilitaciis specialuri kursi

diferencirebuli midgomiT. aseve Zalze mwiria

fizikuri reabilitaciis Sesaxeb monacemebi, rac

Cveni azriT Zalze aqtualuria.

literaturaSi ver movipoveT raime infor-

macia osteoqondropaTiebis dros specialuri

fizikuri datvirTvis testis arsebobis Sesaxeb

an konkretulad am daavadebisaTvis damaxasiaTe-

beli tkivilis Skalis arsebobis Sesaxeb, Tumca

calkeuli saxsrebis Sesaxeb sakmaod mravalf-

erovani informaciaa Skalebisa da specialuri

testebis Taobaze.

zemoT aRniSnulidan gamomdinare, aqtualuri

xdeba am procesebis ufro Rrmad Seswavlis miz-

niT osteoqondropaTiebis diagnostikaSi Tana-

medrove meTodebis ufro farTod CarTva, rac

Tavis mxriv saSualebas mogvcems SemuSavebuli

7

iqnas osteoqondropaTiebis aRdgeniTi kompleq-

suri mkurnalobis (avadmyofTa reabilitaciis)

axali sqema, romelic aamaRlebs mkurnalobis

efeqturobas da Seamcierebs reabilitaciis

vadebs. amasTan sakmaod aqtualuria martivi da

xelmisawvdomi specialuri testis SemuSaveba,

romlis gamoyenebac SesaZlebeli iqneba, ara-

marto Rrma samedicino gamokvlevebis dros,

aramed saeqimo-pedagogiuri dakvirvebis Catare-

bis procesSi, rac xSirad eqimisa da mwvrTnelis

erToblivi muSaobiT xorcieldeba.

sakmaod aqtualuria osteoqondropaTiebis

risk-faqtorebis gaTvaliswinebiT damatebiTi

orTopediuli RonisZiebebis Catareba da dRis

reJimTan erTad kvebis swori organizaciis

Camoyalibeba. aseve aqtualuria vitaminizaciisa

da sakvebis biologiurad aqtiuri danamatebis

(bad) sworad da usafrTxod SerCeva.

Cvens mier warmoebuli gamokvlevebis

mecnieruli siaxle imaSi mdgomareobs, rom

pirveladaa Seswavlili bavSvTa da mozardTa

asakis sportsmenebSi osteoqondropaTiebis

mkurnalobisas antihomotoqsikuri preparatebis

gamoyeneba da efeqturobis Sefaseba obieqturi

8

meTodebiT.

am SemTxvevaSi pirveladaa warmodgenili

osteoqondropaTiebis dros specialuri klini-

kuri Skala da specialuri fizikuri testi,

rogorc diagnostikis, ise mkurnalobis obieq-

turad klinikuri Sefasebis saqmeSi.

aseve pirveladaa Seswavlili osteoqondri-

opaTiebis kompleqsuri mkurnalobisa da fizi-

kuri reabilitaciis efeqtiurobis Sefasebis

kriteriumebi osteoqondropaTiebis dros.

aRniSnuli naSromis praqtikuli Rireb-

uleba mdgomareobs imaSi, rom praqtikulad

SemuSavebuli iqna kompleqsuri mkurnalobis

axali, originaluri meTodi antihomotoqsikuri

preparatebis CarTviT (lazeroTerapia, ultra-

fonoforezi, dietoTerapia, vitaminoTerapia,

kinezoTerapia), romelic ukve farTodaa gamoi-

yenebuli klinikur muSaobaSi. SemuSavebuli

iqna osteoqondropaTiebis dros tkivilis

mixedviT, klinikuri Skala klinikuri tkivi-

lis da Skalis mixedviT, specialuri testi,

romelic SeiZleba gamoyenebuli iqnes saeqimo-

pedagogiuri muSaobis dros.

9

osteoqondropaTiebiosteoqondropaTiebi

osteoqondropaTiebi da maTi etio-paTo-

genezi. osteoqondropaTia miekuTvneba daavade-

baTa jgufs, romelic gvxvdeba bavSvTa da

mozardTa asakSi da xasiaTdeba apofizebis

Rrublisebri nivTierebisa da grZeli lulo-

vani Zvlebis mokle epifizebis Taviseburi

cvlilebebiT. es cvlilebebi viTardeba hipo

- an avaskularul safuZvelze. Oosteoqon-

dropaTiebis etiologia bolomde garkveuli

ar aris, magram eWvgareSea, rom ganmeorebiTi

mikrotravmebi an erTjeradi travma, romelic

sisxlismimoqcevis da nervuli trofikis mo-

Slas iwvevs mniSvnelovan rols asrulebs

osteoqondropaTiebis ganviTarebaSi.

osteoqondropaTia ewodeba epifizebis

Rrublisebri nivTierebis da gaZvalebis

wertilebSi mimdinare nekrozul degener-

aciul procesebs. daavadeba gadis xuT sta-

dias: nekrozi, kompresiuli an impresiuli

motexiloba, fragmentacia, aRdgena, narCeni

movlenebi.

osteoqondropaTiebis gamomwvevi mizezi

10

mravalgvaria: araadeqvaturi meqanikuri dat-

virTva, Zlieri erTmomentiani travma, mik-

rotravma, sisxlZarRvovani da neiro – trofi-

kuli darRveva, nivTierebaTa cvlis darRveva.

daavadebis ganviTarebaze gavlenas axdens

agreTve sisxlZarRvebis meqanikuri dazianeba,

Trombozi, embolia sisxlis mimoqcevis Sem-

dgomi moSliTE(53. 149. 178.)B

paTologiuri procesis lokalizaciis

mixedviT ganasxvaveben 20 - ze meti saxis

osteoqondropaTiebs (293):

sasaxre zedapiris nawilobrivi osteoqon-

dropaTia (kionigis osteoxondriti).

freibergis daavadeba – fexis meore TiTis

proqsimaluri falangis osteoqondropaTia.

paneris daavadeba – iuveniluri madeformire-

beli osteoqondrozi, mxris Zvlis da sxivis

Zvlis Tavis deformacia. gvxvdeba adreul sas-

kolo asakSi. klinikurad: zewoliT tkivili,

moZraobis SezRudva idayvis saxsarSi.

hegemanis sindromi – idayvis saxsris midamos

aseptiuri nekrozi (mxris Zvlis Tavis, sxivis

Zvlis Tavis, mxris WaRi).

ditrixis daavadeba _ nebis Zvlebis dista-

11

luri Tavebis osteoxondropaTia.

osgud-Slateris daavadeba _ didi wvivis

apofizis osteoqondropaTia.

fridrixis sindromi – iSviaTi lokalizaci-

is epifizis aseptiuri nekrozi (laviwis Zvlis

sternaluri bolo).

Soermanis daavadeba (kalves daavadeba) –

welis malebis iuveniluri madeformirebeli

osteoqondrozi, - aseptiuri nekrozis forma.

pertes-kalve-legis daavadeba – barZayis

Zvlis Tavis iuveniluri madeformirebeli os-

teoqondropaTia.

peirsonis daavadeba – travmis Semdgomi bo-

qvenis simfizis nekrozuli ostiti.

budinger-ludlof-levenis sindromi –

kviristavis qondromalacia (zeda nawili).

larsen-iohansonis daavadeba – aseptiuri

nekrozis forma, kviristavis osificirebis dar-

Rveva (qveda nawili).

olbeqis daavadeba – Zvlis aseptiuri nekro-

zis forma, lokalizacia – barZayis medialuri

roki.

keleris daavadeba – terfis naviseburi Zv-

lis osteoqondropaTia.

12

keleris-freibergis daavadeba – fexis meore

TiTis proqsimaluri falangis osteoqondro-

paTia.

baCmanis (Buchman) daavadeba – TeZos Zvlis

wvetis osteoqondropaTia.

s. reinbergi (1964) ZvalSi paTologiuri

procesis lokalizaciasTan dakavSirebiT, ar-

Cevs osteoqondropaTiebis ramodenime saxes. es

aris apofizis osteoqondropaTia da sasaxsre

zedapiris nawilobrivi osteoqondropaTia.

literaturuli monacemebiT, bavSvTa da mo-

zardTa asakis pirebSi, romlebic sportSi ar-

ian Cabmulebi, osteoqondropaTiebidan yvelaze

xSirad gvxvdeboda didi wvivis Zvlis borcvis

osteoqondropaTia, e.w. osgus-Slateris daavade-

ba; quslis Zvlis borcvis osteoqondropaTia

e.w. hagland-Sincis, hagland-severis daavadeba;

terfis naviseburi Zvlis osteoqondropaTia

e.w. keleris daavadeba - I, fexis II-III TiTis

falangis proqsimaluri osteoqondropaTia e.w.

keleris daavadeba – II (268. 166).

gardamaval asakSi, sportSi moRvaweobis

pirvel wlebSi, mozardebSi xdeba kunTovani

masis momateba, sportuli dinamiuri stereoti-

13

pis Camoyalibeba, xSirad - kunTebis gadaZabva.

amave dros, pubertatul periodSi mimdinareobs

mozardTa organizmis aqtiuri zrda. udaoa, rom

es pirvel rigSi sayrden-mamoZravebeli, kerZod

ki Zvlovani sistemis xarjze xdeba. sxeulis

sigrZis mateba upiratesad xdeba qvemo kidu-

rebis xarjze, vidre xerxemlis svetis zrdis

xarjze.

aqedan gamomdinare, adgili aqvs kidurebis

kunTebisa da myesebis zrdaSi CamorCenas da

kompensatorulad maT gaWimvas, ris Sedegadac

didi wvivis borcvze kviristavis sakuTari

iogis mimagrebis adgili mudmiv datvirTvas

ganicdis. mozard organizmSi mimdinare es pro-

cesebi qmnian osteoqondropaTiis ganviTarebis

safuZvels (17. 26. 27. 29. 56).

fizikuri varjiSi, sportiT dakaveba, ze-

gavlenas axdens lulovan Zvlebze, maTi zrdis

zonis daxurvamde (osifikaciamde). rogorc

cnobilia mxris Zvalze zrdis zona ixureba

13-14 wlis asakSi, idayvis saxsarSi – 15-17 wlis

asakSi, muxlis saxsarSi – 20 wlisTvis, didi

wvivis apofizi osifikacias ganicdis 13-14 wlis

asakSi, barZayis Zvali – 18 wlisTvis. zemo kidu-

14

rebis zogierT Zvalze 25 wlis asakSi SeimCneva

epifizaruli xazebi (112. 140. 141).

lulovani Zvlis centralur-Rerovan nawils

warmoadgens diafizi, xolo misi calkeuli

bolo – epifizs. osifikacia, ris Sedegadac

xrtili gardaiqmneba Zvlis struqturad, iwyeba

diafizidan. xrtili, romelic unda gardaiqm-

nas Zvlad, dafarulia fibrozuli membraniT

– periqondriiT. osifikacia iwyeba maSin, rode-

sac am membranaSi warmoiqmneba sisxlZarRvebi.

vaskulirebul periqondrias, ewodeba periosti

(Zvlissazrdela), xolo misi qondrocitebi

(xrtilovani ujredebi) gardaiqmnebian osteo-

blastebad (ujredebi, romlebic warmoqmnian

Zvals). osteoblastebi gamoyofen nivTierebas,

romlebic diafizis garSemo warmoqmnian Zvlo-

van rgols an sayelos. amavdroulad diafizis

centraluri nawilis xrtilovani ujredebi

ganicTian rTul gardaqmnebs, romlis Sedegia

Zvlis kalcifikacia. Zvlis warmoqmnis es ubani

osifikaciis ZiriTadi centria. xrtilovani qso-

vili ganicdis sigrZeSi zrdas da gamsxvilebas,

xolo Zvlis warmoqmnis da periostis ganvi-

Tarebis procesi, romelic iwyeba osifikaciis

ZiriTadi centridan, ,,miemarTeba’’ epifizisaken

(111, 142, 89, 11).

15

osifikacia da Zvlebis zrda sruldeba

maSin, rodesac xrtilovani ujredebi wyveten

ganviTarebas, xolo epifizaruli firfita icv-

leba ZvliT. amas mohyveba diafizis epifizTan

Sezrda, romlis Semdeg Zvlis sigrZeSi zrda

SeuZlebelia. biWebSi didi wvivis Zvlis dista-

luri epifizis osifikacia sruldeba 17 wlis

asakSi, xolo proqsimaluri epifizi – 20 wlis

asakSi. gogonebSi osifikacia sruldeba 2-3

wliT adre. sxvadasxva Zvlebis osifikaciis sa-

Sualo asaki meryevia; rogorc wesi osifikacia

iwyeba 10 wlidan da mTavrdeba 20 wlis asakSi.

saSualod, gogonebis Zvlovani struqturis

momwifeba sruldeba ramodenime wliT adre (11.

138. 142. 165).

grZeli lulovani Zvlebis Camoyalibebis

struqtura sakmaod rTuli procesia. Zvali

– cocxali qsovilia, romelic saWiroebs mkve-

bav nivTierebebs, amitom igi kargad maragdeba

sisxliT. kalciumis marilebis, ZiriTadad ka-

lciumis fosfatisa da karbonatis Calagebis

Sedegad Zvali warmoadgens mkvriv da Zlier

struqturas. amitom kalciumi aris Zvlis Ziri-

Tad sakveb-samSeneblo masala, gansakuTrebiT

16

ki zrdis procesSi. sisxlSi kalciumis maRa-

li Semcvelobis dros, misi nawili Sesanaxad

lagdeba ZvlebSi. xolo, rodesac kalciumis

done qveiTdeba, adgili aqvs Zvlebis rezorbcias

da kalciumi gamoiyofa sisxlSi. travmis da

Zvalze mniSvnelovani datvirTvis dros masSi

lagdeba kalciumis meti raodenoba. raciona-

lur kvebasTan Sexamebuli fizikuri datvirTva

aucilebeli pirobaa Zvlis normaluri zrdisT-

vis. Tumca fizikuri datvirTvebi ar moqmedeben

Zvlebis sigrZeze, magram zrdian maT siganes

da simkvrives, da matriqsSi didi raodenobiT

mikroelementebis CalagebiT zrdian Zvlebis

siZlieres (11. 137. 166. 270. 291. 295).

8-16 wlis asakSi didi wvivis apofizi

SedarebiT mgrZnobiarea travmebis mimarT da

ganmeorebiTi mikrotravmebs mivyavarT misi

struqturis cvlilebamde (150).

xangrZlivi gadaWarbebuli fizikuri da

emocionaluri datvirTvis SemTxvevaSi, zogjer

adgili aqvs gadaRlas da gadaZabvas. orive es

mdgomareoba SeiZleba gamoxatuli iyos sxva-

dasxva xarisxSi, da TiToeul maTgans gaaCnia

specifikuri maxasiaTeblebi. gadaZabva SeiZleba

17

moxdes sayrden-mamoZravebeli aparatis sxva-

dasxva adgilas. sayrden-mamoZravebeli aparatis

Zlieri, mravaljeradi, gadaZabva da erTi saxis

ganmeorebiTi datvirTvebi warmoadgenen zez-

Rurblovan gamaRizianebels, romlebic iwveven

adgilobrivi qsovilebis uSualo dazianebas.

refleqtorulad adgili aqvs funqciis dar-

Revas da adgilobrivi da zogad reaqciebis ga-

Zlierebas. es gamoixateba sisxlZarRvovani cv-

lilebebiTa da nivTierebaTa cvlis darRveviT.

SemdgomSi ki viTardeba qsovilebis trofikis

moSla da morfologiuri cvlilebebi (14. 13.

21. 29. 258).

erTgvarovani da zezRurblovani datvirT-

vebis Sedegad kunTebis myesebSi gadasvlisa da

Zvlovan qsovilze myesis mimagrebis adgili

ganicdis gadaZabvas. es xSirad axalgazrda

sportsmenebSi iwvevs tkivils da aiZulebs maT

Sewyviton varjiSi. ultrastruqturebis cvli-

lebebis xasiaTma, adgilobrivi sisxlis mimoqce-

visa da sxvadasxva formis paTologiuri pro-

cesebis Seswavlam, romlebic viTardeba myesis

irgvliv, myesovan qsovilSi, myesis Zvalze da

Zvlissazrdelaze mimagrebis adgilas Zvlovan

18

qsovilSi aCvena, rom ujredul da subujredul

doneze adgili aqvs bioqimiuri procesebis

cvlilebebs – dismetabolizms. myesis Zvalze

da Zvlissazrdelaze mimagrebis adgilas vi-

Tardeba mikrogaglejebi, mikrosisxlCaqcevebi,

mimdinareobs degeneraciuli cvlilebebi da

yalibdeba uxeSi nawiburovani qsovili, romel-

ic iwvevs tkivils da aqveiTebs sportsmenis

Sromisunarianobas (105. 106. 107. 259. 300).

Zvlovani sistemis ganviTarebis procesSi

fiziologiurad adgili aqvs kalciumis da

sxva mikroelementebis gaZlierebul moxmare-

bas (225). mozard sportsmenebSi gazrdili

fizikuri datvirTvebis fonze, Tu ar moxdeba

mikroelementebis danaxarjis adeqvaturi aR-

dgena, ganviTrdeba maTi zogadi cvlis moSla.

amas emateba adgilobrivi mikrocirkulaciisa

da mineraluri cvlis darRveva. yvelaferi es

iwvevs gaZvalebis procesis darRvevas, xrtilo-

van qsovilze mikrobzarebis gaCenas da mZime

SemTxvevebSi Zvlis aseptiuri nekrozis ganviT-

rebas — yalibdeba osteoqondropaTia (53. 81.

82. 169. 149. 225. 244).

literaturaSi ver movipoveT raime infor-

19

macia osteoqondropaTiebis dros specialuri

fizikuri datvirTvis testis arsebobis Sesaxeb

an konkretulad am daavadebisaTvis damaxasiaTe-

beli tkivilis Skalis arsebobis Sesaxeb, Tumca

calkeuli saxsrebis Sesaxeb sakmaod mravalf-

erovani informaciaa Skalebisa da specialuri

testebis mxriv: (15)

1. muxlis saxsris Sefasebis Skala (J.N. Insall

da Tanaavtorebi 1976 w.).

2. muxlis saxsris sazogadoebis Sefasebis

klinikuri sistema (J.N. Insall da Tanaavtorebi

1989 w)

3. bristolis Skala muxlis saxsrisaTvis

(J. Mackinnon Tanaavtorebi 1988 w.)

4. muxlis saxsris Skala balebis mixedviT

(D.B. Kettelkamp da Tanaavtorebi 1975 w.)

5. muxlis saxsris balebis Skala lisholmis

mixedviT (Y.Tegner, J. Lysholm 1985 w.)

6. muxlis saxsris osteoarTrozis da

travmis gamosavlis Skala (J. davson, E.M. Roos da

Tanaavtorebi 1998 w.)

didi wvivis Zvlis apofizisdidi wvivis Zvlis apofizis osteoqondro-

paTia (osgud-Slateris daavadeba). osgud-Sla-

teris daavadeba pirvelad aRwerilia Oosgudis

20

mier 1903 wels. xolo 1908 wels Slateris

mier. bulgareTSi es daavadeba aRwerili iqna

boiCevis mier 1934 wels. ZiriTadad avaddebian

vaJebi (SefardebiT 4/1), 10-15 wlis askSi. Oosgud-

Slateris daavadeba Zalian xSirad viTardeba

mozard sportsmenebSi, sportuli moRvaweobis

pirvel wlebSi. ø muxlis saxsris funqcia ar

irRveva. Ddaavadeba aris rogorc calmxrivi,

aseve ormxrivi. daavadebis mimdinareoba da

gamosavali keTilsaimedoa, zogierT SemTxvevaSi

adgili aqvs apofizis nawilis avulsiur motex-

ilobas. mkurnaloba ZiriTadad konservatiulia

da upirvel yovlisa gulisxmobs fizikuri dat-

virTvis srul Sewyvetas, zogierT SemTxvevaSi

or wlamdec ki (149). zogierTi literaturuli

monacemebiT, paTologiuri procesi mimdinare-

obs oTx stadiad: iSemiur nekrozuli, revasku-

larizaciuri, aRdgeniTi stadia da epifizis

gaZvalebis stadia (13. 14. 149).

klinikuri suraTidan wamyvani simptomia

tkivili didi wvivis borcvis midamoSi fizikuri

datvirTvisas da mis Semdeg, romelic Zlierdeba

Cajdomisas, kibeze asvlisa da Casvlis dros

(nebismieri moZraoba, romelic kvirisTavis saku-

21

Tari iogis daWimvas iwvevs, tkivils aZlierebs).

aRniSnuli midamo SeSupebulia da palpaciisas

mtkivneuli (44. 296).

aRsaniSnavia, rom arsebobs am daavadebis

mimdinareobis zogierTi asimptomuri forma,

romlis drosac ar arsebobs tipiuri Civilebi

da obieqturi cvlilebebi da romlebic zrdis

damTavrebis Semdeg mJRavndebian, rogorc patella

alta. xSirad gvxvdeba SedarebiT mZime Sedegebic.

organizmis zrdis dros, Zlieri fizikuri dat-

virTvebis zegavleniT (gansakuTrebiT barZayisa

da kanWis kunTebis), didi wvivis da barZayis

epifizaruli zonaze warmoiSoba araadekvaturi

zewola, rasac mivyavarT aramarto patella alta-s,

aramed genu recurvatum-mde, romlebic aReniSnebaT

sportuli karieris sawyis etapze: morbenlebs,

fexburTelebs (93. 178).

diagnozs adasturebs rentgenologiuri

gamokvleva. vlindeba didi wvivis borcvis

Crdilis gafarToeba, Zvlis fragmentacia, adgi-

lobrivad osteoporozis arseboba. zogirTi

avtorebi Tvlis, rom daavadebis klinikuri

diagnistika ufro sarwmunoa, vidre rentgenolo-

giuri. rentgenologiuri monacemebis Sefasebi-

22

sas aucilebelia didi wvivis Zvlis apofizis

osifikaciis variantebis gaTvaliswineba fiz-

iologiurad arsebuli uTanabroba). amitom

diagnozi ufro klinikur monacemebs eyrdnoba.

rentgenogramebze myesebis ZvalTan mimagrebis

adgilebze Cans Zvlissazrdelisa da myesebis

osifikacia, romelic ConCxovani muskulaturis

muSaobis mudmivi daZabulobiTaa gamowveuli

(22. 227. 281).

diferancialuri diagnozi tardeba motexi-

lobasTan, xrtilis simsivnesTan,n, infrapate-

larul bursitTan, osteomielitTan (12).

ultrasonografiuli gamokvlevisas

kviristavzeda sinovialur abgaSi fiqsirdeba

umniSvnelo raodenobiT gamonaJonis arseboba,

gamonaJoni fiqsirdeba agreTve sasaxsre Can-

Tis jibeSi. kviristavzeda sakuTari iogis

distaluri midamo deformirebulia, sisqeSi

momatebuli, mis sisqeSi fiqsirdeba didi wvivis

apofizis fragmentebis arseboba. apofizis Zv-

lovani zedapiri araTanabarkonturiania. fe-

radi kartirebiT vlindeba mcired gamoxatuli

vaskularizacia, nakadi arteriuli tipis. hia-

linuri xrtilis sisqe Semcirebulia, eqogenoba

23

momatebuli, wvril-marcvlovania (214. 187. 215).

literaturuli monacemebiT mkurnaloba

ZiriTadad konservatiulia, rac gulisxmobs

yovelgvari datvirTvis srul Sewyvetas, niko-

tinis da sxvadasxva samkurnalwamlo saSuale-

bebis (eufilinis, askorbinis mJavis, kalciumisa

da novokainis narevis) eleqtroforezs, sisx-

lis mimoqcevis gaumjobesebis mizniT fizioT-

erapiuli procedurebs, (u.m.s.-Terapia, diaTermia

mudmivi magnituri veliT), 8-10 procedura.

reparaciis stadiaSi aRniSnulis fonze unda

midiodes zogadgamajansaRebeli mkurnaloba

(polivitaminebi, kalciumis glukonati, vita-

minebiT da cilebiT mdidari kveba). tkivilis

gamwvavebis dros zogierTi avtori saWirod

Tvlis 2-3 kvirian TabaSiriT imobilizacias,

vazodilatatorebs. zogierTi Tvlis apofizis

gaZvalebis stimulacias Beck-is miTodiT. 1

weli fizikuri datvirTvebidan ganTavisufleba,

fizio da medikamentozuri Terapia, vitaminoT-

erapia – gansakuTrebiT E vitamini, kalciumisa da

fosforis Semcveli srulfasovani dieta, xolo

gamoxatuli tkivilebisas hidrokortizonis

ineqciebs. Zilis win efeqturia gamaTbobeli

24

kompresi ronidaziT. Zalian efeqturia kvarcis

eriTemuli dozis daniSvna 3-5 seansi. avtorTa

garkveuli nawili miuReblad miiCnevs kortiko-

steroidebis gamoyenebas da fizioTerapiuli

procedurebis aucileblobasac gamoricxavs.

ämkurnalobis xangrZlivobaa 2-Tvidan 24 Tvemde

(saSualod 12 Tve). efeqturoba ar aRemateba 44%,

Tumca sakmaod xSiria recidivebi. rac Seexeba

mkurnalobis qirurgiul meTods, aRsaniSnavia

didi wvivis borcvis kanalizaciis operacia,

kviristavis sakuTari iogis gaswvrivi gakveTa,

masinosTozirebeli operaciebi da agreTve didi

wvivis Zvlis fragmentebis mocileba, romleb-

mac SeiZleba saxsris rekurvaciis ganviTareba

gamoiwvios. qirurgiuli mkurnaloba gamoiyeneba

im SemTxvevaSi, roca adgili aqvs fragmentacias

(fragmentis mocilebas) (237. 238. 239. 240. 290.

299. 304. 319)

quslis Zvlis borcvisquslis Zvlis borcvis osteoqondropaTia

(hagland-seviris, hagland-Sincis daavadeba). qus-

lis Zvlis apofizis osteoqondropaTia aRwer-

ilia P. Haglund-is mier 1907 wels da H. Schinz-is

mier 1922 wels. bavSvebSi iSviaTia. daavadeba

iwyeba mwvave an TandaTanobiT mzardi tkiviliT

25

quslis Zvlis borcvis midamoSi, ZiriTadad

datvirTvis Semdeg. borcvis areSi viTardeba

SeSupeba anTebis niSnebis gareSe. palpaciisas

an terfis gaSlisas quslis am midamosi Tavs

iCens gamoxatuli tkivili. avadmyofi cdilobs

siarulisas terfis wina nawils daeyrdnos (255.

292. 312).

rentgenologiuri diagnostikis siZneleebi

dakavSirebulia imasTan, rom normaSi bavSvebSi

quslis Zvlis apofizs aqvs daaxloebiT oTxi

gaZvalebis birTvi, amaTgan Suamdebare, rogorc

wesi gamkvrivebulia. quslis Zvlis da apofizis

zedapirebi araTanabari (235).

quslis Zvlis apofizis osteoqondropaTi-

isaTvis yvelaze metad damaxasiaTebelia gamkvr-

ivebuli gaZvalebis birTvis Wreli struqtura.

saWiroebs diferenciacias aqilobursitisagan,

tendoperiosteopaTiisagan, quslis dezisagan

(330).

mkurnaloba konservatiulia. gamoxatuli

tkivilisas rekomendebulia TabaSiris longet-

iT fexis imobilizacia da datvirTvis gamor-

icxva (264).

medikamentozuri mkurnaloba gulisxmobs

26

novokainis eleqtroforezs, sisxlZarRvebis

dilatatorebs. gamoiyeneba agreTve diaTermia,

ultrabgeriTi Terapia, gamaTbobeli kompresebi.

tkivilebis likvidaciis Semdeg dasaSvebia ki-

durebis datvirTva, aucilebelia specialuri

fexsacmelis tareba farTo mdgradi qusliT

da supinatoriT (206. 210. 252. 323).

terfis naviseburi Zvlisterfis naviseburi Zvlis osteoqondropa-

Tia (keleris daavadeba I). daavadeba pirvelad

aRweriliaAA. Köhler-is mier 1908 wels. daavadeba

iSviaTia, avaddebian bavSvebi 8-12 wlis asakSi.

procesi SesaZlebelia ormxrivi iyos. mikrosko-

pulad damtkicebulia naviseburi Zvlis nekrozi

da mfarveli xrtilis struqturis SenarCuneba

(13. 269. 288).

daavadeba iwyeba tkiviliT terfis SigniTa

zedapirze, koWlobiT. palpaciiT vlindeba Se-

Supeba naviseburi Zvlis saproeqcio areSi. Ses-

aZlebelia Ramis tkivilebis arsebobac. bavSvi

cdilobs siarulis dros daeyrdnos terfis

gareTa zedapirs. daavadebis xangrZlivobaa 8-12

Tvidan 1-2 wlamde (169).

rentgenologiuri suraTi sawyis stadiebze

xasiaTdeba osteoporoziT, Semdeg naviseburi

27

Zvlis gaZvalebis birTvis zomebis SemcirebiT,

gamkvrivebiT, gabrtyelebiT da fragmentaciiT

(268).

diagnozis dadgenisTanave aucilebelia

datvirtvis sruli moxsna. terfs afiqsireben

TabaSiris longetiT, erTdroulad mimarTaven

fizioTerapiul procedurebs: sisxlZarRvebis

dilatatorebis eleqtroforezi, ultrabgeriTi

Terapia, diaTermia (179. 68. 234).

SeSupebisa da tkivilis alagebis Semdeg

dasaSvebia siaruli supinatoriani fexsacmliT.

procesis srul Cacxromamde datvirTva akrZa-

lulia (178).

metatarzaluri Zvlis Tavismetatarzaluri Zvlis Tavis osteoqondropa-

Tia (keleris daavadeba II). daavadeba aRwerilia

A. Köhler-is mier 1920 wels. ZiriTadad gvxvdeba

mdedrobiTi sqesis warmomadgenlebSi 10-20 wlis

asakSi. daavadebis safuZvels warmoadgens II,

ufro iSviaTadad ki III metatarzaluri Zvlis

Tavis aseptiuri nekrozi, Zalzed iSviaTad Ses-

aZlebelia procesi orive Zvals Seexos (13.14).

daavadeba iwyeba winaterfis II-III Zvlebis

tkiviliT, romelic Zlierdeba siarulisas da

palpaciisas. terfis gareTa zedapirze Cndeba

28

SeSupeba. avadmyofebi cdiloben siarulis dros

daeyrdnon qusls, raTa moixsnas datvirTva

terfis wina nawilze. tkivili moicavs drois

xangrZliv periods, Semdeg TandaTanobiT misi

intensivoba klebulobs. mogvianebiT periodSi

tkivilis GgaZlierebis mizezi SesaZlebelia

madeformirebeli osteoarTrozis warmoSoba

gaxdes (53. 178. 268. 269).

rentgenologiurad vlindeba metetarzaluri

Zvlis Tavis gamkvriveba da dadableba, Semdeg

igi Wrel rentgenologiur suraTs iZens, far-

Tovdeba sasaxsre naprali. sabolood Zvlis

Tavis sruli aRdgena ar xdeba (53).

mkurnaloba konservatiulia. mwvave tkivi-

lis da SeSupebis arsebobisas rekomendebulia

TabaSiris modelirebuli longetiT fexis

imobilizacia.

erTdroulad tardeba novokainisa da vazo-

dilatatorebis eleqtroforezi. gamoiyeneba

agreTve ultrabgera, diaTermia, ozokeritisa

da talaxis aplikaciebi, gamTbobi kompresebi

(234. 301).

mwvave periodis gavlis Semdeg rekomendebu-

lia orTopediuli fexsacmlis tareba, romelic

gantvirTavs terfis wina nawils (294).

29

osteoqondropaTiebis medikamenturi osteoqondropaTiebis medikamenturi

mkurnalobamkurnaloba

antihomotoqsikuri Terapiaantihomotoqsikuri Terapia

antihomotoqsikologia. homotoqsikologia

aris ori sityvis kompozicia da niSnavs swav-

lebas homotoqsinebis Sesaxeb. igi samedicino

azrovnebis erT-erTi uaxlesi mimarTulebaa da

daavadebis mkurnalobaSi Tanamedrove medicinis

miRwevebisa da homeopaTiuri midgomis sinTezs

warmoadgens.

organizmis cxovelmyofeloba damokidebu-

lia masSi qimiur SenaerTTa gardaqmnis mimdin-

are procesebze. amgvarad, qimiur nivTierebebs,

organizmis janmrTeli da daavadebuli mdgo-

mareobis gansazRvrisas gadamwyveti mniSvnelo-

ba aqvs.

toqsikur nivTierebebs, romlebic iwveven

adamianis organizmis damcvelobiTi sistemis

ukuqmedebas da daavadebis sxvadasxva fazebs,

ewodeba homotoqsinebi (99. 119. 133. 175).

organizmi (bertalanfis mixedviT) warmoad-

gens Txevad sistemas. nivTiereba, xvdeba ra or-

ganizmSi, axdens masze zemoqmedebas, TviTonac

30

gardaiqmneba da gamoidevneba gareT. rigi niv-

Tierebani gadaitaneba organizmis mier da ar

iwvevs am Txevadi sistemis wonasworobis dar-

Rvevas. zogierTi toqsikuri nivTiereba, xvdeba

ra organizmSi, monawileobs organizmis cx-

ovelmyofelobaSi da iwvevs sapasuxo reaqcias

damcvelobiTi sistemis mxridan, romelic h.h.

rekevegma gansazRvra rogorc daavadeba.

daavadeba aris organizmis biologiurad

mizanmimarTuli damcvelobiTi reaqciebi endo-

genuri da egzogenuri homotoqsinebis sawinaaRm-

degod, agreTve toqsikozebis mimarT organizmis

mxridan kompensirebis mcdeloba (85. 211).

Aarsebobs antihomotoqsikur samkurnalo

saSualebaTa 4 jgufi:

1. kombinirebuli preparatebi – Seicaven

ramdenime potencirebul erTeul nivTierebas.

(mag. Traumeel-S, Osteoheel-S)

2. sxvadasxva homeopaTiuri erTeuli saSu-

alebebis potenciaTa akordi. (atarebs damatebas

“injeel” da “forte”) – Tavis SemadgenlobaSi Seicavs

ZiriTadad dabal potencias, xolo SesaZlebel

pirvelad reaqciaTa Sesafaseblad, damatebiT

maRal da umaRles potenciebs.

31

3. homakordebi – iqmneba sxvadasxva erTeu-

li homeopaTiuri saSualebebis potenciebis

akordis kombinaciiT, romlebic gaerTianebulia

erTian preparatebad.

4. sxvadasxva homeopaTiur erTeul saSuale-

baTa erTeuli potenciebi. (mag. Placenta compositum)

(160).

Osteoheel-S.

SemadgenlobaSemadgenloba: tableti Seicavs: Hekla Lava D6,

Kalium jodatum D4, Asa foetida D4, Stilingua silvatica D4,

Aranea diadema D6, Natrium sulfuricum D4 – Sesabamisad

30 mg; Mercurus praecipitatus ruber D9, Calcium phosphori-

cum D6 – Sesabamisad 60 mg: aseve Lactose-Monohydrat

da Magnesiumstearat.

preparats gverdiTi efeqti ar gaaCnia

Osteoheel-S iniSneba periostitebis, egzosto-

zebis, quslis dezis, otoskleroziT gamowveuli

yurebis Suilis. Zvlebis da SemaerTebeli qso-

vilis sxvadasxva daavadebebisas,

mocemuli preparati naCvenebia ostite-

bisa da osteomielitebisas (antibiotikebiT

mkurnalobasTan erTad; am SemTxvevaSi to-

qsinebis gamoyofas xels uwyobs penicilini).

32

Osteoheel-S gamoyeneba Zvlis fistulebisas, kbi-

lis tkivilisa da parodontozisas (Traumeel-S-

Tan erTad), orsulobis dros kalciumis cvlis

moSlisas, osteomalaciisas (Hormeel-S, Psorinoheel

N, Galium Heel-Tan da sxvasTan erTad).

osteoqondrozisas Osteoheel-S zemoqmedebas

aZlierebs Semdegi preparatebi: Colocynthis Homa-

cord, China Homacord-S, Traumeel-S, xolo osteoskle-

rozisas Barijodeel da sxva.

Osteoheel-S gamoerCeva didi raodenoba Cven-

ebebiT da gamoyenebuli unda iqnes daavadebis

sxvadasxva fazebSi, gansakuTrebiT SemaerTebeli

qsovilis daavadebebisas, rodesac gamoxatulia

gansazRvruli diskraziuli komponentebi (si-

filisi, retoqsikaciuri impregnaciis Sedegebi,

SemaerTebeli qsovilis Sesusteba deponire-

bis fazebisas naklebi winaaRmdegobis mqone

adgilebSi – Locus minoris resistentia), mag., gacivebis

Sedegad gamowveuli Zvlissazrdelas infil-

traciisas, aseve, degeneraciuli cvlilebebi-

sadmi midrekilebisas.

Osteoheel-S SeiZleba gamoyenebuli iqnes feri-

Wamiebis da Traumeel-S-iT winaswar Catarebuli

TerapiiT arsebuli daCirqebisas. aseTi SemTx-

33

vevebisas es preparatebi iniSneba monacvleobiT

(7. 160. 175).

Placenta compositum

SemadgenlobaSemadgenloba: 2.2 ml-iani erTi ampula Sei-

cavs: Placenta suis D6, Embrio suis D8, Vena suis D8, Ar-

teria suis D10, Funiculus umbilicalis suis D10, Hypophysis

suis D10, Secale cornutum D4, Acidum sacrolacticum D4,

Tabacum D10, Strophantus D6, Aesculus D4, Melilotus of-

fi cinalis D6, Cuprum sulfuricum D6, Natriumpyruvat D8,

Baryum carbinicum D13, Plumbum jodatum D18, Vipera berus

D10, Solanum nigrum D6 – Sesabamisad 22 mkl. aseve

saineqcio xsnari natriumqloridi.

CvenebaCveneba: periferiuli sisxlis mimoqcevis

stimulireba arteriosklerozis, tambaqos wevis

da Saqriani diabetis Sedegad gamowveuli qveda

kidurebis gangrenis, gangrenozuli wylulebis,

elefantiazis, nawolebis, dismenoreis, vegeta-

tiuri distoniis, endarteriitis, endometritis,

encefalitis da insultis Semdgomi narCeni

movlenebis, SigniTa yuris daavadebebis Sed-

egad gamowveuli siyruis. gverdiTi efeqti ar

gaaCnia.

Placenta compositum iniSneba agreTve, nivTiere-

34

baTa cvlis gasaaqtiureblad kvanZovani er-

iTemis, emboliis, qronikulad civi kidurebis

dros. rogorc damatebiTi saSualeba – nevroze-

bis, Sakikis, nevralgiebis, mastodiniis, kunTovani

revmatizmis da kuSingis sindrimisas.

sxvadasxva organoebidan miRebuli

gamonawvlilis da biologiuri saSualebebis

SeTavseba Tavis tvinis da gulis sisxlis mimo-

qcevaze mastimulirebel zemoqmedebas axdens.

Placenta compizitum da Aesculus compositum-iT

Catarebuli Terapia naCvenebia ara marto perife-

riuli sisxlis mimoqcevis gasaumjobeseblad,

aramed arteriosklerozis, Sakikebis, masto-

diniis, kanis daavadebebis gamovlinebisas, radgan

Semadgeneli preparatebis aseTi SeTanxmebisas

SemaerTebeli qsovilidan gamoiyofa homo-

toqsinebi. organoebis toqsikuri dazianebisas

damatebiT iniSneba Hepar compositum (RviZli), Cor

compositum (guli), Solidago compositum S (Tirkmelebi),

Discus compositum (xerxemali), Coenzym compositum,

Ubichinon compositum (fermentuli sistemis stimu-

lireba).

preparati mwvave SemTxvevisas iniSneba

yoveldRe, Cveulebriv 1-3-jer kviraSi erTi am-

35

pula kunTSi, kanqveS, kanSi da aucileblobisas

venaSi (7. 99. 124. 160. 175).

Traumeel-S

SemadgenlobaSemadgenloba: preparati Traumeel-S-i warmoad-

gens homeopaTiur saSualebas, romlis Semadgen-

lobaSic Sedis 12 mcenareuli da 2 mineraluri

warmoSobis komponenti.

100 g malamo Seicavs: Arnica D3 – 1.5 g, Calendula

, Hamamelis - Sesabamisad 0.45 g; Echinacea angustifolia

, Echinacea purpurea , Chamomila – Sesabamisad

0.15 g; Symphytum D4, Bellis perennis – Sesabamisad

0.1 g; Hypericum D6, Mellifolium – Sesabamisad 0.09

g; Belladona D1, Aconitum D1 – Sesabamisad 0.05 g;

Merculius Hahnemanni D6 – 0.04 g, Hepar sulfuris D6 0.025

g. eTanoliT stabilizirebuli hidrofiluri

malamo (DAB). 12.5 vol % Ethanol.

CvenebaCveneba: daJeJilobebi, sxvadasxvagvari da-

zianebebi (sporti, satransporto SemTxveva),

daWimuloba, motexilobebi, kontuziebi, sisxl-

Caqcevebi, anTebiTi da degeneraciuli procesebi

sxvadasxva organoebsa da qsovilebSi (paro-

dontiti, parodontozi, RrZilebis daCirqeba),

gansakuTrebiT, sayrden-mamoZravebel aparatSi

36

(tendovaginiti, bursiti, mxris epikondiliti),

arTrozebi.

winaaRmdeg Cvenebaa - momatebuli mgrZno-

beloba mcenare arnikas mimarT.

preparati iniSneba sxvadasxva saxis travme-

bis, rbili qsovilebis revmatizmisas, malTaSua

diskebis da xerxemlis sxva degeneraciuli

daavadebebisas, romelsac Tan axlavs Sesabami-

si vertebrogenuri simptomatika; darCirqebiT

mimdinare anTebebisas, mag. saofle jirkvlebis

abscesi, furunkulebis, karbunkulebis, mastitis,

parodontozis, daCirqebul fistulebis, wvivis

wylulis, ekzemebis, neirodermitis dros.

mocemuli preparati naCvenebia aseve, sul-

fiduri fermentebis aqtivaciisaTvis, mag. alo-

paTiuri mkurnalobis uaryofiTi Sedegebis da

degeneraciuli daavadebebisas; miokardiumis

infarqtis Semdgomi Terapiisas (proTrombinis

regulacia) (7. 124. 160).

Traumeel-S-is zemoqmedebis meqanizmi masSi

Semavali mcenareuli da mineraluri komponen-

tebis Semdegi TvisebebiT ganisazRvreba:

1. vercxliswylis Semcveli komponentebis

moqmedeba anTebiTi da virusuli daavadebebi-

37

sas;

2. sisxlZarRvebis tonusis momateba (Aco-

nitum, Arnika), sisxlZarRvebis gamkvriveba (ka-

lciumi), venozuri Segubebis moxsna, Trombis

warmoqmnis ukuqmedeba (Hamamelis), sisxldenis

SeCereba (Millifolium);

3. ujredovani sunTqvis da Jangva-aRdgeniTi

procesebis gaumjobeseba kalciumis sulfidis

da kalciumis polisulfidis meSveobiT (Hepar

sulfuris);

4. didi damcvelobiTi meqanizmis stimuli-

reba;

5. Wrilobis Sexorcebis gaaqtiveba; Sokuri

mdgomareobis daZleva fitoTerapiis meSveobiT

(Arnica, Calendula, Echinacea, Symphytum), ,,normaluri

da srulfasovani’’ Cirqis warmoqmna;

6. tkivilgamayuCebeli efeqti (Aconitum, Arnica,

Chamomila, Hamamelis, Hypericum);

7. sisxldenis SeCereba (Aconitum, Arnica,

Hamamelis (venuri), Hypericum, Millefolim (arte-

riuli).

Traumeel S-is ZiriTadi moqmedeba: maregeneri-

rebeli – arTrozis, motexilobis, epikondilitis,

38

tendovaginitis.

1. antieqsudaciuri – rbili qsovilebis

revmatizmis, travmis, operaciis Semdgomi, tavis

tvinis Seryevis Semdgomi, arTrozebis, saxsar-

Sida da rbili qsovilebis hematomebis, ten-

dovaginitis, bursitis, otitisas;

anTebis sawinaaRmdego – bursitis, epikondil-

itis, stiloiditis, tendovaginitis, otitisas (70.

160. 199. 329).

preparati Traumeel-S germaniaSi cnobilia

1937-wlidan, Traumeel-S-is gamoyenebis SesaZle-

blobebi dakavSirebulia mis anTebisawinaagm-

dego, analgeziur, SeSupebis sawinaaRmdego,

antieqsudaciur moqmedebasTan. igi farTod

gamoiyebeba sayrden-mamoZravebeli sistemis sx-

vadasxva daavadebebis dros (168).

Traumeel-S-is malamos efeqtianobisa da

amtanobis gamosavlenad Catarebuli iqna mul-

ticentruli gamokvleva. AaRniSnuli kvleva

Catarda 1990 wels, romlis monacemebi gadacemu-

li iqna “Bidogische Heel Gmbh”. kvleva Catarebuli

iqna 378 eqimis mier 3422 pacientze. YkvlevaSi,

xSirad aRniSnuli preparati gamoyenebul iqna

koW-wvivis saxsris daWimulobis samkurnalod

39

(734 pacienti), agreTve arTrozebis (313 paci-

enti), hematomebis (287 pacienti), epikondilite-

bis (179 pacienti), kontuziebis samkurnalod.

30,1%- SemTxvevaSi dainiSna Tanmxlebi Terapia,

51,6%-Si Tanmxlebi aramedikamentozuri Terapia

(masaJi, eleqtroTerapia, krioTerapia da sxva).

pacientTa saSualo asaki, romlebic CarTuli

iyvnen aRniSnul kvlevaSi, Seadgenda 39,9 wels.

Mmamakacebisa da qalebis Sefardeba iyo 51,8%

- 47,7% Tan.

SemTxvevaTa daaxlovebiT naxevarSi (47,5%)

Traumeel-S-is malamo gamoiyeneboda 2-jer dReSi.

34,3% pacientebs dainiSnaT 3-jer dReSi, 14,9%

SemTxvevaSi malamo dainiSna dReSi 4-jer. 48%-Si

malamo gamoiyeneboda naxvevis dadebis gareSe.

rogorc wesi, naxvevis dadeba ZiriTadad bur-

sitebis dros xdeboda.

Traumeel-S-is malamoTi mkurnalobis xangr-

Zlivoba 63,6%-Si Seadgenda 1-kviridan 1-Tvemde.

1kviriani mkurnalobis kursi Catarda 22,4%-Si.

1-dan 3-Tviani mkurnalobis kursi Cautarda pa-

cientTa 9,8%-s, xolo 3-dan 6-Tvemde-1,6%.

Terapiis efeqturoba fasdeboda 5 baliani

sistemiT (SkaliT); ,,Zalian kargi” (sruli

40

gamojanmrTeleba), ,,kargi” (mdgomareobis mniS-

vnelovani da xangrZlivi gaumjobeseba), ,,da-

makmayofilebeli” (umniSvnelo gaumjobeseba),

,,warumatebeli” (Sedegi ar iqna miRweuli) da

,,cudi” (pacientis mdgomareoba gauaresda). 48,3%

SemTxvevavaSi Terapiis efeqturoba Sefasebuli

iqna rogorc ,,Zalian kargi”, 38,4%-Si rogorc

,,kargi”, xolo 11,3%-Si damakmayofilebeli. xolo

2%-Si yvela sxav ganxiluli SemaTxevvebidan

malamoTi mkurnaloba Sefasda rogorc uSedego.

mkurnalobis msvlelobaSi mxolod erTi paci-

entis mdgomareoba gauaresda.

yvelaze efeqturi Traumeel-S-is malamoTi

hematomebis Terapia aRmoCnda. 98,9% SemTxvevaSi

efeqti Sefasebuli iyo rogorc ,,Zalian kargi”

da ,,kargi”.

mkurnalobis Sedegebis Sejamebisas SeiZle-

ba aRiniSnos, rom monoTerapiis efeqturoba

ufro maRalia, vidre mkurnaloba damatebiTi

medikamentozuri da aramedikamentozuri saSu-

alebebiT. MmonoTerapiis SemTxvevaSi Sefaseba

,,kargi” da ,,Zalian kargi” Seadgens 92%-s maSin

roca damatebiTi aramedikamentozuri Terapiis

meTodebis dros-86,8%, xolo damatebiTi medika-

41

mentozuri Terapiisas-86,6%. Oorive meTodis

erTdroulad daniSvnisas ki 76,9%. Ees Sede-

gebi imiT aixsneba, rom damatebiTi Terapias

mimarTavdnen SedarebiT ufro mZime klinikuri

suraTis dros. Sesabamisad Terapiuli efeqtis

miReba iyo ufro rTuli. meore mxriv dadebiTi

Sedegebis didi raodenoba, miRebuli Traumeel-

S-is malamos moniTerapiiT, warmoadgens misi

efeqturobis damadasturebels. Traumeel-S-is

malamoTi monoTerapia Cautarda 1290 pacients.

Traumeel-S-is malamos reaqcia Sefasebuli iqna,

rogorc ,,Zalian kargi”. mxolod 13 SemTxvevaSi

(3422-dan) aRiniSna alergiuli reaqcia-kanis

adgilobrivi gaRiazianeba, romelic swrafad

gadioda. 3 pacients alergiuli reaqciis Zli-

erad gamovlenis gamo, malamoTi mkurnaloba

Seuwyda (168).

valdkirSi (germania) Catarda kvleva, ten-

dinozebis dros kunTebis mimagrebis adgilze

Traumeel-S-is ineqciebis efeqturobis dasadgenad.

aRniSnulis garda kvlevis mizans warmoadgenda

garkveva aZlierebs Tu ara siTburi procedure-

bi Traumeel-S-is mkurnalobis efeqts. KkvlevaSi,

romelSic monawileoba miiRo 178 avadmyofma

42

211 tendinozuri paTologiiT, pacientTa pirvel

jgufs utardebodaT Rrma siTburi procedura

aparat Hydrosan-iT, meore jgufs - Rrma siTburi

procedura Traumeel-S-iT ineqciasTan parale-

lurad, mesame jgufs - infiltracia Traumeel-

S-iT. Ppreparatis ineqciebi keTdeboda 2-jer

kviraSi 4-6 kviris ganmavlobaSi, daavadebis

mimdinareobis xangrZlivobis gaTvaliswinebiT.

miRebuli SedegebiT, tendinozebis Traumeel-S-iT

monoTerapiam ufro gamoxatuli Terapiuli

efeqti aCvena, vidre siTburi procedurebiT an

am ori proceduriT erTdroulma mkurnalo-

bam. tkivilis sindromi mTlianad moixsna 40%-

Si, 40%-Si aRiniSna mdgomareobis gamoxatuli

gaumjobeseba. 10%-Si avadmyofTa mdgomareoba

ar Secvlila, 10%-Si pacientebs aReniSnaT mdgo-

mareobis gauareseba da dasWirdaT damatebiTi

procedurebis Catareba. Traumeel-S-isa da Rrma

siTburi procedurebis sinergiuli damokide-

bulebis ar arseboba savaraudod aixsna imiT,

rom siTburi procedura aCqarebs preparatis

gamoyvanas dazianebis aredan (33).

niuorkis universitetis samedicino cen-

tris Terapiul ganyofilebaSi Catarda kvleva

43

Traumeel-S-is tabletizirebuli formis klini-

kuri usafrTxoebis Sesafaseblad. Traumeel-S-

is klinikuri usafrTxoebis Sefaseba moxda

preparatis gamocdis dasawyissa da dasasruls

sisxlis klinikuri da bioqimiuri analizis sa-

fuZvelze. sacdel pirTa proTrombinuri drois

da nawilobrivi Tromboblasturi drois tes-

tirebis Sedegebis maCveneblebs Soris, prepara-

tis sacdel miRebamde da miRebis Semdeg, arse-

biTi sxvaoba ar dafiqsirda. kvlevaSi monawile

pirebi, 28 dRis ganmavlobaSi GRebulobdnen

TiTo abi Traumeel-S-s 3-jer dReSi. Yyvela

arasasiamovno SegrZneba, romlebsac pacientebi

aRniSnavdnen atarebda msubuq xasiaTs, iyo droe-

biTi da gadioda damatebiTi Terapiuli Carevis

gareSe. Aam dros pacientebze preparatis miReba

ar wydeboda. Yyvela gverdiTi efeqti kvlevis

Sedegad Sefasda rogorc umniSvnelo.

2001 wels, odesis saxelmwifo samedicino

universitetSi, Catarda kvleva preparat Traumeel-

S-is Terapiuli efeqtis rolis Sesaswavlad, rev-

matoiduli arTritiT daavadebul pacientebis

kompleqsur mkurnalobaSi. gamokvleuli iqna

31-qali da 14-mamakaci revmatoiduli arTritis

44

diagnoziT, romelTa asaki meryeobda 17-dan 45-

wlamde. pacientebi daiyvnen ZiriTad da sakon-

trolo jgufebad, ZiriTadi jgufis avadmyofebi

mkurnalobis tradiciuli meTodis damatebiT,

romelic moicavda metotriqsats doziT 7,5mg/

kviraSi, prednizoloni 7,5-10mg/kviraSi. nimesu-

lidi 300mg/kviraSi, ukeTdebodaT Traumeel-S-is

saxsarSida ineqcia kviraSi erTxel da Traumeel-

S-is ineqciebi kunTebSi kviraSi 2-jer. Ppacien-

tebs sakontrolo jgufidan CautardaT mxolod

tradiciuli mkurnaloba. Kkvlevis Sedegebma

aCvena rom ZiriTad jgufSi mdgomareobis

gaumjobeseba pacientTa umravlesobaSi daiwyo

mkurnalobis pirvelive kviris bolos, maSin

roca sakontrolo jgufSi analogiuri cvli-

lebebi aRiniSna 1-kviriT gvian. gamokvleul

pacientebs aReniSnaT T-limfocitebis, T-help-

erebis, T-supresorebis momateba, O-ujredebis,

B-limfocitebis, Sratismieri IgM, IgG-is raode-

nobis Semcireba, rac Tavismxriv metyvelebs gaaq-

tiurebuli B-jgufis imunitetis daqveiTebaze.

Aaseve gamovlinda sinovialuri siTxis kliniko-

labiratoriuli maCveneblebis gaumjobeseba.

(gamWvirvalobis, PH-is, siblantisa da mucinuri

45

koltis simkvrivis momateba, citozis, imunuri

kompleqsebis Semcireba). aRniSnuli dadebiTi

cvlilebebi ZiriTadi jgufis wevrebs aReniS-

nebodaT erTi kviriT adre ufro gamoxatuli

maCveneblebiT. ZiriTad jgufSi Traumeel-S-is

gamoyenebam SesaZlebeli gaxada Semcirebuliyo

steroidebis SemanarCunebeli doza. 52% pacien-

tebSi stacionaluri mkurnalobis kursis bo-

los aRar arsebobda aucilebloba steroidebis

ganmeorebiTi saxsarSida ineqciebisa. Kkvlevam

aCvena Traumeel-S-is kargi amtanoba pacientebis

mier da misi maRali efeqturoba revmatoiduli

arTritis mkurnalobaSi (177).

kievis diplomis Semdgomi daxelovnebis

samedicino akademiaSi, Catarda kvleva, rom-

lis mizans warmoadgenda laboratoriuli

meTodebis safuZvelze Traumeel-S-is Terapiuli

efeqtis Seswavla iuveniluri revmatoiduli

arTritiT daavadebul bavSvebSi. Ddakvirvebis

qveS imyofeboda 7-dan-14 wlamde asakis iuveni-

luri revmatoiduli arTritiT daavadebuli 30

bavSvi, romlebic dayofili iyvnen 2-jgufad.

sakontrolo jgufSi mkurnaloba mimdinare-

obda tradiciuli sqemiT, romelic moicavs

46

anTebissawinaaRmdego arasteroidul saSuale-

bebs, qolinergiul preparatebs, adgilobriv

mkurnalobasa da fizioTerapias. ZiriTadi jgu-

fis pacientebis mkurnalobaSi (15 bavSvi), zemoT

CamoTvlil preparatebs emateboda Traumeel-S-is

ineqciebi kunTebSi yovel me-2 me-3 dRes. (7-10

ineqcia). mkurnalobis xangrZlivoba Seadgenda

4 kviras. gamokvlevis Sedegebi analizdeboda

daavadebis mwvave periodisa da mkurnalobis

1-3 Tvis Semdeg. dadginda rom mwvave periodSi

Catarebul mkurnalobis SedegebSi arsebiTi

sxvaoba ZiriTadi da sakontrolo jgufebis

pacientebSi ar arsebobs. jgufebs Soris mkve-

Tri gansxvaveba, romelic adasturebs Traumeel-

S-is maRal-efeqturobas, gamovlinda mkurnalo-

bis kursis dasasruls. Traumeel-S-is miRebis

damTavrebis Semdeg pacientebis 100%-Si aRiniSna

Asisxlis mdgradi sanacia nuSisebr jirkvlebsa

da cxvir-xaxis areSi, maSin roca aRniSnuli

Sedegi sakontrolo jgufSi 60%-Si dafiqsirda.

Ggarda aRniSnulisa, ZiriTadi jgufis bavSvebis

80%-s, Terapiuli kursis me-3 Tvis bolosTvis

tkivilebi dazianebul saxsrebSi saerTod

gauqraT. sakontrolo jgufSi ki-47%-s. Aase,

47

rom Traumeel-S-i aumjobesebs iuveniluri revma-

toiduli arTritis mkurnalobis efeqturobas,

gansakuTrebiT reabilitaciis stadiaze (19).

ruseTis rentgenoradiologiis samec-

niero centrSi Catarebulma kvlevam cxadyo,

rom preparati Traumeel-S warmatebiT SeiZleba

gamoyenebul iqnas poliosteoalgiisa da spon-

diloalgiis mkurnalobaSi. mkurnaloba Cautar-

daT Cernobilis avariis Sedegebis likvidaciaSi

monawile poliosteopaTiiTa da spondiloal-

giiT daavadebul pirebs. kvlevaSi monawileoba

78 avadmyofma miiRo. 58 pacients preparati

ukeTdebodaT paravertebralurad refleqsuri

zonebis Sesabamisad, dozirebiT 2,2 ml kviraSi

2-jer (sul 10 ineqcia). 20 pacients Traumeel-S-i

ukeTdebodaT kunTebSi - kursze 10 ineqcia.

analogiuri dozirebiT. dadebiTi efeqti, tkivi-

lis Semcirebis saxiT gamovlinda orive jgufis

pacientebSi. Traumeel-S-ma moaxdina gamoxatuli

Terapiuli efeqti poliosteopatiebsa da spon-

diloalgiebis dros, Tumca igi gansakuTrebiT

gamovlinda Sesabamis refleqtorul segment-

ebSi simetriuli paravertebraluri ineqciebis

dros.

48

Traumeel-S-i gavlenas axdens fagocitebisa

da limfocitebis aqtivobaze, rac damtkicda

gamokvlevebis ASedegad Catarebuli janmrTeli

adamianis periferiul sisxlzeBbonis anatomii-

sa da fiziologiis universitetSi. Traumeel-S-is

moqmedebis Seswavla moxda hemo-luminescenci-

uri analiziTa da MTT-testebis gamoyenebis

magaliTze. Ffagocitoz testis Sedegebma aCvena

preparatis imunostimulatoruli efeqti, igi

axdens fagocitozis stimulacias. Traumeel-S-

is erT-erT Semadgenel komponentze. Echinacea

angustifolia Catarebulma analogiurma testebma

(rogorc in vitro aseve in vivo pirobebSi), aCvena misi

fagocitozis mastimulirebeli moqmedeba (62).

germaniis klinikebSi Catarda kvlevebi,

romlis mizans warmoadgens dadgena imisa, rom

Traumeel-S-iT mkurnalobis efeqturoba ar Camou-

vardeba arasteroiduli anTebis sawinaaRmdego

saSualebebiT mkurnalobas. amisaTvis dak-

virveba warmoebda 38 klinikaSi 184 pacientze

6 Tvis ganmavlobaSi. aqedan 106 mkurnalobda

Traumeel-S-iT xolo 78 arasteroiduli anTebis

sawinaaRmdego saSualebebiT. TiTo centrSi

3 pacients eniSneboda Traumeel-S, xolo 3-s -

49

arasteroiduli anTebis sawinaaRmdego saSu-

alebebiT. orive jgufSi mkurnaloba xdeboda

ineqciebis saSualebiT. arasteroiduli anTe-

bis sawinaaRmdego saSualebebiT mkurnaloba

xdeboda intramuskularuli SeyvaniT, xolo

Traumeel-S-isa ki lokaluri SeyvaniT. Traumeels-

S-is gamoyeneba xdeboda 2.2 ml ampulebiT.

Traumeel-S-sa da arasteroiduli anTebis

sawinaaRmdego saSualebebs Soris ar iyo mniS-

vnelovani sxvaoba mkurnalobis dawyebisas

(pirvel stadiaSi). pirvel kviras orive meTodma

gaumjobesebis erTnairi done aCvena yvela param-

etrSi. Semdgomac, orive jgufSi aRiniSneboda

simptomebis aSkara gaumjobeseba yvela param-

etrebSi. meore kviras Traumeel-S-ma aCvena ukeTesi

Sedegebi Semdeg komponentebSi: tkivili umoZ-

raobisas, kidurebis mobilurobis gaumjobeseba

da torsis mobilurobis gaumjobeseba. testma,

romlis mizani iyo daedgina, rom Traumeel-S ar

Camouvardeba, arasteroiduli anTebissawinaaRm-

dego saSualebebs, daamtkica rom Traumeel-S

araTu ar Camouvardeba, aramed upiratesobac

aqvs arasteroidul anTebissawinaaRmdego saSu-

alebebTan, xolo iseT parametrebSi rogoricaa,

50

tkivili umoZraobisas, kidurebis mobilurobis

gaumjobeseba da torsis mobilurobis gaum-

jobeseba, SesamCnevad jobnis arasteroidul

anTebis sawinaaRmdego saSualebebs. Tumca aqve

unda aRiniSnos rom Traumeel-S-is upiratesobis

gamovlena ar iyo dakvirvebis mizani.

orive meTodis farTo gamoyenebis praq-

tikamac daadastura Traumeel-S-is upiratesoba

arasteroidul tkivilgamayuCeblebTan Sedare-

biT. Traumeel-S-is pacientTa 71.0%-ma mkurnaloba

Seafasa rogorc kargi, an Zalian kargi. xolo

arasteroidul anTebis sawinaaRmdego saSu-

alebebis SemTxvevaSi igive Sefaseba gaakeTa

pacientTa 44.2%-ma. (p=0.013 jgufebs Soris Se-

darebisaTvis). mkurnalobis Semdeg fizikuri

SesaZleblobaTa (daSvebadoba) testma ar

mogvca mniSvnelovani cvlilebebi: Traumeel-S-is

pacientTa 91.9%-ma Seafasa rogorc maRali, an

Zalian maRali, xolo igive Sefaseba misca aras-

teroiduli anTebis sawinaaRmdego saSualebebis

pacientTa 80.6%-ma (p = 0.11).

rac Seexeba mkurnalobis amtanobas Traumeel-

S-is 87.7%-ma procesis es kriteriumi Seafasa

rogorc maRali an Zalian maRali, maSin rode-

51

sac arasteroiduli anTebis sawinaaRmdego

saSualebebis - pacientTa mxolod 44.9%-ma gaa-

keTa igive Sefaseba. dakvirvebis ganmavlobaSi

dafiqsirebuli iqna mxolod 3 uaryofiTi

Sedegi da samive arasteroiduli tkivilgam-

ayuCeblebis jgufSi. aqedan orma pacientma uari

Tqva mkurnalobis procesTan dakavSirebuli

uaryofiTi dermaluri reaqciebis gamo. saerTo

jamSi, or kviriani mkurnalobis kursi Sewyvita

Traumeel-S-is pacientTa 7-%-ma xolo araster-

oiduli anTebis sawinaaRmdego saSualebebis

pacientTa 19.5-%-ma.

dakvirvebam daamtkica, rom Traumeel-S-i aris

arasteroiduli anTebis sawinaaRmdego saSuale-

bebis srulfasovani alternativa epikondili-

tis moklevadiani mkurnalobis dros. Sefaseba

xdeboda 5 kriteriumiT. miuxedavad imisa rom

testis mizani iyo, daedgina Traumeel-S-is, rogorc

arasteroiduli tkivilgamayuCeblebis al-

ternativis statusi, man aCvena, rom Traumeel-S-i

utoldeba da zog maCveneblebSi jobnis aras-

teroiduli tkivilgamayuCeblebs.

Traumeel-S-is ZiriTad upiratesobas igive

arasteroiduli tkivilgamayuCeblebTan an ko-

52

rtikosteroidebTan warmoadgens misi, rogorc

homeopaTiuri saSualebis kargi amtanianoba.

Traumeel-S-i farTod gamoiyeneba evropasa da

a.S.S.-Si da amtanianobis done yvelgan Zalian

maRalia. kortikosteroidis gamoyeneba ki ukav-

Sirdeba postineqciur tkivils da kuWTan an

Tormetgoja nawlavTan dakavSirebul arasa-

survel gamovlinebebs. konkretuli dakvirve-

bis mimdinareobisas orive saSualebam aCvena

maRali amtanianobis xarisxi pacientebs Soris

da ar dafiqsirebula arc erTi arasasurveli

gastrointestiuri gamovlineba.

arasteroiduli anTebis sawinaaRmdego saSu-

alebebiTa Ada kortikosteroidebiT mkurnalo-

bis grZelvadiani efeqti kiTxvis niSnis qveS

dgas da bevri damkvirvebeli aRniSnavs rom

es saSualebebi aqrobs tkivils magram mniS-

vnelovnad ar uwyobs xels gamojanmrTelebis

process. Traumeel-S-is gamoyenebis grZelvadi-

ani efeqti ar yofila seriozuli gamokvlevis

sagani. aRniSnuli dakvirveba Zalian mokleva-

diani iyo imisTvis, rom daskvnebi gamogvetana

Traumeel-S-is, rogorc grZelvadiani samkurnalo

saSualebis efeqturobaze.

53

saboloo jamSi SegviZlia vTqvaT, rom

Traumeel-S-is gamoyeneba aris xelsayreli al-

ternativa da Sedegemac daadastura, rom igi

utoldeba da rig komponentebSi jobnis aras-

teroidul anTebis sawinaaRmdego saSualebebs

(186).

damxmare imunuri reaqcia. Terapiis Taname-

drove strategiis ganviTareba mWidrod aris

dakavSirebuli imunuri sistemis funqciebTan,

romelic Sualedur rgols warmoadgens indi-

vidumis organizmis eqspoziciasa (garemo) da

dispozicias (STamomavloba) Soris.

Sualeduri rgolis - imunuri sistemis – amo-

canaa qsovilis sinTezsa da restruqturizacias

Soris wonasworobis (homeostazi) SenarCuneba.

Aam procesebis realizaciisTvis aucilebeli

informacia ujredSi aRwevs gansazRvruli

mediatoruli ujreduli nivTierebebis (niv-

Tiereba – informaciis gadamtani), citokinebis

daxmarebiT. Aam SemTxvevaSi ZiriTad citokins

GTF- (matransformirebeli zrdis faqtori)

warmoadgens, romelic ujredul cvlaSi gad-

arTvis maregiulirebel rols asrulebs. (7.

54

99).

Hhomeostazis paTologiuri cvlilebebi

yovelTvis mimdinareobs imunuri sistemis

araspecifikur (mag. makrofagi) da specifikur

(T da B limfocitebi) darRvevebTan erTad; ami-

tom sul ufro met mniSvnelobas iZens imunur

sistemaze mimarTuli zemoqmedebis saSualebiT

daavadebis daTrgunva. arasasurveli gverdiTi

efeqtebis moWarbebis gamo, izrdeba imunuri

Terapiis klasikuri koncefciis kritikuli gad-

afasebis aucilebloba, magaliTad, rogoricaa

proanTebiTi limfocitebis ganadgureba, imunuri

sistemis da citokinebis sinTezis daTrgunva an

limfocitebis aqtiurobis inhibireba anTebis

sawinaaRmdego qimioTerapiis meSveobiT. imunoT-

erapiis strategiis Tanamedrove tendenciebi

klasikurisagan gansxvavdeba imiT, rom:

isini mimarTulia araspecifikuri imu-

nitetis umniSvnelovanesi mediatorebis ( TGF-

da IL-1) donis daqveiTebisaken.

maregulirebel limfocitebze uSualo

zemoqmedebis meSveobiT xdeba GTF- faqtoris

gamoTavisufleba anTebiTi procesis inhibire-

bisaTvis (119. 133. 175).

55

tendenciebis orive aspeqti “antihomotoqsi-

kuri medicinis damxmare imunologiuri reaqci-

is” dros gamoiyeneba. reaqcia Semdegnairad

mimdinareobs: antihomotoqsikuri preparatis

formisa da miRebis wesis miuxedavad dabal da

saSualo potenciaSi arsebuli mcenareuli da

cxoveluri warmoSobis proteinebi aRiqmeba mak-

rofagebis (aseve, makrofagis monaTesave wvrili

nawlavis lorwovani garsis M-ujredebiT –pox-

ieri ujredebi) mier.SemdegSi isini lizosomebSi

moineleba da mcire fragmenti(jaWvSi 3-dan

15-mde aminomJava: “motivi”) ujredis zedapirze

ganlagdeba da iq histoTavsebad kompleqsebs

ukavSirdeba.

agentiT aramarkirebuli “mopatrule” T-lim-

focitebi aRiqvamen motivs (uerTeben Tavis re-

ceptorebs) an motivebs, brundeba uaxloes lim-

fur kvanZSi (“houmingi”) da mravldeba motivis

raodenobis Sesabamisad, riTac maregulirebeli

limfocitebis sxvadasxva klonebs aZlevs saw-

yiss (Th3 limfocitebi). mniSvnelovania is rom

sinTezi xdeba mxolod D1-D14 potenciebisas.

potenciebis ufro maRali koncentracia Th-3

ujredebis sinTezs ewinaaRmdegeba, xolo maRali

56

potenciebisas, piriqiT, “motivis” warmoqmna ar

xdeba. “motivirebuli” Th-3klonebi organizmSi

sisxlisa da limfis mimoqcevis saSualebiT

vrceldeba. (211. 85).

anTebiTi procesis SemTxvevaSi xdeba

maTi qemotaqsisuri mizidva (qemokinebi, komple-

mentis faqtorebi da mravali sxva) Sesabamis

keraSi. saboloo jamSi isini awydebian proan-

TebiTi da anTebiTi procesis xelisSemwyob

T4 limfocitebs da maT subpopulaciebs Th-1

da Th2 ujredebis saxiT (anu T-helperebs) da

dezintoksikaciurad moqmedeben maTze. is ki,

Tavis mxriv, inmflamatoruli limfocitebis

umZlavres inhibitors warmoadgens. amgvarad

SeiZleba SevaCeroT anTebiTi procesi da win

aRvudgeT mis qronizacias. maSasadame, anTebis

mainhibirebel da mastimulirebel citokinebs

Soris wonasworobis aRdgenis Sedegad xdeba

anTebiTi procesis dasruleba(175).

antihomotoqsikuri Terapiis moqmedebis

meqanizmi: sasicocxlo funqciaTa SesanarCu-

neblad yovel organos esaWiroeba energia,

romelic nivTierebaTa cvlis Sedegad mudmivad

57

unda miewodebodes. amitom energetikuli cvlis

darRveva yovelTvis azianebs endogenuri gziT

regulirebad energomomaragebasac.

organizmi energetikulad Ria sistemas war-

moadgens, romelic saWiroebs Sesaferisi energi-

is (sakvebis saxiT) mowodebas da araSesaferisis

gareT gamodevnas. organizmis yvela reaqcia

erTgvarovan garemoSi dabal temperaturaze

mimdinareobs, amitom saWiroa maTi daCqareba e.i.

katalizi (7).

efeqturi katalizis pirobad ujredebSi da

maT Soris arsebuli Sesaferisi substratebi

gvevlineba. ujredgare sivrce gars ekvris

ujredebs, amitom isini reagireben ise, rogorc

iqnebian informirebuli ujredgare sivrcis

dinamikuri struqtura Dda misi regulireba

(,,ZiriTadi regulacia”) ujredgare da ujred-

Sida katalizis efeqturobiT ganisazRvreba.

Ees ZiriTadi substanciis struqturazea

damokidebuli (ujredgare matrica). igi yvela

ujredisa da ujredul SenaerTSi warmoad-

gens matriculi komponentebisgan molekulur

sacers; es komponentebia Saqris proteinebi

(maRalpolimeruli kompleqsebi proteglikan-

58

klikozaminoglikanebi), stuqturuli proteinebi

(kolagenebi, elastini) da badisebri (SemboWavi)

glikoproteinebi (magaliTad, fibroneqtini,

vitroneqtini, Trombospondini). Pproteglikan-

glikozaminoglikanebis uaryofiTi muxti gana-

pirobebs wylis SekavSirebisa da ionuri cvlis

unars, rac matricaSi izoioniis, izoosmiis da

izotoniis garants warmoadgens.

matrica brmad daboloebuli vegetatiuri

nervuli boWkoebis meSveobiT ,,CarTulia” cns-

Tan, xolo kapilaruli qseliT uerTdeba Sida

sekreciis jirkvlebis (hi pofizi, farisebri

jirkvali, Tirkmelzeda jirkvlebi da sxva).

tvinis ReroSi orive sistema erTmaneTTan aris

dakavSirebuli da uerTdeba tvinis umaRles

centrs. amgvaradaa agebuli ZiriTadi regu-

laciis sistema (piSingeris sivrce), risi meSveo-

biTac matricis yvela cvlileba SeiZleba da-

regulirdes fsiqo-endokrinul-imunologiur

doneze. AmasTan xdeba bioriTmebis SeTanxmeba.

amgvarad, matricaSi zemdgomi maregulire-

beli ubnebis zemoqmedebiT regulireba mud-

mivad warmoebs. AmatricaSi maregulirebel

centrs fibroblasti warmoadgens (cns-Si mas

59

gliuri ujredi Seesabameba). yvela Semaval

informaciaze (hormonebi, neironivTierebebi, me-

tabolitebi, katabolitebi, PH-is cvlileba da

sxva) igi dauyovnebliv reagirebs situaciis

Sesabamisi matriculi komponentebis sinTeziT.

masTan, igi ar akeTebs arCevans ,,kargsa” da

,,cud” informacias Soris. amis gamo, mdgradma

arafiziologiurma lokalurma procesma (mag.:

,,kera”) SeiZleba gamoiwvios matricis garSemo

dazianebis gavrceleba, da bolos, cns-s da en-

dokrinuli sistemis ukukavSirebis meSveobiT

sistemuri gavrceleba (160. 119. 7).

mniSvnelovania, rom proteglikani-gliko-

zaminoglikanebis mfiltarav da SemakavSirebel

TvisebaTa safuZvelze yovelTvis arsebobs

SlakebiT matricis dabinZurebis saSiSroeba,

rasac erTvis Tavisufali radikalebiT, prote-

olizur sistemaTa aqtivaciiTa da proanTebiT

situaciaSi gadasvliT mimdinare latenturi

qsovilovani acidozi. Bbolos da bolos Ses-

aZlebelia adgili hqondes yvela humorul da

ujredul elementTa dazianebas – SegrZnebebis

Tavdapirveli umniSvnelo darRvevidan qroni-

kul daavadebasa da avTvisebian warmonaqmnTa

Camoyalibebis procesamde (7).

60

osteoqondropaTiebis aRdgeniTi osteoqondropaTiebis aRdgeniTi

mkurnaloba fizikuri meTodebiTmkurnaloba fizikuri meTodebiT

ultrafonoforeziultrafonoforezi

ultrabgera mkvrivi garemos maRali six-

Siris (16000 hercze meti) meqanikuri rxevebia,

romelTa sixSire aRemateba adamianis smenis

organos sixSiris aRqmis farglebs. ultrabg-

eris moqmedeba adamianis organizmze rTulia

da mravalferovani. am moqmedebis meqanizmSi

ZiriTadi mniSvneloba aqvs meqanikur, siTbur da

fizikur-qimiur faqtorebs. meqanikur faqtorSi

igulisxmeba ultrabgeris akustikuri wneviT

moqmedeba, romelic qsovilebisa da ujredebis

Taviseburi mikromasaJiT gamoixateba. am dros

ujreduli membranis ganvladoba matulobs,

vlindeba akustikuri mikronakadi protoplazma-

Si, rac iwvevs ujreduli elementebis da mTli-

anad ujredis funqciis stimulacias (23).

Uultrabgeris siTburi faqtori dakavSire-

bulia ultrabgeris talRebis STanTqmasa da

misi energiis siTbur energiad gardaqmnasaTan,

romelsac garkveuli mniSvneloba aqvs ultra-

bgeris Terapiul moqmedebaSi. es gamoixateba

61

qsovilebSi bioqimiuri procesebis daCqarebiT,

kvebisa da trofikis gaumjobesebiT, difuzuri

procesebis cvlilebebiT. AaRsaniSnavia rom

siTbos meti raodenobaa nervul da Zvlovan

qsovilebSi..

Ffizikur-qimiuri faqtori gulisxmobs

ultrabgeris moqmedebas biofizikur da bioqi-

miur procesebze. aqtiurdeba Jangva-aRdgeniTi

procesebi, warmoiqmneba biologiurad aqtiuri

nivTierebani, icvleba PH, matulobs koloiduri

nivTerebebis dispersiuloba da sxva.

samive aRniSnuli faqtoris gavleniT vlin-

deba ultrabgeris is mravalmxrivi moqmedeba

organizmze, rac gamoixateba tkivilgamayuCebeli,

anTebis sawinaaRmdego, spazmolizuri, madesen-

sibilizebeli, sisxlZarRvTa gamafarToebeli

efeqtiT. Uultrabgeris procedura iwvevs

sisxlisa da limfis mimoqcevis gaZlierebas,

Cqardeba qsovilTa regeneraciis procesi, iz-

rdeba fagocitozi, umjobesdeba simpaTikur

_ adrenaluri sistemis glukokortikoiduri

funqcia (110. 790).

EerT-erTi yvelaze mniSvnelovani Tviseba,

romliTac gamoirCeva ultrabgera aris anTe-

62

bis keraSi daSlis produqtebis gawovis daC-

qareba. makrofagebis lizosomuri fermentebis

gaaqtiurebis xarjze anTebiTi kera swrafad

iwmindeba ujreduli detritisgan anTebis eqsu-

daciur stadiaSi. anTebis proliferaciul da

reparaciul stadiaSi imatebs ujredebis enzi-

muri aqtivoba, Zlierdeba maTi metabolizmi.

Uultarafonoforezis dros adamianis or-

ganizmze moqmedebs rogorc ultrabgera, ise

samkurnalo nivTiereba, romelic qsovilebSi

ultrabgeris saSualebiT SehyavT. Uultrabger-

iTi rxevebi amaRleben preparatis moqmedebasa

da SeRwevadobas rbil qsovilebSi. Kkanidan

samkurnalo nivTiereba Seiwoveba organizmSi,

vinaidan ultrabgeris moqmedebiT kanis gan-

vladoba matulobs. 1. ultrafonoforezisT-

vis iyeneben Semdeg samkurnalo nivTierebebs:

hidrokortizons, indometacins, voltarens, an-

algins, zeels da sxva. bolo periodSi mraval

qveyanaSi farTod gamoiyeneba ultrafonofor-

ezi Traumeel-S-is malamoTi. 2. Uultrabgerisa

da samkurnalo nivTierebaTaA kompleqsi ufro

efeqturia, vidre am faqtorebis cal-calke

gamoyeneba. ultrafonoforezs warmatebiT

63

gamoiyeneben Zval-saxsarTa da nevrologiuri

daavadebebis samkurnalod mravali wlis ganma-

vlobaSi, iseTebisa rogoricaa osteoqondrozis

fesvobrivi sindromi qvemwvave da qronikuli

mimdinareobisas, madeformirebeli osteoar-

Trozi, bextereevis daavadeba, radikularuli

sindromi, nevriti, nevralgia, revmatoiduli ar-

Triti, bursiti, mioziti, spondilozi, periferi-

uli travmuli dazianeba da sxva (23. 110. 79).

eqsperimentulma gamokvlevebma daamtkices

rom ultrafonoforezis samkurnalo efeq-

turobas ZiriTadad ultrabgera gansazRvravs.

Kkonkretuli samkurnalo saSualebis Seyvana,

mxolod amaRlebs ultrabgeris efeqturobas

da ar cvlis mis moqmedebis arss. zogi monace-

mebiT, ultrabgeram, piriqiT, SeiZleba Secvalos

wamlis moqmedeba, radgan ultrabgeras gaaCnia

maRali biologiuri aqtivoba, xolo samkurnalo

preparati Seiyvaneba mcire raodenobiT. Aam

sakiTxis gaTvaliswinebiT, aqtualuri rCeba

sakiTxi preparatis mizanmimarTulad daniSv-

nasTan dakavSirebiT ultrafonoforezis gziT

(179).

safuZvliani kvlevebis Semdeg miiCnies up-

64

erspeqtivod ultrafonoforezi Tiaminis. vi-

tamin C-s, eufilinis, xolo rac Seexeba sxva

samkurnalo saSualebebs (lidaza, ronidaza),

aseTi gamokvlevebi dRemde ar Catarebula.

ultrafonoforezis dros, samkurnalo

preparati organizmSi kanis gavliT aRwevs,

rogorc difuziis xarjze, romelic mniS-

vnelovnad Zlierdeba ultrabgeris zemoq-

medebiT, aseve sakuTari forezis Sedegad. mniS-

vnelovan rols asrulebs aseve, proceduris

dros preparatze meqanikuri Sezelva. wamlis

SeRwevis gza da siRrme ultrafonoforezis

dros bolomde ar aris Seswavlili. preparati

ultrafonoforezis dros arc ise Rrmad aRw-

evs, ar scildeba epidermiss. sisxlSi preparati

aRmoCndeba ultrafonoforezidan 1-2 sT-is

Semdeg. v.s. ulaSika-s monacemebiT, wamlis ul-

trafonoforezis dros kanSi aRmosaCenad gac-

ilebiT naklebi dro sWirdeba, vidre eleqtro-

forezis dros. preparatis sisxlSi moxvedris

vada gamosxivebis pirobebiTac ganisazRveba.

mcire intensivobisa da xanmokle zemoqmedebisas,

isini ufro didxans yovndebian depoSi, vidre

intensiuri da xangrZlivi zemoqmedebisas. Seyva-

65

nili preparatis raodenoba fonoforezis dros

mraval faqtorzea damokidebuli: gamosxivebis

parametrebze, gamxsnelze, preparatis fizio-

qimiur Tvisebebze da kanis mdgomareobaze. yve-

laze mniSvnelovnad ultrafonoforezis efeq-

turobaze moqmedebs gamosxivebis intensivoba,

sixSire da xangrZlivoba.

rogorc kvlevebma aCvenes, ultrabgeris

intensivobis momatebisas, nivTierebis Seyvana

Zlierdeba, magram isic gansazRvrul donemde

– 0,6-0,8 vt/sm2-mde, radgan misi Semdegi momateba

dabla wevs ultrafonoforezis efeqturobas

da preparatis gamZleobas ultrabgeriTi, rxeve-

bisadmi. aseve izrdeba preparatis SeRwevadoba

proceduris xangrZlivobis gazrdiT. amasTanave

paralelurad xdeba preparatis Semadgeneli

ingredientebis daSla, rac ar iZleva saSuale-

bas proceduris Zalian xangrZlivad Catarebisa

(179).

ultrafonoforezis dros, kanSi preparatis

mciredi raodenobis Sesvlis gamo (malamos

1-3%), aqtualuri rCeba ara marto optimaluri

malamoebis damzadebis sakiTxi, aramed kanis

gamtareblobis momatebis gzebis Zieba (23. 110).

66

lazeroTerapialazeroTerapia

sityva ,,lazeri” – LAZER abreviaturaa

inglisuri frazisa Light Amplifi cation by stimulated

Emission of Radiation da misi qarTuli Targmani

ase Jrers: ,,sinaTlis gaZliereba iZulebiTi

gamosxivebis gziT”. danadgars, romelic aseTi

saxis sinaTles iZleva ,,optikuri qvanturi gen-

eratori” ewodeba. samecniero literaturaSi

,,optikuri qvanturi generatori” da ,,lazeri”,

rogorc sinonimebi, gaigivebulia. qvanturi gen-

eratori aris teqnikuri mowyobiloba, romelic

gamoasxivebs eleqtromagnitur gamosxivebas si-

naTlis sxivis konis saxiT viwyo speqtralur

diapazonSi (1. 2. 35. 45).

lazeris gamoyenebas medicinaSi safuZvlad

udevs misi universaluri Tvisebebi,romelTagan

unda gamovyoT Semdegi:

1. maRali intesioba.

2. mono-qromatuloba

3. koherentuloba

4. mimarTuli gamosxiveba

lazeruli energiis unikalurma Tvisebebma

ganapiroba misi gamoyenebis sferoebis masStabe-

67

bi Terapiuli Tu qirurgiuli medicinis yvela

sferoSi. dabalintensiuri lazeroTerapia medi-

cinis SedarebiT axali dargia (1.2. 169. 170).

lazeruli samkurnalo procedurebis umt-

kivneuloba, meTodebis mravalferovneba, ab-

solituri winaaRmdegCvenebebis minimaluroba,

mkurnalobis Semdgomi remisiis gaxangrZliveba

ganapirobebs dabalintensiuri lazerebis

warmatebiT gamoyenebas mwvave da qronikuli

daavadebebis samkurnalod, profilaqtikuri

RonisZiebebis kompleqsSi da xSirad sruliad

damoukideblad, monoTerapiis saxiT.

dasabuTebulia dabalintensiuri laz-

eroTerapiis maRali efeqturoba da usafrTx-

oeba TiTqmis yvela profilis daavadebaTa

mkurnalobaSi. dabalintensiuri lazeroTer-

apiis oponentTa yovelgvari mcdeloba daemt-

kicebinaT misi fsiqoTerapiuli efeqti, gabaTil-

ebulia lazeruli medicinis mTeli klinikuri

praqtikiT. msoflios sxvadasxva qveynebSi

Catarebuli gamokvlevebi (“ormagi brma” meTodi)

adasturebs am meTodis maRal klinikur efeq-

turobas (128. 129. 130).

lazeroTerapiis efeqturoba sayrden-mamoZ-

68

ravebeli sistemis daavadebebis dros aixsneba

misi maRali Terapiuli efeqturobiT, rogorc

mkurnalobis damoukidebeli meTodiT da aseve

kombinirebuli moqmedebis SesaZleblobiT

mkurnalobis tradiciul meTodebTan erTad (1.

109). aRsaniSnavia lazeroTerapiul meTodTa

umravlesobis arainvaziuroba, umtkivneuloba

da komfortuloba pacientisaTvis (171).

osteoqondrozis dros lazeroTerapiis amo-

canaa tkivilgamayuCebeli, anTebis sawinaaRmdego

da SeSupebis sawinaaRmdego moqmedeba.

lazeruli energiis Terapiuli efeqti mag-

nitur areSi mniSvnezlovnad matulobs. es gan-

pirobebulia mikrocirkulaciis, qsovilovani

metabolizmis, neirohumoraluri meqanizmebis

da biologiuri substratebis funqciuri aqti-

vaciis sxva faqtorebis gaZlierebiT (139).

adamianis organizmze magnituri velis moqmede-

baSi avtorTa erTi jgufi gamoyofs reaqciaTa

tetradas: varjiSi, mSvidi aqtivacia,momatebuli

aqtivacia, stresi (78). imave avtorTa mosazrebiT

magnituri velis mimarT mTliani organizmis

mgrZnobeloba ufro maRalia, vidre qsovilo-

van da ujredul doneze. zogierT avtorTa

69

mosazrebiT magnituri veli araspecifiuri gama-

Rizianebelia. amitom misi moqmedeba SeiZleba

ganvixiloT rogorc fizioTerapiuli, zogadma-

stimulirebeli (58).

nevrologiur daavadebaTa samkurnalod

lazeri SedarebiT gvian iqna gamoyenebuli,

magram dReisaTvis arsebuli mniSvnelovani

klinikuri gamokvlevebis safuZvelze SeiZleba

davafiqsiroT, rom am sferoSi lazeroTerapia

nozologiurad araspecifiuri, universaluri

samkurnalo saSualebaa (25).

lazeroTerapiis mizani radikulitebis dros

aris tkivilgamayuCebeli, SeSupebis da anTebis

sawinaaRmdego moqmedeba, qsovilebis sisxlis

mimoqcevis da trofikis gaumjobeseba, nerviuli

ganvladobis aRdgenis daCqareba (36).

lazeriT mkurnalobis efeqturobas

aZlierebs lazeropunqtura. pleqsitis dros

wiTeli da infrawiTeli lazeriT Catare-

buliFlazeropunqturis Sesaxeb dafiqsirda

pozitiuri Sedegebi: aRdga mgrZnobeloba,

kunTTa tonusi da moZraobis moculoba (30.32.)

monacemebiT lumbagos, kunTebis daWimulobis

da postherpesuli nevralgiis dros wiTeli

70

(0,63 mkm) da infrawiTeli (0,85 mkm) lazeriT kom-

binirebulma mkurnalobam Sedegi avadmyofTa

79%_Si gamoiRo (147).

damtkicebulia, rom dabalintensiuri laz-

eris moqmedebiT nervebis funqcionaluri Ses-

aZleblobebis moculoba 29_32%_iT izrdeba

(75. 69). monacemebiT lazeri aaqtiurebs ra

aferentuli struqturebis impulsacias, avlens

Terapiul efeqts cns_is sxvadasxva doneze, rac

Tavis mxriv aregulirebs tkivilis meqanizms

neirorefleqtoruli gziT.

ukanaskneli wlebis gamokvlevebSi naCve-

nebia dabalintensiuri lazerebis moqmedeba

reparaciuli Oosteogenezis procesebze. kerZod,

adgili aqvs osteoblastebis proliferaciis

daCqarebas, kortikaluri firfitebis gaCenas da

Zvlis tvinovani arxis aRdgenas, romlis real-

izaciis meqanizmi SeiZleba aixsnas moZRvrebiT

parabiozis Sesaxeb (8. 6).

Tssu samedicino reabilitaciis da spor-

tuli medicinis kaTedraze sxvadasxva spor-

tuli travmis mqone pacientebs lazeroTerapia

utardebodaT rogorc mkurnalobis damoukide-

beli saSualeba monoTerapiis saxiT, aseve kom-

71

pleqsurad, fizioTerapiis sxva saSualebebTan

an medikamentur TerapiasTan kompleqsSi (1. 2).

dabalintensiuri lazeroTerapia Cautarda

Slateris sindromiT daavadebul 32 pacients

(1. 2). maTgan 10-s yoveli seansis win muxlis

saxsarsa da mtkivneul midamoebSi uzeldnen

malamo ‘Traumeel-S”. danarCenebs dasxivebas

utarebdnen malamos gareSe. lazeroTerapiis

reJimi da eqspozicia TiToeuli pacientisaT-

vis individualurad iyo SerCeuli, tkivilis

intensiobis, miofascialuri tkivilebis gavr-

celebis arealis mixedviT. Tumca mkurnalobis

ZiriTadi sqema erTnairi iyo. yovel pacientze

dakvirveba mimdinareobda individualurad. Tu

meore-mesame seansze mdgomareoba umjobesde-

boda - mkurnaloba imave reJimiT grZeldeboda.

winaaRmdeg SemTxvevaSi dozis da reJimis Secvla

safexureobrivad xdeboda tkivilis moxsnamde

da Semdeg grZeldeboda miRweuli reJimiT.

lazeroTerapiis pozitiuri efeqti gam-

ovlinda uklebliv 32-ive avadmyofSi. Tumca

,,Traumeel-S” damuSavebulebSi efeqti ufro adre

dafiqsirda. me-5 seansis Semdeg Yyvela pacienti

Tavs praqtikulad janmrTelad grZnobda da da-

72

narCeni seansebi miRebuli Sedegebis SenarCune-

basa da fiqsirebaze iyo gaTvlili. mkurnalobis

procesSi gamoikveTa Semdegi kanonzomiereba:

14 wlamde asakis mozardebSi daavadebis simp-

tomebi lokaluri iyo. amdenad mkurnalobis

pozitiuri Sedegebi mokle droSi dafiqsirda

da eqspoziciac mcirevadiani – 8-10 wT iyo.

mozrdilebSi tkivilebi garda lokalurisa,

gafantuli iyo miofascialurad: sazardulis,

barZayis medialuri kunTebis da wvivis kunTe-

bis midamoebSi. amitom seansebis xangrZlivoba

30 wT- mde aRwevda. (1. 2)

monolazeroTerapiuli aplikaciebi efeq-

turia msubuqi rbilqsovilovani travmebis

dros da aseve kalcifikatebis gawovis mizniT.

saSulo simZimis rbilqsovilovani da Zval-

saxsrovani travmebis dros Terapiuli efeqti

miiRweva lazeruli aplikaciebis da sxva fiz-

ioprocedrebis, rogoricaa fonoforezi, ul-

trabgera, kompleqsuri gamoyenebis dros. mZime

sportuli travmebis samkurnalod ki mkurnalo-

bis zemoTaRweril fizikur meTodebTan erTad

aucilebeli xdeba medikamentozuri Terapiis

CarTvac (1. 2).

73

lazeruli energiis Terapiuli efeqti mag-

nitur areSi mniSvnelovnad matulobs (125).

mTliani organizmis mgrZnobeloba magnituri

velis mimarT ufro maRalia, vidre qsovilovan

da ujredul doneze (126). lazeri aaqtiurebs ra

aferentuli struqturebis impulsacias, avlens

Terapiul efeqts cns-is sxvadasxva doneze, rac

Tavis mxriv aregulirebs tkivilis meqanizms

neirorefleqtoruli gziT (100. 101. 102. 103).

sportuli travmebis da sportsmenis spor-

tuli moRvaweobis reJimis Taviseburebebidan

gaTvaliswinebiT aucilebelia lazeroTera-

piuli mkurnalobis swori reJimis operatiuli

Catareba (23).

sportuli travmebis dros lazeroTerapiis

efeqturoba dadasturebulia sxvadasxva avtore-

bis mier. eqsperimentuli da Semdgom klini-

kuri gamokvlevebis safuZvelze dadginda, rom

dabalintensiuri lazeroTerapiis mudmiv mag-

nitur velTan erTad kombinirebuli moqmedebiT

adgili aqvs qsovilebSi mikrocirkulaciis

aRdgenas. kerZod: miocitebis da endocitebis

gaaqtivebas, kapilarebis funqciis stimulirebas

maTi gafarTovebis da sarezervo kapilarebis

74

gaxsnis xarjze. aRiniSneba kapilaruli qselis

gafarToveba (127).

lazeroTerapiis biologiuri efeqtis

meqanizmi realizdeba misi dadebiTi gavleniT

iSemiur ubnebSi mimdinare procesebze, veg-

etatiur regulaciaze, imunur sistemasa da

reparaciul aqtivobaze zemoqmedebiT (163. 164).

literaturaSi arsebuli monacemebi, laz-

eroTerapiis efeqturobis Sesaxeb, Zvalsaxsro-

vani daavadebebis dros sakmaod urTierTga-

momricxavia. es aixsneba mkurnalobis mimarT

sxvadasxva midgomiT, meTodebis da gamoyenebuli

dozebis individualuri SerCeviT (61).

infrawiTeli lazerebi qsovilebSi Rrmad

SeRwevadobis (10 sm-mde) gamo moqmedeben ara

mxolod kansa da kanqveSa qsovilebze, aramed

Zvlebze, saxsrebze, magistralur nerviul Re-

roebze, Sinagan organoebze da Tavis tvinze. maT

aqvT anTebissawinaaRmdego, tkivilgamayuCebeli

da aRdgeniTi procesebis mastimulirebeli mo-

qmedeba (64. 57).

mkvlevarTa umravlesobis azriT dilT-is bi-

ologiur moqmedebas safuZvlad udevs eleqtro-

magnituri gamosxivebis koherentuli kvantebis

75

energetikuli urTierTmoqmedeba biologiuri

struqturebis anatomiur-molekulur struq-

turebTan. am struqturebis damaxasiaTebeli Tav-

iseburebaa makromolekulebis kondensirebuli

mdgomareoba. aRniSnuli makromolekulebis mier

koherentuli kvantebis gamosxivebis STanTqma

iwvevs molekulis rezonansul agznebas, rac

dakavSirebulia garkveul sivrcobriv ubnebSi

bioqimiuri reaqciebis gaaqtiurebasTan (49. 50.

65. 66. 67).

infrawiTeli gamosxivebis Rrmad SeRweva-

doba ganpirobebulia mis mier rezonansuli

STanTqmis uunarobiT (37.39). biologiur qso-

vilebSi, maTi optikuri erTferovnebis gamo,

lazeruli energiis STanTqmisas adgili aqvs

temperaturis 0,01- 0,1 – iT cvlilebas, rac

ganapirobebs difuziis procesebis araTanabar

mimdinareobas. amas moyveba temperaturis gra-

dientis aRmoceneba membranebis axlomdebare

qsovilebSi da eleqtronuli potencialis cv-

lileba membranebze, maTi deformacia da sabo-

loo jamSi K da Na ionebis Termodinamiuri

gamodevna membranebidan. procesi grZeldeba

cilovani arxebis gaxsniT, ionebis da polaruli

76

molekulebis aqtiuri transportirebiT, endoci-

tozis gaZlierebiT (96).

infrawiTeli lazerebi qsovilebSi Rrmad

SeRwevadobis (10 sm-mde) gamo moqmedeben ara

mxolod kansa da kanqveSa qsovilebze, aramed

Zvlebze, saxsrebze, magistralur nervul Reroe-

bze, Sinagan organoebze da Tavis tvinze. maT

aqvT anTebissawinaaRmdego, tkivilgamayuCebeli

da aRdgeniTi procesebis mastimulirebeli mo-

qmedeba (76. 77. 79). dabalintensiur lazerul gamosxivebas aqvs

unari moaxdinos biologiur sistemebSi sxva-

dasxva morfo-funqcionaluri Zvrebi. literatu-

ruli monacemebi mowmoben, rom lazerul gamosx-

ivebas safuZvlad udevs ujredis membranuli

warmonaqmnebis da Sidaujreduli organelebis

struqturul-funqciuri gardaqmnebi, romlebic

ganpirobebulni arian specialuri aqceptorebis

mier energiis kvantebis rezonansuli STanTqmiT

(147. 148. 151).

aRsaniSnavia, rom morfologiuri meTodebiT

dilT-is moqmedebis Sedegad ujredis struqtu-

ruli komponentebis formirebis procesi nak-

lebadaa Seswavlili. gansxvavebuladaa Sefase-

buli Catarebuli gamokvlevebis Sedegebic.

77

klinikuri da eqsperimentuli dakvirvebe-

bis Sedegebi adastureben, rom dabalintensiuri

lazeroTerapia organizmze moqmedebs generali-

zebulad, moicavs ra sapasuxo reaqciebSi yvela

organos, qsovilebs da funqcionalur sistemebs

(45). lazeruli gamosxiveba organizmis im siste-

maSic iwvevs sapasuxo reaqciebs, romlebsac

eleqtromagnituri moqmedeba ar Sexebia (4. 74.

71. 80).

lazeruli samkurnalo procedurebis umt-

kivneuloba, meTodebis mravalferovneba, abso-

luturi winaaRmdegCvenebebis minimaluroba,

mkurnalobis Semdgomi remisiis gaxangrZliveba

ganapirobebs dabalintensiuri lazerebis war-

matebiT gamoyenebas mwvave da qronikuli daa-

vadebebis samkurnalod da profilaqtikuri

RonisZiebebis kompleqsSi da xSirad sruliad

damoukideblad, monoTerapiis saxiT. dasabuTe-

bulia dilT-is maRali efeqturoba da usa-

frTxoeba TiTqmis yvela profilis daavadebaTa

mkurnalobaSi (162, 147. 148).

78

osteoqondriopaTiebis aRdgeniTi osteoqondriopaTiebis aRdgeniTi

mkurnaloba kinezoTerapiis meTodiTmkurnaloba kinezoTerapiis meTodiT

termini ,,samkurnalo fizkultura’’ b. i.

SimSileviCma (1929 w.) SemoiRo. agreTve xmar-

obem terminebs: ,,kinezoTerapia’’, ,,motoTerapia’’,

,,miokinezoTerapia’’ da sxva.

Tanamedrove klinikur medicinaSi

mkurnalobis sxva meTodebTan erTad farTod

aris danergili samkurnalo fizikuri kul-

turis meTodi, romelSic pirvel rigSi igu-

lisxmeba sxvadasxva daavadebisa da dazianebis

dros mkurnalobisa da profilaqtikis mizniT

fizikuri varjiSebis gamoyeneba (6).

sadReisod samkurnalo fizkulturam,

rogorc mkurnalobis aqtiurma da paTogenezur-

ma meTodma, TvalsaCino adgili daimkvidra um-

ravles daavadebaTa kompleqsur mkurnalobaSi.

sxvadasxva daavadebis mkurnalobis sxvadasxva

etapze samkurnalo fizkulturis meTodi Sei-

Zleba gamoiyenon, rogorc mkurnalobis Ziri-

Tadi an damxmare saSualeba. yvela SemTxvevaSi

samkurnalo fizkulturis saboloo amocanaa

sruliad an nawilobriv mainc daubrunos

79

avadmyofs dakarguli Sromis unari, romlis

miRwevac fizikuri varjiSis gareSe zogjer

praqtikulad SeuZlebeli xdeba. amrigad, Tana-

medrove medicinaSi samkurnalo fizkulturis

saSualebiT xdeba avadmyofis sxvadasxva so-

cialuri sakiTxis mogvareba, amitom mas didi

mniSvneloba aqvs (6. 47. 48).

samkurnalo fizkultura udides rols

asrulebs ama Tu im daavadebiT gamowveu-

li garTulebebis acilebaSi, igi ara marto

mkurnalobis, aramed profilaqtikis erT-erTi

saukeTeso saSualebaa, romelic medikamentiTa

da qirurgiuli meTodiT Catarebul mkurnalobas

ufro efeqturs xdis. samkurnalo fizkultura,

rogorc fizikuri reabilitaciis wamyvani saSu-

aleba, mkurnalobis fizikur meTodebTan erTad

ganapirobebs aRdgeniT mkurnalobas.

samkurnalo fizkulturis saSualebebis

gamoyenebiT ufro advildeba avadmyofis naadre-

vi gamojanmrTeleba da misTvis Sromis unaris

dabruneba. sadReisod avadmyofis mkurnalobas

yvela SemTxvevaSi kompleqsuri meTodiT axor-

cieleben, amitom masSi Semavali mkurnalobis

saSualebaTa racionaluri gamoyeneba da maTi

80

urTierTSexameba ganapirobebs mkurnalobis

maRal efeqturobas. mkurnalobis kompleqsuri

kursis Semadgeneli nawilebisagan samkurnalo

fizkulturis meTodi gamoirCeva imiT, rom igi

umravlesi daavadebis SemTxvevaSi mkurnalobis

mTel periodSia gamoyenebuli, zog etapze ki

mas gadamwyveti mniSvneloba aqvs (6).

samkurnalo fizkulturis dros avadmyofs

uxdeba cxovrebisaTvis iseTi aucilebeli

fizikuri Tvisebebis gamomuSaveba, rogoricaa:

Zala, siswrafe, gamZleoba, koordinacia da sxva.

agreTve, samkurnalo fizkulturis dros xdeba

avadmyofis fsiqologiuri momzadeba.

samkurnalo fizkultura mkurnalobis

araspecipikuri meTodia. agreTve unda aRiniSnos,

rom samkurnalo fizkultura mastimulirebel

zegavlenas axdens organizmis yvela sistemaze

(nervul, gul-sisxlZarRvTa, sasunTq, sayrden-

mamoZravebel da sxva sistemebze), amis Sedegad

ki neiro-humoraluri meqanizmis saSualebiT

fizikur varjiSze sapasuxo reaqcia gamovlin-

deba.

samkurnalo fizkultura mkurnalobis aq-

tiuri meTodia, vinaidan, mkurnalobis yvela

81

sxva meTodisagan gansxvavebiT, am procesSi

avadmyofi TviTon aqtiurad da Segnebulad

Rebulobs monawileobas (es meTodi saWiroebs

mkurnalobis procesSi avadmyofis fsiqikis

CarTvas). Segnebulad ama Tu im saxis varjiSis

aTviseba da sworad Sesruleba, Tavis mxriv,

mniSvnelovnad wevs samkurnalo fizkulturis

Terapiul efeqturobas.

samkurnalo fizkulturas ganixilaven,

rogorc paTogenezuri Terapiis meTods. paTo-

genezuri Terapiis meTodi mas ewoda imitom, rom

samkurnalo fizkulturisa da pirvel rigSi

fizikuri varjiSis moqmedeba avadmyofis or-

ganizmze upirveles yovlisa ganapirobebs misi

imuno-biologiuri Zalebis mobilizacias, ris

Sedegadac daavadebisadmi organizmis winaaRm-

degobis unari Zlierdeba (6. 185. 194).

samkurnalo fizkultura funqciuri Terapi-

is erT-erTi ZiriTadi meTodia. aRniSnuli

aixsneba imiT, rom fizikuri varjiSebi mniS-

vnelovnad aumjobesebs rogorc organoTa

sistemebis, ise mTeli organizmis funqciur

mdgomareobas. fizikuri varjiSebis moqmedebis

procesSi organizmSi viTardeba Seguebis, anu

82

adaptaciuri meqanizmi, ris Sedegadac organizmi

TandaTan eCveva mzard fizikur datvirTvebs.

moZraobiTi funqcia mastimulirebeli pro-

cesia, romelic xels uwyobs organizmis zrda-

ganviTarebas da Camoyalibebas. amitom fizikuri

varjiSis, rogorc meTodis, gamoyeneba mkurnalo-

bisa da profilaqtikis mizniT yvela asakSi

dasaSvebia imitom, rom igi avlens funqciur

zemoqmedebas, rac, Tavis mxriv, organizms (orga-

noebsa da sistemebs) unarCunebs morfologiur

statussac.

samkurnalo fizkultura, rogorc funqci-

uri Terapiis meTodi, swored gamoyenebis SemTx-

vevaSi iwvevs avadmyofis TandaTan gavarjiSebas.

Oorganizmis gavarjiSeba ki, rogorc cnobilia,

mis maRal funqciur mdgomareobaze miuTiTebs

(6. 143).

samkurnalo fizkulturis meTodis gamoyen-

ebis dros aucilebelia wvrTnis Semdegi wesebis

dacva: TiToeuli avadmyofisadmi individualuri

midgoma, e.i. individualizacia rogorc meTodi-

kis, ise dozirebis sakiTxSi. am SemTxvevaSi mxved-

velobaSi unda miiRon daavadebis Tavisebureba

da avadmyofis organizmis saerTo mdgomareoba,

83

fizikur varjiSTa moqmedebis sistematurobis

dacva, rogorc varjiSTa SemTxvevaSi, ise maTi

moqmedebaTa TanmimdevrobaSi. aRniSnuli unda

gamomdinareobdes paTogenezuri Terapiis im

amocanebidan, romlebic dasaxuli iqneba ama Tu

im daavadebis mkurnalobasTan dakavSirebiT.

samkurnalo fizkultura aqtiuri, araspeci-

fikuri, funqciuri da paTogenezuri mkurnalo-

bis da profilaqtikis meTodia, romelic uzrun-

velyofs aRdgeniT mkurnalobas (reabilitacias),

ris Sedegadac avadmyofs srulad an nawilo-

briv ubrundeba Sromis unari.

samkurnalo fizkultura sportuli medi-

cinis erT-erTi ganuyofeli nawilia, romlis

gareSedac dRes warmoudgenelia sportsmenis

saboloo gamojanmrTeleba da misTvis Sromis

unaris dabruneba. medicinaSi Terapiuli efeq-

tis misaRebad samkurnalo fizkulturas xSirad

daavadebis pirveli dReebidan (zogjer pirveli

saaTidan) iyeneben.

fizikuri varjiSis moqmedebis Sedegad

mTliani organizmis funqciuri mdgomareoba

icvleba, rac janmrTeli an daavadebuli ada-

mianisadmi individualuri midgomis principis

84

dacvas saWiroebs.

fizikuri varjiSis moqmedeba daavadebul

organizmze da misi sapasuxo reaqcia ZiriTadad

nervul-humoraluri meqanizmiT xorcieldeba.

ar SeiZleba ar aRiniSnos fizikur varjiSTa

fsiqogenuri moqmedeba. sakmirisia adamianma war-

moidginos fizikuri varjiSis Sesruleba, rom

maSinve umjobesdeba sisxlis mimoqceva, gazTa

cvla, kunTebis tonusi da sxva (ideo-motoruli

zemoqmedeba) (68. 47).

fizikuri varjiSis fsiqologiur zemoqmede-

bas adamianis (avadmyofis) organizmi, gadahyavs

kunTuri miuSaobisaTvis mzadyofnis mdgomare-

obaSi. fizikuri varjiSis moqmedebis nervuli

regulaciis meqanizmi emyareba im rTul urT-

ierTkavSirs, romelic adamianis organizmis

ganviTarebis (zrdis) procesSi myardeba cen-

tralur nervul sistemas, Sinagan organoebs,

kunTebsa da sxv. Soris.

sxvadasxva saxis fizikuri varjiSi sxvadasx-

vanairad moqmedebs adamianis organizmze. fizi-

kuri varjiSis moqmedebis dros xdeba kunTebis

dozirebuli SekumSva-moduneba (moZraoba), ris

safuZvelzec kunTebidan da saxsrebidan pro-

85

prioreceptoruli xasiaTis impulsebi gadaecema

centralur nervul sistemas (Tavis tvinis qer-

qs). specialurad SerCeuli fizikuri varjiSe-

biT SeiZleba zemoqmedeba centralur nervul

sistemaze ise, rom masSi agzneba-SekavebiT pro-

cesebs Soris darRveuli wonasworoba aRdges,

rac (somatur da vegetatur nervul sistemaze

gavleniT) ganapirobebs organoTa darRveuli

funqciebis aRdgenas (6. 48).

amrigad, fizikuri varjiSi centraluri ner-

vuli sistemis saSualebiT zegavlenas axdens

paTologiuri sistemis dinamikaze da iwvevs mis

ukuganviTarebis daCqarebas, agreTve aRdgeniTi

procesebis stimulirebas, dazianebuli organos

(sistemis) funqciis gaumjobesebas, mTeli orga-

nizmis saerTo funqciis gaumjobesebas.

fizikuri varjiSi dadebiT zegavlenas

axdens qsovilTa cvlaze, rac Tavis mxriv, kargad

moqmedebs hemodinamikasa da plazmodinamikazec.

am dros organizmSi fizikur-qimiuri da bioqimi-

uri procesebi mniSvnelovnad aqtiurdeba. dadge-

nilia, rom kunTuri muSaobis Sedegad aRiniSna

potenciuri elementebiT iseTi nivTierebebis

gamdidreba, rogoricaa: adenozintrifosforis

86

mJava, fosfageni da glikogeni (a. v. paladini).

rZemJavis resinTezi Zlierdeba (d. l. ferdmani),

fermentaciuli procesebi aqtiurdeba.

fizikuri varjiSi dadebiTad moqmedebs

travmuli procesis ukuganviTarebaze da dakar-

guli funqciis aRdgenaze. travmuli paTologi-

is SemTxvevaSi fizikur varjiSebs axasiaTebs

avadmyofis organizmze zogadi da adgilobrivi

zemoqmedeba. zogadi zemoqmedeba gamoixateba

organizmis saerTo funqciuri mdgomareobis

gaumjobesebiT, adgilobrivi – ki jer qsovilTa

darRveuli mTlianobis aRdgeniT, xolo Semdeg

misi funqciuri mdgomareobis srulyofiT. aR-

saniSnavia, rom am dros avadmyofis gamojanm-

rTeleba damokidebulia TviT travmis xasiaTze,

mis lokalizaciaze da sxva. fizikuri varjiSi

xels uwyobs travmul ubanSi sisxlisa da

limfis mimoqcevis gaumjobesebas, trofikuli

procesebis gaZlierebas da regeneraciis stimu-

lirebas. travmul dazianebis dros fizikuri

varjiSi aCqarebs rogorc anatomiuri mTliano-

bis da funqciuri mdgomareobis (moZraobis)

aRdgenas, aseve Sromis unaris gaumjobesebas

(6. 48. 185).

87

arCeven fizikuri varjiSis matonizirebeli,

trofikuli, kompensaciuri da manormalizire-

beli moqmedebis meqanizms.

fizikuri varjSis zegavleniT mniSvnelovnad

umjobesTeba qsovilebSi nivTierebaTa cvla,

izrdeba energetikuli maragi da Sesabamisad

umjobesdeba qsovilTa kveba. KkunTuri muSao-

bis Sedegad Zlierdeba sisxlis mimoqceva, rac

pirvel rigSi plastikuri masalis – cilebis

aTvisebiTa da regeneraciuli procesebis daC-

qarebiT vlindeba. Ffizikuri varjiSi mniS-

vnelovnad uwyobs xels nawiburis (korZis)

droulad warmoqmnas da kompensaciuri hiper-

trofiis ganviTarebas.

fizikuri varjiSis zegavleniT xdeba fun-

qciis normalizacia. paTologiuri procesis (an-

Tebis) ukuganviTareba an qsovilTa regeneracia

sabolood ar niSnavs daavadebul organizmSi

ama Tu im dazianebul organoTa sistemis qso-

vilTa funqciis aRdgenas.

avadmyofis klinikuri gamojanmrTeleba ar

gulisxmobs mis saboloo morCenas. medikamen-

tozuri mkurnalobis Sedegad xdeba funqciis

pasiuri normalizacia, xolo fizikuri varji-

88

Sis zemoqmedebiT funqciis normalizacia aqti-

urdeba. aRniSnuli pirvel rigSi gulisxmobs

daavadebuli organizmis ama Tu im organoTa

sistemis iseT funqciur srulyofas, romelic

aucilebelia misi moZraobis procesebisaTvis.

amis miRweva ki mxolod fizikuri varjiSiT Sei-

Zleba. daavadebuli organizmis funqciis sruli

normalizacia xdeba maSin, rodesac avadmyofs

srulad an nawilobriv ubrundeba Sromis unari,

risi miRwevac yvelaze ukeT fizikuri varjiSis

zegavleniT SeiZleba (6. 47. 194).

89

osteoqondropaTiebis mkurnalobis dros osteoqondropaTiebis mkurnalobis dros

sakvebSi biologiurad aqtiuri sakvebSi biologiurad aqtiuri

danamatebis (bad) gamoyenebadanamatebis (bad) gamoyeneba

bolo aTwleulebis ganmavlobaSi Tana-

medrove farmakologiuri saSualebebis da-

dasturebulma toqsikurma da alergiulma

garTulebebma, garkveul wilad wina planze

wamoswia uZvelesi aRmosavluri medicinis

gamoyenebis aucilebloba. aRmosavluri me-

dicina gulisxmobs mcenareuli da mineraluri

produqtebis naturaluri saxiT miwodebas, xolo

gansxvaveba Tanamedrove dasavlur medicinasTan

is aris, rom produqtebis warmoeba xdeba maRali

qimiuri teqnologiis safuZvelze. sakvebis bi-

ologiurad aqtiuri danamatebi, rogorc wesi

miekuTvnebian sakvebis bunebriv komponetTa _

mikronutrientTa klass da gamoxatuli fiz-

iologiuri da farmakologiuri zemoqmedebiT

gavlenas axdenen organizmze da mis ZiriTad

regulatorul da metabolur procesebze. bad-i

warmoadgens samkurnalo da profilaqtikuri

medicinis or tradiciul sferos, _ dietologi-

is da farmakologiis _ sinTezs, romlis zR-

90

varze viTardeba mesame mecnieruli mimarTuleba

_ mikronutrientologia (24. 38. 73. 92).

umetesad samedicino sferoSi momuSave

pirebSi sufevs azri, rom sakvebTan biologi-

urad aqtiuri danamatebi warmoadgenen siaxles,

droSi gamoucdel, aratradiciuli saSualebebs,

romlebsac aranairi kavSiri ar aqvT profilaq-

tikasTan da miTumetes klinikur medicinasTan

(46).

umetes mikronutrientebs axasiaTebT sam-

kurnalo-profilaqtikuri moqmedebis ramod-

enime mimarTuleba, rac maT da Sesabamisad

sakvebTan biologiurad aqtiur danamatebs prin-

cipulad ansxvavebs sinTezur farmakologiuri

preparatebisgan, romlebsac axasiaTebT viwro

da erTmxrivi moqmedeba (136).

mikronutrientebs, rogorc janmrTeli, aseve

daavadebuli organizmis bioqimiuri reaqciebisa

da fiziologiuri funqciis regulaciis unari

aqvT. mikronutrientebi romlebsac gaaCniaT

gacilebiT farTo fiziologiuri moqmedeba,

SeuZliaT sagrZnoblad aamaRlon medikamento-

zuri mkurnalobis efeqti (40).

aRsaniSnavia, rom umetesi mikronutrientebis

91

maRali (farmakologiuri) dozebiT miwodeba, ar

iwvevs toqsiur efeqts, vinaidan maTi toqsiuri

doza ar arsebobs, an misi miRweva praqtikulad

ar xerxdeba. maT umeteswilad ar gaaCniaT

gverdiTi movlenebi. mikronutrientebis aseTi

pozitiuri Tviseba gamomdinareobs iqedan rom,

isini yovelTvis arseboben adamianis sakvebSi

da amitom gaaCniaT SeTvisebis, metabolizmis da

biologiuri moqmedebis evoluciurad mdgradi

fiziologiuri meqanizmi. magram, yovelTvis

unda gvaxsovdes, rom arseboben mikronutrien-

tebi, romlebsac axasiaTebT dozis gadaWarbeba,

magaliTad hiperkaliemia, D hipervitaminozi da

sxva (40. 118. 121. 122. 134. 161).

amJamad ukve sakmarisad kargad aris Ses-

wavlili da klinikurad aprobirebuli mTeli

rigi sakvebTan biologiurad aqtiuri danamatebi,

romlebsac SeuZliaT moaxdinon fiziologiuri

efeqtebi, srulad Sesabamisi farmakologiuri

preparatebis moqmedebis efeqtisa (41).

garda ZiriTadi sakvebi nivTirebebisa (mak-

ronutrientebi - cilebi, naxSirwylebi, cilebi)

biologiurad aqtiuri danamatebi Seicaven mik-

ronutrientebsac (vitaminebi, vitaminebis msgavsi,

92

makroelementebi, mikroelementebi, fermentebi

da a.S.).

makronutrientebi, arseboben sakvebSi didi

raodenobiT da warmoadgenen energiis ZiriTad

wyaros da saSen masalebs. makronutrientebisgan

gansxvavebiT mikronutrientebi sakvebSi arsebo-

ben minimaluri koncentraciiT _ miligramebSi

da mikrogramebSi. Tu makronutrientebi uz-

runvelyofen organizms saSeni masaliTa da

energiiT, mikronutrientebi asruleben regula-

toruli funqciis farTo speqtrs _ sakvebis

samkurnalo-profilaqtikul efeqts (41. 218).

mikronutrientebis absoluturi an Sedarebi-

Ti deficiti warmoadgens mTeli rigi gavrcele-

buli daavadebebis etiologiur faqtors.

umravlesi sinTetikuri preparatebisagan

gansxvavebiT mikronutrientebs TiTqmis ar

gaaCniaT garTuleba da gverdiTi efeqti da maTi

xangrZlivi gamoyeneba SeiZleba (155. 156. 157).

swored mikronutrientebis kompleqsuri

gamoyeneba gvaZlevs saSualebas miviRiT

mkurnalobis maqsimaluri efeqti, radgan evo-

luciis ganmavlobaSi sakvebSi arsebuli mik-

ronutrientebs Soris Camoyalibda mWidro

93

sinergistuli kavSiri.

drois umokles monakveTSi unikaluri

teqnologiiT SesaZlebeli gaxda naturaluri

wyaroebidan gamoeyoT mikronutrientebi ise rom

maTi biologiuri aqtiuroba da Tviseba Senar-

Cunebuli yofiliyo, Sedegad Camoyalibda sam-

kurnalo-profilaqtikuri preparatebis axali

klasi, romelsac ewoda sakvebTan biologiurad

aqtiuri danamatebi (40. 41. 113. 114).

bad-ebis Tvisebebi: cximovani, naxSirwylovani,

cilovani da mineraluri cvlis regulacia;

fermentuli sistemis aqtivacia; ujreduli

membranis struqturuli komponentebi; antio-

qsidanturi dacva; ujreduli sunTqvis (Jangva-

fosforilireba) procesebis uzrunvelyofa;

eleqtrolituri balansis SenarCuneba; tutovan-

marilovani wonasworobis SenarCuneba; imunuri

aqtiurobis regulacia; sisxlwarmoqmnis pro-

cesebSi monawileoba; sisxlis daleqvis regu-

lacia; sayrden-mamoZravebeli aparatis struq-

turuli da funqcionaluri uzrunvelyofa;

SemaerTebeli qsovilis sinTezi; qsenobiotike-

bis biotransformaciis procesebis regulacia;

normalurad mofunqcionire organizmSi bioqi-

94

miuri reaqciebisa da fiziologiuri fuqciebis

regulacia; mikronutrientebis specifikuri

deficitis Sevseba da makavSirebuli klinikuri

darRvevebis mkurnaloba; organizmis fiziolo-

giuri funqciis xelSewyoba; farmakologiuri

efeqtiT daavadebisa da daavadebiswina mdgo-

mareobis koreqcia (40. 95. 120. 173).

95

sakuTari gamokvlevebisakuTari gamokvlevebi

gamokvlevis meTodebigamokvlevis meTodebi

bavSvTa da mozardTa asakis sportsmenebSi

ganviTarebuli osteoqondropaTiebis klinikuri

diagnozis dasma did sirTules ar warmoadgens.

am dros anamnezis monacemebidan wamyvani simpto-

mia gazrdili datvirTvebis an travmis Semdeg

ganviTarebuli tkivilebi, gansakuTrebiT siaru-

lis an ganmeorebiTi datvirTvebisas, mtkivcneu-

loba palpaciiT sxvadasxva areebSi, gamomdinare

osteoqondropaTiebis lokalizaciidan.

gamokvlevis instrumentuli meTodebidan

gamoiyeneboda upirveles yovlisa:

rentgenologiuri gamokvleva osteoqon-

dropaTiuli zonisa mkurnalobis dawyebamde

(sxvadasxva klinikidan).

ultrasonografiuli gamokvleva ,

mkurnalobis dawyebamde da mkurnalobis Semdeg,

daviT tatiSvilis diagnostikur centrSi, eqimi

nino dumbaZe. ultrabgeriTi sistemebi ,,SIEMENS

SOLINE ANTARES, SIEMENS SONOLINE ELEGRA’,

maRalsixSiruli (7.5 – 13 mhz) gadamwodebiT. re-

96

Jimebi: SIE SCAPE panoramuli, THL - qsovilovan

harmoniuli.

osgud-Slateris daavadebis ultrabgeriTi

kvlevisas vlindeboda infrapatelaruli Rrma

bursitis suraTi, kviristavis sakuTari iogis

distaluri nawilis sisqeSi momateba, boWkoe-

bis eqogenobis daqveiTeba, apofizis Zvlovani

zedapiris araTanabarkonturianoba. Sorswasul

SemTxvevebSi calkeuli fragmentebis arseboba.

reparaciis stadiaSi feradi kartirebiT isaxeba

gaZlierebuli, arteriuli tipis vaskulariza-

cia, rac normaSi ar fiqsirdeba.

imis gamo rom, mozard sportsmenebze mud-

mivad moqmedebs osteoporozis ganviTarebis

xelSemwyobi faqtorebi, kvlevis meTodebSi

CavrTeT densitometriuli gamokvleva. ZiriTadi

meTodi, romliTac osteoporozis gamokvleva

xdeboda adre, aris rentgenologiuri meTodi.

densitometriuli gamokvleva warmoadgens kv-

levis Tanamedrove meTods.

densitometriuli gamokvlevebi sruldeboda

Tbilisis saxelmwifo samedicino unuversite-

tis endokrinologiis kaTedraze. eqimi – medi-

cinis mecnierebaTa doqtori, profesori koba

97

koplataZe.

dReisaTvis, Zvlis densitometria gaxda

Zvlis mineraluri simkvrivis diagnostikis

sayovelTaod miRebuli meTodi. densitometria

warmoiSva maSin, rodesac naTeli gaxda, rom

rentgenografiuli gamokvleva sakmarisi ar iyo

Zvlis mineraluri simkvrivis gansasazRvrad

(Genant et al. 1998).

rentgenologiurad Zvlis qsovilis demin-

eralizaciis gansazRvra SesaZlebelia, rodesac

Zvlis simkvrive qveiTdeba 40%-iT.

ultrabgeriTi gamokvlevis upiratesoba

aris misi arainvaziuroba. is, rom meTodiT xa-

siaTdeba Zvlis simkvrive, mikroarqiteqtonika,

elastiuroba, struqturuli da geometriuli

Tvisebebis maxasiaTebelia.

,,Sunlight Omnisense”-i aris ultrabgeriTi xel-

sawyo, romelsac SeuZlia ZvalSi ultrabgeris

gavrcelebis siCqaris gazomva ConCxis sxvadasx-

va nawilSi. is Sedgeba mTavari nawilisagan da

gadamcemisagan. Ggazomvis Sedegebi gamoixateba

ganzomilebiT metri/wamSi.

ultrabgera Zvlis kortikalur Sres gadis

ufro swrafad (4000 m/w), vidre trabekulurs

98

(1800 m/w). rbil qsovilebSi ultrabgera gaivlis

bevrad ufro nela, vidre ZvalSi. haerSi ki igi

TiTmis saerTod ar gadis. xelsawyod muSaobas

swored es movlena udevs safuZvlad.

ultrabgeriTi talRebis warmosaqmnelad

da aRsaqmelad gamoiyeneba specialuri mimRebi.

mimRebi edeba kans im wertilSi, sadac gvsurs

gamokvlevis Catareba. mimRebsa da kans Soris

saWiroa specialuri Jeles wasma. ultrabgeras

gamoscems mimRebis erTi nawili,igi vrceldeba

ZvalSi da Semdeg xdeba misi aRqma mimRebis

meore nawilis mier.

bgeriTi talRebi vrceldeba yvela mi-

marTulebiT. yoveli molekula avrcelebs

signals Semdegze. xelsawyo Rebulobs saWiro

informacias pirveli signalis aRqmiT, romelic

miaRwevs mimRebamde. ZvalSi SeRwevisas talRa

gardatydeba garkveuli kuTxiT, vrceldeba Zv-

lis gaswvriv da gamodis Zvlidan igive kuTxiT.

dro, romelsac andomebs bgeriTi talRa am

monakveTis gavlas, aris is parametri, romelsac

zomavs xelawyo.

yovel pacientze Catarebuli gamokvlevis

Sedegi warmodgenilia sami gansxvavebuli param-

99

etris saxiT:

1. ZvalSi ultrabgeris gavrcelebis siC-

qare (SOS), gamoxatuli ganzomilebiT metri/

wamSi.

2. T-score – gviCvenebs gansxvavebas pacientis

Zvlis simkvrivesa da axalgazrda janmrTel

populaciaSi Zvlis simkvrivis saSualo maCven-

ebels Soris.

3. Z-score – gviCvenebs gansxvavebas pacientis

Zvlis simkvrivesa da amave asakisa da sqesis

populaciaSi Zvlis simkvrivis saSualo maCven-

eblebs Soris.

yoveldRiurad xdeba sistemis xarisxis

Semowmeba specialuri xelsawyos gamoyenebiT,

romelSic ultrabgera gadis gansazRvruli

siCqariT. amis meSveobiT vadgenT Tu ramdenad

zusti monacemebis miRebaa SesaZlebeli gamokv-

levis Sedegad.

gamokvlevis Sedegebi ganixileba special-

uri kompiuteruli programebiT, am SemTxvevaSi

Rebuloben monacemebs ultrabgeris gavrceleb-

is siCqaris Sesaxeb, simkvrivis indeqs, asakisa

da sqesis normebTan mimarTebaSi monacemebis

procentul monacemebs da agreTve Zvlis sim-

100

kvrivis maCveneblebels da am parametrebidan

saSualo gadaxras.

Zvlis mineraluri simkvrivis gansazRvris

monacemebis safuZvelze janmrTelobis dacvis

msoflio organizaciam SeimuSava Semdegi gan-

sazRvrebebi:

normaluri – Zvlis masis pikis saSualo

donidan ara nakleb erTi standartuli erTeu-

liT (SD) gadaxra (T-score metia –1).

dabali Zvlis masa an osteopenia. Zvlis

masis pikis saSualo donidan qvemoT, Zvlis qso-

vilis simkvrive 1.0 da 2.5 SD-sOSoris (T-score –1

da –2.5 Soris).

osteoporozi. Zvlis simkvrive 2.5 SD an meti,

Zvlis masis pikis saSualoze qvemoT (T-score –2.5

da naklebi).

jandacvis msoflio organizaciis rekomen-

daciis Tanaxmad, osteoporozis diagnostika

xorcieldeba T-s normis standartuli gadaxris

maCveneblis (SD)safuZvelze:

SD –1-mde – norma

-1 SD-dan –2.5 SD+-mde – osteopenia

-2.5 SD-ze naklebi, motexilobis gareSe –

osteoporozi

101

-2.5 SD-ze naklebi, + 1 motexiloba – mZime

osteoporozi G

gamokvleul pacientTa 92%-s aRmoaCnda

Zvlovani masis met-naklebi daqveiTeba – gam-

oikveTa Zvlis simkvrivis daqveiTebis tendencia

(osteopeniisa da osteoporozis saxiT), rac

SeiZleba CaiTvalos osteoqondropaTiebis gan-

viTarebis erT-erT mniSvnelovan winapirobad.

imis gamo, rom ar arsebobda osteoqondro-

paTiebis dros tkivilis Sefasebis specifikuri

Skala, obieqturi da subieqturi klinikuri

gamokiTxvis mixedviT Cvens mier SemuSavebuli

iqna Semdegi specialuri Skala:

tkivili ar aris, mxolod palpaciiT aris

gamoxatuli egzostozi – 0 bali.

mcireodeni tkivili didi fizikuri dat-

virTvebis Semdeg, romelic dasvenebisTanave

gaivlis – 1 bali

zomieri tkivili datvirTvisas, romelic

dasvenebis Semdeg gaivlis – 2 bali

Zlieri tkivili fizikuri datvirTvis dros,

romelic rCeba didxans – 3 bali

tkivili mcire datvirTvisas, siarulisas,

kibeze asvlisas – 4 bali

102

zemoTaRniSnuli Skalis mixedviT Sefase-

bis obieqturad Camosayalibeblad Cvens mier

SemuSavebuli iqna specialuri fizikuri dat-

virTvis testi (xtunviTi varjiSebi saxtunelaTi,

1 wuTSi 60 xtunva 10 sm-is simaRleze), romelic

pacentebs utardebodaT mkurnalobis dasawyisSi,

me-10 dRes, me-15 dRes da mkurnalobis kursis

dasasruls. testis Catarebis dros xdeboda

drois dafiqsireba, romlis drosac Cndeboda

Tundac mcireodeni tkivili Cveni dakvirve-

biT:

tkivili iwyeboda datvirTvis me-5-15 wm-ze

4 baliT Sefasebul pacientebSi,

15-30 wm – 3 bali

30-60 wm – 2 bali

60-180 wm – 1 bali

180 wm an meti – 0 bali

amis garda efeqturobis Sefaseba xdeboda

specialuri gamokiTxviT anketirebis gziT,

rogorc pacientis, aseve eqimis mier. mkurnalo-

bis efeqturobis Sefaseba xdeboda Semdegi

formulirebiT:

,,Zalian kargi’’ (sruli gamojanmrTeleba

sportSi sruli CarTviT)

103

,,kargi’’ (mdgomareobis mniSvnelovani gaum-

jobeseba, sportSi nawilobrivi CarTviT)

,,damakmayofilebeli’’ (umniSvnelo gaum-

jobeseba, sportSi CarTvis Seferxeba)

,,warumatebeli’’ (dadebiTi Sedegi ar

dafiqsirda)

,,cudi’’ (pacientis mdgomareoba gauares-

da)

zemoTaRniSnuli testebisa da Skalebis ad-

eqvaturoba anu e.w. validuroba (ingl. Validity)

sakmaod maRalia, rogorc Sinaarsobrivi, aseve

kriterialuri da konstuqciuli anu koncep-

cialuri TvalsazrisiT, Tumca maTi maTemati-

kuri meTodebis mixedviT Camoyalibeba Semdgomi

kvlevis mizania da aucileblad gagrZeldeba.

iseve rogorc axali gamokiTxvis sqemis Sed-

genisasac, romelzec aseve unda gagrZeldes

muSaoba saerTaSoriso normebis sruli dacviT,

raTa Camoyalibdes saboloo saxiT.

mkurnalobis sqemaSi CarTuli iqna german-

uli farmacevtuli firma ,,HEEL’’-is mier war-

moebuli antihomotoqsikologiuri preparatebi:

Traumeel-S-is malamo, Osteoheel-is tabletebi, Placenta

compositum-is ampulebi. am preparatebis CarTva

104

gamoiwvia maTma Zalze maRalma usafrTxoebam,

ukuCvenebebis ararsebobam, gverdiTi movlenebis

ukiduresma simcirem da naklebma simZimem.

garda antihomotoqsikuri preparatebisa,

pacientebs utardebodaT ultrafonoforezis,

lazeroTerapiisa da samkurnalo fizkulturis

kursi.

fizioTerapiuli (ultrafonoferezi) pro-

cedurebi tardeboda Tssu-is centraluri

klinikis samedicino reabilitaciis bazaze

eqimebi: dodo leJava, manana Sengelia, manana

kopaliani.

ulrafonoforezis procedurebi tardeboda

aparat “ÓÇÒ-101”. aparati “ÓÇÒ-101” muSaobs 880

khc sixSireze, uwyvet da impulsur reJimSi. im-

pulsTa xangrZlivoba aris 2.4 da 10 mwm, aparati

erTdeba 220 voltze. intensivobis Skalis param-

etrebi meryeobs 0.05 dan 1.0 vt/sm2

osteoqondropaTiebis dros tardeboda

saxsrebis irgvliv zemoqmedeba 0.7 vt/sm2 inten-

sivobiT, uwyvet reJimSi, labiluri meTodikiT.

lazeroTerapia tardeboda amave bazaze

aparati A,,adept’’-iT, eqimebi: a. gogelia, m. maTia-

Svili. LlazeroTerapia tardeboda 0.89 mkm tal-

105

Ris sigrZis magnitolazeruli SuqgamtariT. M

mkurnalobis pirvel xuT seansze dasxiveba

xdeboda maRali sixSiriT (1500-1700 hc) da dab-

ali simZlavriT (8-10 vt). tkivilis kupirebis

Semdeg es maCvenebeblebi mcirdeboda optimalur

dozamde. dasxivebis doza TviTeul seansze ar

aRemateboda 0.5 j/sm2 – lazeroTerapiis meTodi

yvela SemTxvevaSi kontaqturi iyo.

samkurnalo varjiSebis procedurebi

utardebodaT amave bazaze samkurnalo fiz-

kulturis darbazSi. eqimebi: ia SatberaSvili

da nargiza gogiberiZe.

samkurnalo fizkulturis kursi moicavda 10

dRes. pacientebi davyaviT sam asakobriv jgufad

imisaTvis, rom mocemuli datvirTva pirobiTad,

Sexamebuli yofiliyo asakTan. samive jgufis

pacientebs utardebodaT Cvens mier SemuSave-

buli specialur varjiSTa kompleqsi, romelic

yvelasaTvis identuri iyo, xolo gansxvavebas

TviTeuli jgufusaTvis warmoadgenda mxolod

datvirTvis xarisxi (raodenoba, xangrZlioba).

asakobriv jgufebad davyaviT Semdegnairad: I

jgufSi gavaerTianeT pacientebi - 10-12 w, II

jgufSi – 13-15 w, III jgufSi – 16 w. da zemoT.

106

varjiSTa kompleqsi moicavs 3 tipis varjiSs,

statikuri (izometruli), dinamiuri (izotonuri)

da gawelviTi varjiSebi. Cvens mier Sedgenili

varjiSTa programa Sedgeba 23 saxis varjiSisa-

gan: 3 – statikuri, 15 – dinamiuri da 5 – gawel-

viTi.

statikuri (izometruli) varjiSebi:

1. barZayis oTxTava kunTi: sawyisi mdgomare-

oba zurgze wola, zemo kidurebi tanis gaswvriv,

gaSlil mdgomareobaSi, odnav ganziduli. terfi

maqsimalurid moziduli mdgomareobaSi, barZayis

oTxTava kunTs monacvleobiT vWimavT 5 wm, Semdeg

vadunebT 5 wm da a.S. igive meore fexiT. sunTqva

riTmuli, Tavisufali. I jgufi – 8-10 – 18-20 -

jer

II jgufi – 10-12 – 20-23 - jer

III jgufi – 12-15 – 23-25 - jer

2. barZayis oTxTava kunTi: sawyisi mdgo-

mareoba zurgze wola, zemo kidurebi tanis

gaswvriv gaSlili mdgomareobaSi, odnav gan-

ziduli. terfi maqsimalurad mozidul mdgo-

mareobaSi, barZayis oTxTava kunTs mWimavT da

fexs vwevT 40-ze, vaCerebT 5 wm-s ganmavlobaSi,

vubrundebiT sawyis mdgomareobas, 5 wm-s Semdeg

107

vimeorebT. igive meore fexiT. sunTqva riTmuli,

Tavisufali.

I jgufi – 8-10 – 18-20 - jer

II jgufi – 10-12 – 20-23 - jer

III jgufi – 12-15 – 23-25 - jer

3. barZayis oTxTava kunTi da kanWis tyupi

kunTebi: sawyisi mdgomareoba naxevrad Camjdari,

kedelTan vjdebiT ise, rom zurgi da weli mib-

jenilia kedelze, qvemo kidurebi menj-barZayisa

da muxlis saxsrebSi 90-iT moxrili, xelebi

CamoSvebuli, sunTqva riTmuli, Tavisufali.

I jgufi – 15-20 – 45-50 - wm

II jgufi – 20-25 – 55-60 - wm

III jgufi – 25-30 – 65-75 - wm

dinamiuri (izotonuri) varjiSebi:

4. velotrenaJori. TviToeuli varjiSi iwye-

boda da mTavrdeboda velotrenaJoriT, siCqare

da simZlavre SerCeuli iyo asakobrivi jgufis

mixedviT.

I jgufi – 5 – 15 - wm

II jgufi – 5 – 15 - wm

III jgufi – 5 – 20 - wm



108

gaSlili mdgomareobaSi, odnav ganziduli, ter-

fi moziduli maqsimalurad da monacvleobiT

fexis aweva da daweva ise, rom fexi iataks ar

exeba, sunTqva riTmuli, Tavisufali.

I jgufi – 8-10 – 18-20 - jer

II jgufi – 10-12 – 20-23 - jer

III jgufi – 12-15 – 23-25 - jer


mareoba zurgze wola, zemo kidurebi tanis

gaswvriv, gaSlili mdgomareobaSi, odnav ganz-

iduli, terfi moziduli maqsimalurad. muxlis

saxsari 40-iT moxrili devs samedicino burTze

da monacvleobiT fexs vxriT muxlis saxsarSi

Semdeg vasworebT. igive meore fexiT, sunTqva

riTmuli, Tavisufali.

I jgufi – 10-12 – 20-22 - jer

II jgufi – 12-15 – 22-25 - jer

III jgufi – 15-18 – 25-28 - jer

7. sawyisi mdgomareoba wola gverdze, sx-

euli erT sibrtyeSi, Sesabamisi mxaris xeli

TavqveS, meore tanis win – wonasworobisaTvis.

sawinaaRmdego mxaris fexs monacvleobiT vwevT

jer zemoT, Semdeg qvemoT, ise rom fexi meore

109

fexs ar exeba. igive meore fexiT. sunTqva riT-

muli, Tavisufali.

I jgufi – 8-10 – 18-20 - jer

II jgufi – 10-12 – 20-23 - jer

III jgufi – 12-15 – 23-25 - jer

8. barZayis ukana jgufis kunTebi: sawyisi

mdgomareoba mucelze wola, zemo kidurebi

tanis gaswvriv, qvemo kidurebi gaSlili da

odnav ganziduli, monacvleobiT fexs vxriT

muxlis saxsarSi da vasworebT, ise, rom terTi

iataks ar exeba. igive meore fexiT. sunTqva


I jgufi – 10-12 – 20-22 - jer

II jgufi – 12-15 – 22-25 - jer

III jgufi – 15-18 – 25-28 - jer

9. sawyisi mdgomareoba wola gverdze, sx-

euli erT sibrtyeSi, Sesabamisi mxaris xeli

TavqveS, meore tanis win – wonasworobisaT-

vis. sawinaaRmdego mxaris fexi vxriT muxlis

saxsarSi da vaTavsebT tanis win, meore fexs

monacvleobiT vwevT jer zemoT, Semdeg qvemoT,

ise rom fexi iataks ar exeba. sunTqva riTmuli,

110

Tavisufali.

I jgufi – 8-10 – 18-20 - jer

II jgufi – 10-12 – 20-23 - jer

III jgufi – 12-15 – 23-25 - jer



qvemo kidurebi gaSlili da odnav ganziduli,

terfi moziduli maqsimalurad, gaSlil fexs

vwevT 45-iT, vafiqsirebT, fexs vxriT muxlis

saxsarSi, vasworebT fexs da vubrundebiT sawyis

mdgomareobas, ise, rom fexi iataks ar exeba. igive

meore mxares. sunTqva riTmuli, Tavisufali.

I jgufi – 8-10 – 18-20 - jer

II jgufi – 10-12 – 20-23 - jer

III jgufi – 12-15 – 23-25 - jer

11. sawyisi mdgomareoba dgomSi, qvemo kidu-

rebi odnav ganziduli, xelebi mxris siganeze

da CaWidebul orZels. taniT gadavdivarT ukan

da vjdebiT ise, rom fexebi moixaros muxlis

saxsarSi 90-iT, xolo wvivebi vertikalur mdgo-

mareobaSi darCes umoZraod.

I jgufi – 8-10 – 15-18 - jer

111

II jgufi – 10-12 – 18-20 - jer

III jgufi – 12-15 – 23-25 - jer

12. sawyisi mdgomareoba dgomSi, fexs vdebT

safexurze (safexuris simaRlis SerCevisas

gaTvaliswinebuli iyo sportsmenis asaki) paci-

enti adis da Camodis, ise rom fexs ar aSorebs

safexurs. igive meore mxares.

I jgufi – 8-10 – 15-18 - jer

II jgufi – 10-12 – 18-20 - jer

III jgufi – 12-15 – 23-25 - jer

13. kanWis tyupi kunTi da wvivis grZeli

da mokle momzidveli kunTebi: ,,balansirebis

dafa”-ze vdgebiT Sua nawilSi da terfs monacv-

leobiT, maqsimalurad ganvzidavT da movzidavT.

igive meore fexiT.

I jgufi – 8-10 – 18-20 - jer

II jgufi – 10-12 – 20-23 - jer

III jgufi – 12-15 – 23-25 - jer

14. vjdebiT ,,Leg press”-ze orive terfi Tavs-

deba dafaze. dafas ganvzidavT sxeulidan ise,

rom fexebi gaiSalos muxlis saxsarSi, Semdeg

112

vubrundebiT sawyis mdgomareobas. varjiSis

Sesrulebis periodSi terfi srulad devs da-

faze. ganzidvisas amovisunTqavT, mozidvisas

CavisunTqavT.

I jgufi – 8-10 – 18-20 – jer – 8-12 kg

II jgufi – 10-12 – 20-23 – jer – 8-12 kg

III jgufi – 12-15 – 23-25 – jer – 12-16 kg

15. barZayis oTxTava kunTi: vjdebiT ,,Leg

extension”-ze ise, rom orive fexis muxlqveSa

foso mibjenilia zemoTa sayrden rgolze, xolo

terfebis zemoTa zedapiri qvemoTa sayrden

rgolze. fexebs vSliT muxlis saxsarSi, Semdeg

vubrundebiT sawyis mdgomareobas. gaSlisas

amovisunTqavT, moxrisas CavisunTqavT.

I jgufi – 8-10 – 18-20 – jer – 4-8 kg

II jgufi – 10-12 – 20-23 – jer – 4-8 kg

III jgufi – 12-15 – 23-25 – jer – 4-12 kg

16. barZayis ukana jgufis kunTebi: vdgebiT

,,Standing leg curl”-Tan, fexs vaTavsebT ise, rom

wvivis wina proqsimaluri nawili mibjenili

iyos zemoTa sayrden rgolze, xolo aqilevsis

myesis are qvemoTa sayrden rgolze. fexs vxriT

muxlis saxsarSi, Semdeg vubrundebiT sawyis

113

mdgomareobas. moxrisas amovisunTqavT, gaSlisas

CavisunTqavT.

I jgufi – 8-10 – 18-20 – jer – 4 kg

II jgufi – 10-12 – 20-23 – jer – 4 kg

III jgufi – 12-15 – 23-25 – jer – 4-8 kg

17. ZunZuli.

I jgufi – 10 – 20 - wT

II jgufi – 15 – 25 - wT

III jgufi –15 – 30 - wT

18. sirbili.

I jgufi – 10 – 20 - wT

II jgufi – 15 – 25 - wT

III jgufi –15 – 30 - wT

gawelviTi varjiSebi:


mareoba jdomSi, fexi moxrilia muxlis saxsarSi

ise, rom terfi aRmoCndes amave mxares dundula

kunTis gareTa zedapirTan, terfi ganziduli

maqsimalurad da iatakze zemoTa zedapiriT

devs. meore fexi gaSlili Tavisuflad xelebi

tanis ukan da veyrdnobiT maT. gadmovdivarT

taniT ukan nel-nela ise, rom vigrZnoT oTx-

114

Tava kunTis sasiamovno gawelva, daZabulobis

gasvlis Semdeg kidev gadavdivarT nel-nela

da a.S. igive meore fexiT. sunTqva riTmuli,

Tavisufali.

I jgufi – 10-15 – 20-25 - wm

II jgufi – 10-15 – 20-25 - wm

III jgufi –10-15 – 25-30 - wm

20. barZayis ukana jgufis kunTebi: sawyisi

mdgomareoba mdgomSi, fexi iweva 90 da gaSlil

mdgomareobaSi vdebT Svedur kedelze, terfi

maqsimalurad moziduli da viWerT xeliT.

zurgi gasworebuli, Tavi aweuli, mzera terfi-

saken da nela-nela gadavdivarT win. sasiamovno

daZabulobis SegrZnebisas vCerdebiT, rodesac

gaivlis kvlav vwelavT da a.S. sunTqva riTmuli,

Tavisufali.

I jgufi – 10-15 – 20-25 - wm

II jgufi – 10-15 – 20-25 - wm

III jgufi –10-15 – 25-30 - wm

21. barZayis momzidveli kunTebi: sawyisi

mdgomareoba jdomSi, veyrdnobiT kedels, fexebi

moxrili, muxlebi maqsimalurad daSorebuli,

115

terfebs vaerTebT da maqsimalurad movzidavT

tanisken. idayvebiT vawvebiT muxlebs, msubuqi

gawelvis SegrZnebisTanave vCerdebiT, xolo

daZabulbis gasvlisas kvlav vawvebiT da a.S.

sunTqva riTmuli, Tavisufali.

I jgufi – 10-15 – 20-25 - wm

II jgufi – 10-15 – 20-25 - wm

III jgufi –10-15 – 25-30 - wm

22. barZayis oTxTava kunTi da muxlis sax-

sari: sawyisi mdgomareoba mdgomSi. vdgebiT

pirisaxiT kedlisaken da erTi xeliT veyrdno-

biT. muxls vxriT da ukanganziduli sawinaaRm-

dego mxaris xeliT vkidebT terfs da vawvebiT

dundula kunTisaken, ise rom muxlis saxsari

moZraobdes ukana mimarTulebiT. msubuqi gawel-

vis SegrZnebisas vaCerebT, Semdeg vagrZelebT

gawelvas da a.S. igive meore mxares. sunTaqva


I jgufi – 10-15 – 20-25 - wm

II jgufi – 10-15 – 20-25 - wm

III jgufi –10-15 – 25-30 - wm

23. kanWis tyupi kunTi: sawyisi mdgomareo-

ba dgomSi. vdgebiT pirisaxiT kedlisaken da

116

winamxrebiT veyrdnobiT. erTi fexi moxrili

muxlis saxsarSi, xolo terfi mibjenili ke-

delTan. erTi nabijiT ukan vdgamT meore. taniT

viwevT win, sasiamovno daZabulobis SegrZnebisas

vCerdebiT, gavlisas vargZelebT win gadaxras

da a.S. sunTqva riTmuli, Tavisufali.

I jgufi – 10-15 – 20-25 - wm

II jgufi – 10-15 – 20-25 - wm

III jgufi –10-15 – 25-30 - wm

savarjiSo cikli davyaviT 3 etapad: I etapi

moicavda savarjiSo ciklis 1-3 dRes, II – me-4-6

dRe, III – me-7-10 dRe. varjiSebs Soris inter-

vali iyo 2-3 wT.

samkurnalo fizkulturis programaSi sxva-

dasxva varjiSi erTveboda da eTiSeboda sxva-

dasxva etapis sxvadasxva dRes, rac naCvenebia 1,

2 da 3 cxrilebSi.

117

varjiSebi

I etapi

II etapi

III etapi

I

dRe

II dRe

III

dRe

IV

dRe

V dRe

VI dRe

VII dRe

VIII dRe

IX dRe

X dRe

1+

++

++

--

--

-

2+

++

++

+-

--

-

3-

-+

++

++

++

+

4+

++

++

++

++

+

5+

++

++

+-

--

-

6+

++

++

--

--

-

7+

++

++

++

++

+

8+

++

++

+-

--

-

9+

++

++

++

++

+

10+

++

++

++

++

+

11-

--

-+

++

++

+

12-

--

-+

++

++

+

13+

++

++

++

++

+

14-

--

--

++

++

+

15-

--

-+

++

++

+

16-

--

--

-+

++

+

17-

--

--

-+

++

+

18+

++

++

++

++

+

19+

++

++

++

++

+

20

++

++

++

++

++

21

++

++

++

++

++

22

++

++

++

++

++

23

++

++

++

++

++

cxrili 1

I jgufi

118

varjiSebi

I etapi

II etapi

III etapi

I

dRe

II dRe

III dRe

IV dRe

V dRe

VI dRe

VII dRe

VIII dRe

IX dRe

X dRe

1+

++

++

--

--

-

2+

++

++

+-

--

-

3-

-+

++

++

++

+

4+

++

++

++

++

+

5+

++

++

+-

--

-

6+

++

++

--

--

-

7+

++

++

++

++

+

8+

++

++

+-

--

-

9+

++

++

++

++

+

10+

++

++

++

++

+

11-

--

-+

++

++

+

12-

--

-+

++

++

+

13+

++

++

++

++

+

14-

--

--

++

++

+

15-

--

-+

++

++

+

16-

--

--

-+

++

+

17-

--

--

-+

++

+

18+

++

++

++

++

+

19+

++

++

++

++

+

20

++

++

++

++

++

21

++

++

++

++

++

22

++

++

++

++

++

23

++

++

++

++

++

cxrili 2

II jgufi

119

cxrili 3

III jgufi

varjiSebi

I etapi

II etapi

III etapi

I dRe

II dRe

III dRe

IV dRe

V dRe

VI dRe

VII

dRe

VIII

dRe

IX

dRe

X dRe

1+

++

++

--

--

-2

++

++

++

--

--

3-

-+

++

++

++

+4

++

++

++

++

++

5+

++

++

+-

--

-6

++

++

+-

--

--

7+

++

++

++

++

+8

++

++

++

--

--

9+

++

++

++

++

+10

++

++

++

++

++

11-

--

-+

++

++

+12

--

--

++

++

++

13+

++

++

++

++

+14

--

--

-+

++

++

15-

--

-+

++

++

+16

--

--

--

++

++

17-

--

--

-+

++

+18

++

++

++

++

++

19+

++

++

++

++

+20

++

++

++

++

++

21

++

++

++

++

++

22

++

++

++

++

++

23

++

++

++

++

++

120

kvlevis masalakvlevis masala

Tbilisis saxelmwifo samedicino univer-

sitetis centraluri klinikis samedicino re-

abilitaciasa da sportuli medicinis kaTedraze

1996-2005 wlebSi mkurnaloba Caitara osteoqon-

dropaTiis diagnoziT 1020 pacientma, romelTa

Soris 612 (60%) iyo osgud-Slateris diagnoziT,

258 (25,3%) hagland-Sincis (hagland-severis) di-

agnoziT, 150 (14.7%) ki keleri I-II-is diagnoziT.

pacientTa 89% (908) iyo biWi, 11% (112) gogona.

735 mozardSi (72.05%) daavadeba gamoxatuli iyo

calmxrivad, 285-Si (27.95%) –ormxrivad.

cxrili 4

n=1020daavadeba raodenoba procenti (%)

osgud-Slateris

daavadeba612 60

hagland-Sincis

(hagland-severis)

daavadeba

258 25,3

keleri I-II-is daa-

vadeba150 14.7

121

cxrili 5

n=1020

sqesi raodenoba procenti (%)

biWebi 908 89

gogonebi 112 11

cxrili 6

n=1020

raodenoba procenti (%)

calmxrivi 735 72.05

ormxrivi 285 27.95

asakis mixedviT pacientebi ganawilda Semde-

gnairad: yvelaze meti avadmyofi 710 (70%) iyo

12-14 asakovan jgufSi, 207 (20.3%) avadmyofi 8-11

asakobriv jgufSi da yvelaze naklebi raode-

noba 103 (9.7%) 15-17 asakovan jgufSi.

cxrili 7

pacientTa ganawileba asakobrivi jgufis

mixedviT

n=1020

asaki(w) raodenoba procenti (%)

8-11 207 20.3

12-14 710 70

15-17 103 9.7

122

kvlevaSi monawile pacientTagan 561 (55%) iyo

fexburTeli, 153 (15%) ragbisti, 102 (10%) kalaT-

burTeli, 81 8% CogburTeli, 123 12% ki sportis

sxva saxeobebidan (tanvarjiSi, curva, Widaoba).

cxrili 8

pacientTa ganawileba sportis saxeobebis

mixedviT

n=1020saxeoba raodenoba procenti (%)

fexburTi 561 55

ragbi 153 15

kalaTburTi 102 10

CogburTi 81 8

sportis sxva

saxeobebi (tan-

varjiSi, curva,

Widaoba).

123 12

osteoqondropaTiebis risk-faqtorebis

Seswavlam aCvena, rom yvelaze xSiri maprovo-

cirebeli faqtoria swrafi zrda da arara-

cionaluri, gazrdili fizikuri datvirTvebiT

gamowveuli gadaZabva - 540 SemTxveva (52,9%),

16.9%-Si (173 pacienti) mikrotravma, 12.9%-Si (132

pacienti) saTamaSo gruntis xSiri cvalebadoba,

17.3%-Si (175 pacienti) arasworad SerCeuli spor-

123

tuli inventari. 199 avadmyofs (19.5%) aReniSna

brtyelterfianoba, gamokvleul mozardTagan

894 (87.6%), aRniSnavda sakveb racionSi Ca-iT

mdidari produqtebis naklebobas.

cxrili 9

osteoqondropaTiebis gamomwvevi

risk-faqtorebi

n=1020risk-faqtorebi raodenoba procentebi

(%)swrafi zrda da arara-

cionaluri, gazrdili

fizikuri datvirTvebiT

gamowveuli gadaZabva

SemTxveva

540 52,9

mikrotravma 173 16.9

saTamaSo gruntis xSiri

cvla132 12.9

arasworad SerCeuli

sportuli inventari175 17.3

cxrili 10

n=1020

terfis forma raodenoba

procentebi

(%)

brtyelterfiani 199 19.5

norma 821 80.5

124

cxrili 11

n=1020raodenoba procentebi (%)

aRniSnavda sakveb

racionSi Ca-iT mdidari

produqtebis naklebobas894 87.6

ar aRniSnavda sakveb

racionSi Ca-iT mdidari

produqtebis naklebobas126 12.4

daavadebis xangrZlivobis mixedviT pacien-

tebi Semdegnairad ganawilda- 2-10 dRe – 496

avadmyofiF 48.6%, 10-20 dRe 345 – avadmyofi 33.8%,

20 da meti dRe – 179 avadmyofi 17.6%.

cxrili 12

pacientTa ganawileba daavadebis xangr-

Zlivobis mixedviT

n=1020dReebis raode-

noba

pacientTa raode-

nobaprocenti (%)

2-10 dRe 496 48.6

10-20 dRe 345 33.8

20 da meti dRe 179 17.6

125

kvlevis meTodebSi aRwerili, Cvens mier Sed-

genili specialuri tkivilis Skalis monacemebi

Semdegnairad ganawilda.

126 pacientis (12.4%) tkivili Sefasda 1

baliT.

429 pacientis (42%) – 2 baliT

159 pacientis (15.6%) - 3 baliT

306 pacientis (30%) – 4 baliT

cxrili 13

Sedgenili specialuri tkivilis Skalis

monacemebi

n=1020

Sefaseba

pacientTa raode-

noba

procenti (%)

1 bali 126 12.4

2 bali 429 42

3 bali 159 15.6

4 bali 306 30

mkurnalobis taqtikis mixedviT pacientebi

3 jgufad daiyo. MmaTSi pacientebi raodenobis,

diagnozebisa da daavadebis simZimis mixedviT

maqsimalurad Tanabradaa ganawilebuli.

sakontrolo jgufSi (340 pacienti, saerTo

raodenobebis 33.3%, romelTagan 204-s (60%)

126

aReniSneboda osgud-Slateris daavadeba, 85-s

(25%) hagland severis daavadeba, 51-s (15%)

keleris-I-II daavadeba) mkurnaloba tardeboda

lazeroTerapiiTa da ultrafonoforeziT vol-

tarenis malamoTi (tradiciuli Terapia).

cxrili 14

sakontrolo jgufSi pacientTa ganawileba

osteoqondropaTiis tipis mixedviT

n=340daavadeba pacientTa

raodenoba

procenti (%)

osgud-Slateris daa-

vadeba

204 60

hagland severis

(hagland Sincis) daa-

vadeba

85 25

keleris-I-II daavadeba 51 15

I jgufSi (340 pacienti 33.3%) maT Soris 204

(60%) pacienti iyo osgud-Slateris diagnoziT,

86 (25.3%) hagland-severis diagnoziT da 50

(14.7%) keler I-II diagnoziT.

127

cxrili 15

I jgufSi pacientTa ganawileba


n=340

daavadebapacientTa raode-

noba

procenti

(%)osgud-Slateris daavade-

ba204 60

hagland severis (hagland

Sincis) daavadeba86 25.3

keleris-I-II daavadeba 50 14.7

II jgufSi (340 pacienti 33.3%) maT Soris,

204-s (60%) hqonda osgud-Slateris daavadeba,

87-s (25.6) hagland-severis daavadeba, 49-s (14.4%)

keler I-II-s daavadeba.

cxrili 16

II jgufSi pacientTa ganawileba


n=340

daavadebapacientTa

raodenoba

procenti

(%)

osgud-Slateris daavade-

ba204 60

hagland-severis (hagland

-Sincis) daavadeba87 25.6

keleris-I-II daavadeba 49 14.4

I jgufis pacientebs utaredebodaT laz-

eroTerapia da ultrafonoforezi Traumeel-S-is

128

malamoTi, iRebdnen Osteoheel-s-is abebs (TiTo abi

dReSi 3-jer enis qveS, Wamamde 30 wuTiT adre)

da ukeTdebodaT Placenta compositum-is ineqciebi

kviraSi orjer (sul 5 ineqcia).

II jgufSi (340 pacienti 33.3%) pacientTa

mkurnaloba mimdinareobda lazeroTerapiiTa da

ultrafonoforeziT Traumeel-S-is malamoTi.

yvela pacients eZleoda biodanamati life pac

juniori.

lazeroTerapiisa da ultrafonoforezis

procedurebis raodenoba da dozireba samive

jgufisaTvis iyo erTnairi.

ultrafonoforezisa da lazeroTerapiis

kursi 10-15 seansisagan Sedgeboda, romlis

Semdeg pacientebs utardebodaT samkurnalo

fizkulturis 10 dRiani kursi. Tuki pacients

10 dRiani Terapiis Semdeg aRar aReniSneboda

tkivili specialur datvirTvis testze, uwyde-

bodaT ultrafonoforezisa da lazeroTer-

apiis procedurebi da eniSnebodaT samkurnalo

fizkultura.

mkurnbaloba mimdinareobda 20-25 dRis ganma-

vlobaSi. mkurnalobis periodSi yvela pacienti

isvenebda sportuli datvirTvisagan.

129

osgud-Slateris daavadebis mkurnalobaosgud-Slateris daavadebis mkurnaloba

kvlevaSi monawile 1020 pacientidan 612 (60%)

iyo osgud-Slateris diagnoziT, maT Soris 551

(90.03%) biWi da 61 (9.97%) gogona. 159 avadmyofs

(25.98%) egzostozi aReniSneboda ormxrivad, 453-s

(74.02%) calmxrivad. P58 pacients (9.5%) ganvi-

Tarebuli hqonda brtyeli terfi.

cxrili 17

osgud-Slateris daavadebul pacientTa

ganacileba sqesis mixedviT

n=612sqesi raodenoba procenti (%)

biWi 551 90.03

gogona 61 9.97

cxrili 18

n=612egzostozi raodenoba procenti (%)

calmxrivi 159 25.98

ormxrivi 453 74.02


tebi Semdegnairad gadanawilda: 2-10 dRe 203

pacienti (33.2%), 10-20 dRe 275 pacienti (44,93%), 20

dRe da meti 134 pacienti (30%).

130

cxrili 19

pacientTa gadanawileba osgud-Slateris

daavadebis xangrZlivobis mixedviT

n=612mkurnalobis xan-

grZlioba

pacientTa

raoenobaprocenti (%)

2-10 dRe 203 33.2

10-20 dRe 275 44,93

20 da meti dRe 134 30

osgud-Slateris daavadeba aReniSna 336

fexburTels (54.9%), 64 kalaTburTels (10.5%),

91 ragbists (14.9%), 42 Cogburbels (6.7%) da

42 sportis sxvadasxva saxeobebiT dakavebul

sportsmenebs (13%).

cxrili 20


ganawileba sportis saxeobis mixedviT

n=612sportis saxeoba raodenoba procenti (%)

fexburTi 336 54.9

kalaTburTi 64 10.5

ragbisti 91 14.9

CogburTeli 42 6.7

sportis sxvadasx-

va saxeobeba79 13

specialuri tkivilis Skalis xelmZRvanelo-

bis Sedegad, osgud-SlateriT daavadebulTa

131

11.8%-is (72 sportsmeni) tkivili Sefasda 1 baliT,

44.1%-is (270 sportsmeni) – 2 baliT, 14.7%-is (90

sportsmeni) – 3 baliT, 29.4%-is (180 sportsmeni)

– 4 baliT.

cxrili 21


tkivilis Sefaseba specialuri tkivilis Ska-

lis mixedviT

n=612balebis raodenoba raodenoba procenti (%)

1 bali 72 11.8

2 bali 270 44.1

3 bali 90 14.7

4 bali 180 29.4

pacientebi mkurnalobis taqtikis mixedviT

daiyo 3 jgufad (TiToeul jgufSi 204 avd-

myofi). jgufebSi pacientebi raodenobis, asakis,

daavadebis mimdinareobisa da tkivilis inten-

sivobis mixedviT (gamoxatuli balebSi) maqsi-

malurad Tanabradaa ganawilebuli.

mkurnalobis Sedegad pacientebis mdgo-

mareoba gaumjobesda samive jgufSi. yvelaze

naklebi Terapiuli efeqti miRebuli iqna sakon-

trolo jgufSi, sadac pacientebs mkurnaloba

utardebodaT tradiciuli meTodiT, xolo

yvelaze maRali Terapiuli efeqti miRebuli

iqna I jgufSi, sadac pacientebis mkurnaloba

kompleqsurad midioda.

132

mkurnalobis me-5 dRes: I jgufSi 174 pacienti

(85.3%) aRniSnavda tkivilis klebas, II jgufSi

142 pacienti (69.6%) aRniSnavda mdgomareobis

gaumjobesebas, maSin, roca sakontrolo jguf-

Si aseTi pacientebis raodenoba iyo 40.7% (83

sportsmeni).

cxrili 22

mkurnalobis me-5 dRes osgud-Slateris

daavadebul pacientebSi tkivilis klebis di-

namika

jgufi raodenoba procenti (%)

I jgufi n=204 174 85.3

II jgufi n=204 142 69.6

sakontrolo jgufi n=204 83 40.7

mkurnalobis me-10 dRes pacientebs Cautar-

daT Cvens mier SemuSavebuli datvirTvis testi,

romlis mixedviT datvirTvis fonze dgindeboda

pacientTa tkivilis intensivoba, Sefasebuli

balebSi. Sedegebi Semdegnairi iyo:

I jgufSi: 125 pacients (61.3%), tkivili aRar

aReniSnebodaT (0 bali)

II jgufSi: tkivili aulagda (0 bali) 110

sportsmens (53.9%), xolo sakontrolo jgufSi

– 81 sportsmens (39.7%)

133

cxrili 23


daavadebul pacientebSi tkivilis Sefaseba 0

- baliT

n=204jgufi raodenoba procenti (%)

I jgufi 125 61.3

II jgufi 110 53.9

sakontrolo jgufi 81 39.7

sportsmenTa tkivilis klebis dinamika

mkurnalobidan 10 dRis Semdeg mocemulia cxri-

lebSi 18, 19, 20.

cxrili 24

sakontrolo jgufi

n=2041 2 3 4 5

pa-

cientTa

saerTo

raode-

noba

sawyisi

Sefaseba

balebiT

me-10 dRes

Sefaseba

balebiT

pa-

cientTa

raode-

noba

procentu-

li raode-

noba (%)

24 1 bali0 bali 16 66.7 (6710)1 bali 8 33.3 (3310)

90 2 bali

0 bali 49 54.4 (545)1 bali 33 36.7 (3752 bali 8 8.9 (293)

30 3 bali

0 bali 10 33.3 (339)1 bali 7 23.3 (248)2 bali 8 26.7 (278)3 bali 5 16.7 (175)

60 4 bali

0 bali 6 10 (104)1 bali 9 15 (155)2 bali 9 15 (155)3 bali 21 35 (356)4 bali 15 25 (256)

134

cxrili 25

I jgufi1 2 3 4 5

pacientTa

saerTo

raodenoba

sawyisi

Sefaseba

balebiT

me-10 dRes

Sefaseba

balebiT

pa-

cientTa

raode-

noba

Pprocentu-

li raode-

noba (%)

24 1 bali

0 bali 21 87.5 (886)

1 bali 3 12.5 (126)

90

2

bali

0 bali 67 74.4 (745)

1 bali 23 25.6 (265)

2 bali --- ---

30 3 bali

0 bali 19 63.3 (639)

1 bali 6 20.1 (207)

2 bali 5 16.6 (177)

3 bali --- ---

60 4 bali

0 bali 18 30 (306)

1 bali 18 30 (306)

2 bali 15 25 (256)

3 bali 9 15 (155)

4 bali --- ---

pacientebs, romelTac datvirTvis testze

aRmoaCndaT uaryofiTi reaqcia, uwydebodaT fiz-

ioTerapiuli procedurebi, romlis nacvladac

mkurnalobis kursSi erTveboda samkurnalo

fizkultura.

mkurnalobis me-15 dRes pacientebze Catare-

buli analogiuri datvirTvis testis Sedegad,

135

tkivilis klebis dinamika Semdegnairi iyo:

I jgufSi: tkivili ar aReniSna 187 pacients

(91.7%)

cxrili 26

II jgufi

pacientTa

saerTo

raodenoba

sawyisi

Sefaseba

balebiT

me-10 dRes

Sefaseba

balebiT

pa-

cientTa

raode-

noba

Pprocentu-

li raode-

noba (%)

24 1 bali

0 bali 19 79.2 (789)

1 bali 5 20.8 (219)

902 bali

0 bali 60 66.7 (675)

1 bali 28 31.1 (315)

2 bali 2 2.2 (22)

30 3 bali

0 bali 16 53.3 (539)

1 bali 6 20.1 (207)

2 bali 7 23.3 (248)

3 bali 1 3.3 (33)

60 4 bali

0 bali 15 25 (256)

1 bali 15 25 (256)

2 bali 9 15 (155)

3 bali 15 25 (256)4 bali 6 10 (104)

II jgufSi: tkivili Sefasda 0 baliT 176

pacientSi (86.3%)

sakontrolo jgufSi ki 136 sportsmenSi

(66.7%)

136

cxrili 27


daavadebul pacientebSi tkivilis klebis

raodenobrivi da procentuli gamosaxva

n=204jgufi raodenoba procenti (%)

I jgufi 187 91.72

II jgufi 176 86.33

s a k o n t r olo

jgufi136 66.74


mkurnalobidan 15 dRis Semdeg dawvrilebiT

mocemulia cxrilebSi 28, 29, 30.

cxrili 28

sakontrolo jgufipacientTa

saerTo

raode-

noba

sawyisi

Sefaseba

balebiT

me-15

dRes

Sefaseba

balebiT

pa-

cientTa

raode-

noba

procentuli

raodenoba

(%)

24 1 bali0 bali 22 91.7 (926)1 bali 2 8.3 (86)

902 bali

0 bali 72 80 (804)1 bali 14 15.6 (164)2 bali 4 4.4 (42)

30 3 bali

0 bali 16 53.3 (539)1 bali 5 16.6 (177)2 bali 4 13.3 (136)3 bali 5 16.7 (177)

137

60 4 bali

0 bali 30 50 (506)1 bali 6 10 (104)2 bali 6 10 (104)3 bali 9 15 (155)4 bali 9 15 (155)

cxrili 29

I jgufi

pacientTa

saerTo

raodenoba

sawyisi

Sefaseba

balebiT

me-15 dRes

Sefaseba

balebiT

pacientTa

raodenoba

Pprocentu-

li raode-

noba (%)

24 1 bali 0 bali 24 100 (100-4)

1 bali --- ---

90 2 bali 0 bali 88 97.7 (982)

1 bali 2 2.3 (22)

2 bali --- ---

30 3 bali 0 bali 27 90 ( 906)

1 bali 2 6.7 (75)

2 bali 1 3.3 (33)

3 bali --- ---

60 4 bali 0 bali 48 80 (805)

1 bali 3 5 (53)

2 bali 6 10 (104)

3 bali 3 5 (53)4 bali --- ---

138

cxrili 30

II jgufi

pacientTa

saerTo

raodenoba

sawyisi

Sefaseba

balebiT

me-15 dRes

Sefaseba

balebiT

pacientTa

raode-

noba

Pprocen-

tuli

raodenoba

(%)

241 bali 0 bali 24 100 (100-4)

1 bali --- ---

90 2 bali

0 bali 86 95.6 (962)

1 bali 4 4.4 (42)

2 bali --- ---

30 3 bali

0 bali 24 80 (807)

1 bali 2 6.7 (75)

2 bali 3 10.0 (106)

3 bali 1 3.3 (33)

604 bali

0 bali 42 70 (706)

1 bali 3 5 (53)

2 bali 9 15 (155)

3 bali 3 5 (53)

4 bali 3 5 (53)

amis garda efeqturobis Sefaseba xdeboda

specialuri gamokiTxviT anketirebis gziT,

rogorc pacientis, aseve eqimis mier.

I jgufSi, pacientTa mkurnalobis efeqtur-

oba Sefasebuli iqna rogorc ,,Zalian kargi’’

180 pacientSi (88.2%), ,,kargi’’ 14 pacientSi (6.9%),

139

,,damakmayofilebeli” 10 pacientSi (4.9%). Se-

faseba ”warumatebeli” aRniSnul jgufSi ar

dafiqsirebula.

cxrili 31

I jgufSi pacientTa Sefaseba anketirebis

gziT

n=204Sefaseba raodenoba procenti (%)

,,Zalian kargi’’ 180 88.22

,,kargi’’ 14 6.9

,,damakmayofilebeli” 10 4.9

”warumatebeli” --- ---

II jgufSi pacientTa mkurnalobis efeqtur-

oba Sefasebuli iqna rogorc ,,Zalian kargi’’ 169

pacientSi (82.8%2) (I da II jgufis monacemTa

sxvaoba statistikurad ara sarwmunoa P<0.05),

,,kargi’’ 16 pacientSi (7.9%), ,,damakmayofilebeli”

15 pacientSi (7.4%). Sefaseba ”warumatebeli”

aRniSnul jgufSi dafiqsirda 4 pacientSi

(1.9%).

140

cxrili 32

II jgufSi pacientTa Sefaseba anketirebis

gziT

n=204Sefaseba raodenoba Pprocenti (%)


,,kargi’’ 16 7.9


”warumatebeli” 4 1.9

rac Seexeba sakontrolo jgufs, pacientTa

mkurnalobis efeqturoba Sefasebuli iqna

rogorc ,,Zalian kargi’’ 129 pacientSi (63.2%4) (I da II jgufis monacemebi statistikurad

sarwmunod aRemateba sakontrolo jgufis mo-

nacemebs – P>0.01), ,,kargi’’ 29 pacientSi (15.2%),

,,damakmayofilebeli” 26 pacientSi (12.7%). Se-

faseba ”warumatebeli” ki aRniSnul jgufSi

dafiqsirda 20 pacientSi (9.9%).

cxrili 33

sakontrolo jgufSi pacientTa Sefaseba

anketirebis gziT



,,kargi’’ 29 15.2



141

ganmeorebiTi ultrasonografiuli gamokv-

levis Semdeg I jgufis pacientTa 87.7% 2 -s (179

sportsmeni), ar aRmoaCnda kviristavis sakuTari

iogis distaluri nawilis paTologia da infra-

patelaruli Rrma bursitis suraTi. analogiuri

ultrasonografiuli gamokvlevis monacemebi

II jgufSi 162 pacientSi (79.4%3) dafiqsirda,

xolo sakontrolo jgufSi ki 125 sportsmenSi

(61.3%2). (I da II jgufis monacemebi statisti-

kurad sarwmunod aRemateba sakontrolo jgu-

fis monacemebs – P>0.01 xolo, I da II jgufis

monacemTa sxvaoba statistikurad ara sarwmunoa

P<0.05) aRsaniSnavia, rom ultrasonografiis mo-

nacemebiT sakontrolo jgufis 60 avadmyofSi

(29.4%) dafiqsirda sxvadasxva zomis momatebuli

eqogenobis ubnis arseboba, apofizis Zvlovani

zedapiris araTanabarkonturianobis arsebobiT.

apofizis Zvlovani zedapiris araTanabarkontu-

rianoba I jgufSi dafiqsirda 25 pacientSi (12.3%),

xolo II jgufSi 37 pacientSi (18.15%) aRiniSna.

agreTve aRsaniSnavia, rom ultrasonografiis

monacemebiT sakontrolo jgufis 19 avadmyofSi


eqogenobis ubnis arseboba, apofizis Zvlovani

142

zedapiris araTanabarkonturianoba fragment-

aciis arsebobiT. apofizis Zvlovani zedapiris

araTanabarkonturianoba fragmentaciis arse-

bobiT I jgufSi ar dafiqsirebula, xolo II

jgufSi, mxolod 5 pacientSi (2.45%) aRiniSna.

cxrili 34


levis Sedegebi

n=204paTologia sakontro-

lo jgufi

I jgufi II jgufi

kvirisTavis sakuTari

iogis distaluri

nawilis paTologia

da infrapatelaruli

Rrma bursitis sura-

Ti – ar dafiqsirda

125 61.3%

4179 87.7%

2162 79.4%

3

sxvadasxva zomis

momatebuli eqogeno-

bis ubnis arseboba,

apofizis Zvlovani

zedapiris araTana-

barkonturianoba

fragmentaciis arse-

bobiT – dafiqsirda

19 9.3% --- --- 5 2.45%

sxvadasxva zomis

momatebuli eqogeno-

bis ubnis arseboba,

apofizis Zvlovani

zedapiris araTana-

barkonturianoba

fragmentaciis arse-

bobiT – dafiqsirda

60 29.4% 25 12.3% 37 18.15%

143

hagland-Sincisa (haglan-severis) da hagland-Sincisa (haglan-severis) da

keleris I-II daavadebis mkurnalobakeleris I-II daavadebis mkurnaloba

kvlevaSi monawile 1020 pacientidan, 258 (63.3%)

iyo haglad-Sincis diagnoziT, xolo 150 (36.7%)

keleri I da II davadebiT. maT Soris 357 (87.5%)

biWi da 51 (12.5%) gogona. 126 avadmyofs (30.9%)

egzostozi aReniSneboda ormxrivad, 282-s (69.1%)

calmxrivad. P141 pacients (34.55%) ganviTare-

buli hqonda brtyeli terfi.

cxrili 35

n=408raodenoba procenti (%)

hagland Sincis

(hagland-severis)

diagnoziT pacientTa

raodenoba

258 63.3

keler I-II-i diagnoziT

pacientTa raodenoba150 36.7

cxrili 36

n=408

raodenoba procenti (%)

biWi 357 87.5

gogona 51 12.5

144

cxrili 37

egzostozi raodenoba Pprocenti (%)

ormxrivad 126 30.9

calmxrivad 282 69.1

cxrili 38

terfis forma raodenoba procenti (%)

brtyelterfiani 141 34.55

norma 267 63.3

daavadebis xangrZliobis mixedviT pacien-

tebi Semdegnairad gadanawilda: 2-10 dRe 142

pacienti (34.8%), 10-20 dRe 221 pacienti (54.2%), 20

dRe da meti 45 pacienti (11%).

cxrili 39

pacientTa ganawileba hagland-Sincisa

(hagland-severis) da keler – I-II daavadebebis

xangrZliobis mixedviT

n=408raodenoba procenti (%)

2-10 dRe 142 34.8

10-20 dRe 221 54.2

20 da meti dRe 45 11

hagland-Sincisa da keleri I-II daavadeba

aReniSna 225 fexburTels (55.1%), 38 kalaTbur-

Tels (9.3%), 62 ragbists (15.2%), 39 Cogburbels

(9.6%) da 44 sportis sxvadasxva saxeobebiT

145

dakavebul sportsmenebs (10.8%).

cxrili 40

hagland-Sincisa (hagland-severis) da

keleri I-II daavadebul

pacientTa ganawileba sportis saxeobis

mixedviT

n=408sportis saxeoba raodenoba procenti (%)

fexburTi 225 55.1

kalaTburTi 38 9.3

ragbi 62 15.2

CogburTi 39 9.6

sportis sxvadasxva saxeoba 44 10.8

specialuri tkivilis Skalis xelmZRvanelo-

bis Sedegad, hagland-SinciTA da keleri I-II-iT

daavadebulTa 13.2%-is (54 sportsmeni) tkivili

Sefasda 1 baliT, 39%-is (159 sportsmeni) – 2

baliT, 16.9%-is (69 sportsmeni) – 3 baliT, 30.9%-

is (126 sportsmeni) - 4 baliT.

146

cxrili 41

hagland-Sincisa (hagland-severis) da

keleri I-II daavadebul pacientTa

tkivilis Sefaseba specialuri tkivilis

Skalis mixedviT

n=408Sefaseba balebiT raodenoba Pprocenti (%)

1 bali 54 13.2

2 bali 159 39

3 bali 69 16.9

4 bali 126 30.9

pacientebi mkurnalobis taqtikis mixedviT,

iseve rogorc osgud-SlateriT daavadebuli

sportsmenebi, daiyo 3 jgufad (TiToeul jgufSi

136 avadmyofi). jgufebSi pacientebi raodenobis,

asakis, daavadebis mimdinareobis da tkivilis

intensivobis mixedviT (gamoxatuli balebSi)

maqsimalurad Tanabradaa ganawilebuli.

mkurnalobis Sedegad pacientebis mdgo-

mareoba gaumjobesda samive jgufSi. SedarebiT

naklebi Terapiuli efeqti miRebuli iqna sakon-

trolo jgufSi, sadac pacientebs mkurnaloba

utardebodaT tradiciuli meTodiT, xolo

yvelaze maRali Terapiuli efeqti miRebuli

iqna I jgufSi, sadac pacientebis mkurnaloba

kompleqsurad midioda.

147

mkurnalobis me-5 dRes: I jgufSi 109 pacienti

(80.1%) aRniSnavda tkivilis klebas, II jgufSi

89 pacienti (65.4%) aRniSnavda mdgomareobis

gaumjobesebas, maSin, roca sakontrolo jguf-

Si aseTi pacientebis raodenoba 37.5% iyo (51

sportsmeni).

cxrili 42

hagland-Sincisa (hagland-severis) da keleri

I-II daavadebul pacientTa mkurnalobis me-5 dRes

tkivilis Semcirebis dinamika


sakontrolo 51 37.5

I jgufi 109 80.1

II jgufi 89 65.4

mkurnalobis me-10 dRes pacientebs Cautar-

daT Cvens mier SemuSavebuli datvirTvis testi,

romlis mixedviT datvirTvis fonze dgindeboda

pacientTa tkivilis intensivoba, Sefasebuli

balebSi. Sedegebi Semdegnairi iyo:


aReniSnebodaT (0 bali)



– 47 sportsmens (34.6%).

148

cxrili 43

mkurnalobis me-10 dRes hagland-Sincisa

(hagland-severis) da keler – I-II daavadebul

pacientTa tkivilis Sefaseba 0 - baliT

jgufi raodenoba Pprocenti (%)

sakontrolo 47 34.6

I jgufi 69 50.7

II jgufi 62 45.6


mkurnalobidan 10 dRis Semdeg mocemulia cxri-

lebSi 44, 45, 46.

cxrili 44

sakontrolo jgufi

pa-

cientTa

saerTo

raode-

noba

sawyisi

Sefaseba

balebiT

me-10 dRes

Sefaseba

balebiT

pa-

cientTa

raode-

noba

Pprocentu-

li raode-

noba (%)

181 bali 0 bali 11 61.1 (6112)

1 bali 7 38.9 (3912)

532 bali

0 bali 25 47.2 (477)

1 bali 21 39.6 (407)

2 bali 7 13.2 (125)

23 3 bali

0 bali 9 39.1 (3910)

1 bali 6 26 (269)

2 bali 5 21.9 (229)

3 bali 3 13 (137)

149

42 4 bali

0 bali 5 11.9 (125)

1 bali 8 19 (196)

2 bali 9 21.4 (216)

3 bali 11 26.3 (267)

4 bali 9 21.4 (216)

cxrili 45

I jgufi

pacientTa

saerTo

raodenoba

sawyisi

Sefaseba

balebiT

me-10 dRes

Sefaseba

balebiT

pa-

cientTa

raode-

noba

Pprocen-

tuli

raode-

noba (%)

181 bali 0 bali 14 77.8 (7810)

1 bali 4 22.2 (2210)

532 bali

0 bali 32 60.3 (607)

1 bali 17 32.2 (326)

2 bali 4 7.5 (84)

233 bali

0 bali 13 56.5 (5611)

1 bali 5 21.7 (229)

2 bali 3 13.1 (137)

3 bali 2 8.7 (96)

42 4 bali

0 bali 10 23.8 (247)

1 bali 10 23.8 (247)

2 bali 8 19 (196)

3 bali 9 21.6 (216)

4 bali 5 11.8 (125)

150

cxrili 46

II jgufipacientTa

saerTo

raodenoba

sawyisi

Sefaseba

balebiT

me-10 dRes

Sefaseba

balebiT

pa-

cientTa

raode-

noba

Pprocen-

tuli

raode-

noba (%)

181 bali 0 bali 13 72.2 (7211)

1 bali 5 28.8 (2811)

532 bali

0 bali 29 54.7 (547)

1 bali 19 35.9 (367)

2 bali 5 9.4 (94)

233 bali

0 bali 11 47.9 (4811)

1 bali 6 26 (269)

2 bali 4 17.4 (178)

3 bali 2 8.7 (96)

42 4 bali

0 bali 9 21.4 (216)

1 bali 10 23.8 (247)

2 bali 9 21.4 (216)

3 bali 10 23.8 (247)

4 bali 4 9.6 (104)

pacientebs, romelTac datvirTvis testze

aRmoaCndaT uaryofiTi reaqcia, uwydebodaT fiz-

ioTerapiuli procedurebi, romlis nacvladac

mkurnalobis kursSi erTveboda samkurnalo

fizkultura.

151


buli analogiuri datvirTvis testis Sedegad,

tkivilis klebis dinamika Semdegnairi iyo:

I jgufSi: tkivili ar aReniSna 119 pacients

(87.5%)

II jgufSi: tkivili Sefasda 0 baliT 111 pa-

cientSi (81.6%)


(64.7%).

cxrili 47

mkurnalobis me-15 dRes hagland-Sincisa

(hagland-severis) da keler – I-II daavadebul

pacientTa tkivilis Sefaseba 0 - baliT


sakontrolo 88 64.7

I jgufi 119 87.5

II jgufi 111 81.6


mkurnalobidan 15 dRis Semdeg dawvrilebiT

mocemulia cxrilebSi 48, 49, 50.

152

cxrili 48

sakontrolo jgufi

pa-

cientTa

saerTo

raode-

noba

sawyisi

Sefaseba

balebiT

me-15 dRes

Sefaseba

balebiT

pa-

cientTa

raode-

noba

procen-

tuli

raode-

noba (%)

181 bali

0 bali 16 88.9 (898)

1 bali 2 11.1 (118)

532 bali

0 bali 4177.4

(776)

1 bali 9 17 (175)

2 bali 3 5.6 (64)

23 3 bali

0 bali 1252.2

(5211)

1 bali 4 17.4 (178)

2 bali 3 13 (137)

3 bali 4 17.4 (178)

42 4 bali

0 bali 19 45.1 (458)

1 bali 4 9.5 (104)

2 bali 6 14.4 (156)

3 bali 6 14.4 (156)

4 bali 7 16.6 (176)

153

cxrili 49

I jgufi

pacientTa

saerTo

raodenoba

sawyisi

Sefaseba

balebiT

me-15 dRes

Sefaseba

balebiT

pa-

cientTa

raode-

noba

procentu-

li raode-

noba (%)

181 bali

0 bali 18 100 (100-6)

1 bali --- ---

532 bali

0 bali 49 92.5 (9240

1 bali 4 7.5 (84)

2 bali --- ---

233 bali

0 bali 19 82.7 (838)

1 bali 2 8.7 (96)

2 bali 1 4.3 (44)

3 bali 1 4.3 (44)

42

4 bali

0 bali 33 78.5 (776)

1 bali 3 7.2 (74)

2 bali 3 7.2 (74)

3 bali 2 4.7 (53)

4 bali 1 2.4 (22)

154

cxrili 50

II jgufipa-

cientTa

saerTo

raode-

noba

sawyisi

Sefase-

ba

balebiT

me-15 dRes

Sefaseba

balebiT

pacientTa

raode-

noba

Pprocentu-

li raode-

noba (%)

181 bali 0 bali 18 100 (100-6)

1 bali --- ---

532 bali

0 bali 47 88.7 (894)

1 bali 6 11.3 (114)

2 bali --- ---

233 bali

0 bali 17 74.1 (749)

1 bali 3 13 (137)

2 bali 2 8.6 (96)

3 bali 1 4.3 (44)

424 bali

0 bali 29 69.2 (697)

1 bali 4 9.5 (104)

2 bali 3 7.1 (74)

3 bali 3 7.1 (74)

4 bali 3 7.1 (74)

garda aRniSnulisa, mkurnalobis efeqtur-

obis Sefaseba xdeboda specialuri gamokiTxviT

- anketirebis gziT (rogorc pacientebis, aseve

eqimis mier).

I jgufSi, pacientTa mkurnalobis efeqtur-

155

oba Sefasebuli iqna rogorc ,,Zalian kargi’’

115 pacientSi (84.6%2), ,,kargi’’ 13 pacientSi (9.5%),

,,damakmayofilebeli” 6 pacientSi (4.4%). Sefaseba

”warumatebeli” aRniSnul jgufSi 2 pacientSi

(1.5%) dafiqsirda.

cxrili 51

I jgufSi hagland-Sincisa (hagland-sev-

eris) da keler I-II-iT daavadebul pacientTa

mkurnalobis efeqturobis Sefaseba anketire-

bis gziT


,,Zalian kargi’’ 115 84.6 (2)

,,kargi’’ 13 9.5



II jgufSi, pacientTa mkurnalobis efeqtur-

oba Sefasebuli iqna rogorc ,,Zalian kargi’’ 107

pacientSi (78.7%3) (I da II jgufis monacemTa

sxvaoba statistikurad ara sarwmunoa P<0.05),

,,kargi’’ 17 pacientSi (12.5%), ,,damakmayofile-

beli” 8 pacientSi (5.9%). Sefaseba ”warumate-

beli” aRniSnul jgufSi dafiqsirda 4 pacien-

tSi (1.9%).

156

cxrili 52

II jgufSi hagland-Sincisa (hagland-sev-

eris) da keler I-II-iT daavadebul pacientTa

mkurnalobis efeqturobis Sefaseba anketire-

bis gziT


,,Zalian kargi’’ 107 78.7 (3)

,,kargi’’ 17 12.5



rac Seexeba sakontrolo jgufs, pacientTa

mkurnalobis efeqturoba Sefasebuli iqna

rogorc ,,Zalian kargi’’ 84 pacientSi (61.8%4) (I

da II jgufis monacemebi statistikurad sarwmu-

nod aRemateba sakontrolo jgufis monacemebs

– P>0.01), ,,kargi’’ 21 pacientSi (15.4%), ,,damakmay-

ofilebeli” 15 pacientSi (11%). Sefaseba ”waru-

matebeli” ki aRniSnul jgufSi dafiqsirda 16

pacientSi (11.8%).

157

cxrili 53

sakontrolo jgufSi hagland-Sincisa

(hagland-severis) da keler I-II-iT daavadebul

pacientTa mkurnalobis efeqturobis Sefaseba

anketirebis gziT


,,Zalian kargi’’ 84 61.8 (4)

,,kargi’’ 21 15.4

,,damakmayofilebeli” 15 11



levis Semdeg I jgufis pacientTa 83.8%2-s (114 sportsmeni), ar aRmoaCnda sinovitisa da bursi-

tis suraTi. analogiuri ultrasonografiuli

gamokvlevis monacemebi II jgufSi 103 pacien-

tSi (75.7%3) dafiqsirda, xolo sakontrolo

jgufSi ki 78 sportsmenSi (57.4%4). (I da II jgufis monacemebi statistikurad sarwmunod

aRemateba sakontrolo jgufis monacemebs –

P>0.01 iseve rogorc, I da II jgufis monacemebi

– P>0.05) aRsaniSnavia, rom ultrasonografiis

monacemebiT sakontrolo jgufis 42 avadmyofSi


eqogenobis ubnis arseboba, Zvlovani zedapiris

araTanabarkonturianobis arsebobiT. Zvlovani

zedapiris araTanabarkonturianoba I jgufSi

dafiqsirda 21 pacientSi (15.5%), xolo II jgufSi

158

28 pacientSi (21.85%) aRiniSna. aRsaniSnavia, rom sonografiis monacemebiT sakontrolo jgufis

16 avadmyofSi (11.8%) dafiqsirda sxvadasxva

zomis momatebuli eqogenobis ubnis arseboba,

Zvlovani zedapiris araTanabarkonturianoba

fragmentaciis arsebobiT. fragmentaciis arse-

boba I jgufSi dafiqsirda 1 pacientSi (0.7%),

xolo II jgufSi mxolod 5 pacientSi (2.45%)

aRiniSna.

cxrili 54


levis Sedegebi

n=136paTologia

sakontro-

lo jgufiI jgufi II jgufi

sinovitisa da

bursitis suraTi

– ar dafiqsirda 7857.4%

(4) 11483.8%

(2) 10375.7%

(3)sxvadasxva zomis

momatebuli

eqogenobis ubnis

arseboba, Zvlo-

vani zedapiris

araTanabarkontu-

rianoba – dafiq-

sirda

42 30.8% 21 15.5% 28 21.85%

sxvadasxva zomis

momatebuli

eqogenobis ubnis

arseboba, Zvlo-

vani zedapiris

araTanabarkontu-

rianoba calkeuli

fragmentaciis ar-

sebobiT – dafiq-

sirda

16 11.8% 1

0.7% 5 2.45%

159

miRebuli Sedegebis ganxilvamiRebuli Sedegebis ganxilva

winamdebare naSromi pirvelia, sadac Ses-

wavlili iqna osteoqonrdopaTiebis (osgud-

Slateris, hagland-Sincis, keleri I da II) anti-

homotoksikuri preparatebiT, dietiT, vitaminoT-

erapiiT, lazeroTerapiiT, ultrafonoforezis

procedurebiTa da samkurnalo varjiSebis pro-

gramiT kompleqsuri mkurnalobis efeqturoba.

antihomotoqsikuri preparatebis, gansa-

kuTrebiaT Traumeel-S-s malamos maRalefeqturi

moqmedeba sayrden-mamoZravebeli sistemis sx-

vadasxva daavadebebze mraval gamokvlevaSia

Seswavlili. mTel rig kvlevebSi aRiniSna

mkurnalobis vadebis mkveTri Semcireba sare-

abilitacio jgufSi sakontrolosTan Sedare-

biT.

osteoqondropaTiebze Catarebul SromaTa

simcirem da arsebuli mkurnalobis meTodebis

nakleb efeqturobam, ganapiroba Cveni kvlevis

Catareba, romlis mizans warmoadgenda antihomo-

toksikuri preparatebis, fizioTerapiuli proce-

durebisa da specialuri samkurnalo varjiSe-

bis programis kompleqsuri mkurnalobis efeq-

160

turobis Seswavla, maTi gavlena mkurnalobis

vadebis Semcirebaze, raTa SesaZlebeli gaxdes

sportsmenebis maqsimalurad mokle periodSi

sportSi dabruneba.

radganac osteoqondropaTiebiT daavadebul

sportsmenebze mudmivad moqmedeben osteoporo-

zis gamomwvevi risk-faqtorebi (sportsmenTa

gazrdili fizikuri datvirTvebis fonze, maTi

kveba-vitaminizaciis arasaTaTanadod organizeba.

gamokvleul mozardTagan 894 (87.6%), aRniSnavda

sakveb racionSi Ca-iT mdidari produqtebis na-

klebobas), mizanSewonilad CavTvaleT, kvlevis

meTodebSi CagverTo densitometruli gamokv-

leva, raTa gangvesazRvra mozard-sportsmenTa

Zvlis simtkice. gamokvleul pacientTa 92%-s

aRmoaCnda Zvlovani masis met-naklebi daqveiT-

eba – gamoikveTa Zvlis simkvrivis daqveiTebis

tendencia (osteopeniisa da osteoporozis

saxiT), rac SeiZleba CaiTvalos osteoqondro-

paTiebis ganviTarebis erT-erT mniSvnelovan

winapirobad. densitometriuli gamokvlevis

Sedegebis safuZvelze mizanSewonilad CaiTva-

la osteoqondropaTiebis mkurnalobis sqemaSi

kveba-vitaminizaciis saTanadod daregulirebisa

161

da kalciumis Semcveli preparatis (Osteoheel-S)

CarTvis aucilebloba.

Tbilisis saxelmwifo samedicino univer-

sitetis centraluri klinikis samedicino

reabilitaciasa da sportuli medicinis kaT-

edraze 1996-2005 wlebSi mkurnaloba Caitara

osteoqondropaTiis diagnoziT 1020 pacientma.

maTze Catarebulma kvlevam gviCvena rom, mozard

sportsmenebSi osteoqondropaTiebidan yvelaze

xSirad gvxvdeba osgud-Slateris daavadeba (612

– 60%). hagland-Sincis diagnoziT 258 (25,3%)

sportsmeni dafiqsirda, keleri I-II-is diagnoziT

ki 150 (14.7%). arsebuli monacemebidan Cans, rom

qondropaTiebi gacilebiT xSirad gvxvdeba bi-

WebSi 908 (89%), vidre gogonebSi 112 (11%), rac

SeiZleba imiTac aixsneba rom CvenTan profesiu-

lad sportiT ZiriTadad biWebi arian dakave-

buli (gamonakliss warmoadgens CogburTi).

daavadeba 735 mozardSi (72.05%) gamoxatuli

iyo calmxrivad, 285-Si (27.95%) –ormxrivad.

yvelaze xSirad, aRniSnuli paTologiebi

mozard sportsmenebSi viTardeboda 12-14 wlis

asakSi - 710 avadmyofi (70%) Dda igi iSviaT

SemTxvevebSi gvxvdeba 17 wels zemoT.

162

kvlevaSi monawile pacientTagan 561 (55%)

iyo fexburTeli, 153 (15%) ragbisti, 102 (10%)

kalaTburTeli, 81 (8%) CogburTeli, 123 (12%) ki

sportis sxva saxeobebidan (tanvarjiSi, curva,

Widaoba). paTologiis yvelaze xSiri ganviTare-

ba fexburTelebSi aixsneba imiT, rom sportis es

saxeoba erT-erTi yvelaze travmulia sportis

sxva saxeobebTan SedarebiT da xSiria saTa-

maSo gruntis cvla. Tumca,AaRsaniSnavia isic,

rom mozard sportsmenTa umetesoba sportis

aRniSnuli saxeobiTaa dakavebuli.

osteoqondropaTiebis risk-faqtorebis Ses-

wavlam aCvena, rom yvelaze xSiri maprovocire-

beli faqtoria swrafi zrda da araracionaluri,

gazrdili fizikuri datvirTvebiT gamowveuli

gadaZabva 540 SemTxveva (52,9%), 16.9%-Si (173 paci-

enti) mikrotravma, 12.1%-Si (132 pacienti) saTa-

maSo gruntis xSiri cvla, 17.1%-Si (175 pacienti)

arasworad SerCeuli sportuli inventari. P199

avadmyofs (19.5%) aReniSna brtyelterfianoba,

romelTagan 141 (70.85%) iyo hagland-Sincisa da

keleris I-II daignozebi, rac imas miuniSnebs, rom

brtyelterfianoba, gansakuTrebiT, aRniSnuli

osteoqondropaTiebis ganviTarebas iwvevs.

163


tebi Semdegnairad ganawilda- 2-10 dRe – 496

avadmyofiF (48.6%), 10-20 dRe 345 – avadmyofi

(33.8%), 20 da meti dRe – 179 avadmyofi (17.6%).

kvlevis meTodebSi aRwerili, Cvens mier Sed-

genili specialuri tkivilis Skalis monacemebi

Semdegnairad ganawilda:

126 pacientis (12.4%) tkivili Sefasda 1 bal-

iT. - (72 (11.8%) osgud Slateris diagnoziT).

429 pacientis (42%) – 2 baliT - (270 (44.1%)

osgud-Slateris diagnoziT).

159 pacientis (15.6%) - 3 baliT - (90 (14.7%)


306 pacientis (30%) – 4 baliT – (180 (29.4%)


mkurnalobis me-5 dRisTvis, sakontrolo

jgufTan SedarebiT I jgufSi 2-jer meti paci-

enti aRniSnavda dadebiT dinamikas.

osgud-SlateriT daavadebulTa mkurnalobis

me-5 dRes: I jgufSi 174 pacienti (85.3%) aRniS-

navda tkivilis klebas, II jgufSi 142 pacienti

(69.6%) aRniSnavda mdgomareobis gaumjobesebas,

maSin, roca sakontrolo jgufSi aseTi pacien-

tebis raodenoba 83 iyo (40.7%).

164

hagland-SinciTa da keleris I-II-iT daavade-

bulTa mkurnalobis me-5 dRes: I jgufSi 109

pacienti (80.1%) aRniSnavda tkivilis klebas, II

jgufSi 89 pacienti (65.4%) aRniSnavda mdgo-

mareobis gaumjobesebas, maSin, roca sakontrolo

jgufSi aseTi pacientebis raodenoba 51 iyo

(37.5%).

mkurnalobis me-10 dRes, pacientebze Catare-

buli datvirTvis testis SedegebiT, gamovlinda

rom tkivili 0 baliT I da II jgufebSi sakon-

trolo jgufTan SedarebiT gacilebiT met

pacientSi Sefasda. aRniSnuli Sedegi ufro

gamoxatuli iyo osgud-SlateriT daavadebul

pacientebSi.

osgud-SlateriT daavadebul spotsmenebSi


aReniSnebodaT (0 bali).




Hhagland-Sincisa da keleris I-II diagnoziT

sportsmenebSi I jgufSi: 69 pacients (50.7%),

tkivili aRar aReniSnebodaT (0 bali).


165




buli analogiuri datvirTvis testis Sedegad:

osgud-SlateriT daavadebulTa I jgufSi:

tkivili ar aReniSna 187 pacients (91.7%).

II jgufSi: tkivili Sefasda 0 baliT 176

pacientSi (86.3%).


(66.7%).

Hhagland-Sincisa da severis diagnoziT

sportsmenebSi: I jgufSi: tkivili ar aReniSna

119 pacients (87.5%).

II jgufSi: tkivili Sefasda 0 baliT 111 pa-

cientSi (81.6%).


(64.7%).

mkurnalobis efeqturobis Sefasebisas

specialuri gamokiTxviT, - anketirebis gziT, I

jgufSi dafiqsirda ,,Zalian kargis”-is sarwmu-

nod maRali maCvenebeli sakontrolo jgufTan

SedarebiT (P>0.01).

osgud-SlateriT daavadebul pacientebSi,

I jgufSi, pacientTa mkurnalobis efeqturoba

166

Sefasebuli iqna rogorc ,,Zalian kargi’’ 180 pa-

cientSi (88.2%), II jgufSi - 169 pacientSi (82.8%),

sakontrolo jgufSi - 129 pacientSi (63.2%), I

da II jgufis monacebi statistikurad sarwmu-

nod aRemateba sakontrolo jgufis monacemebs.

(P>0.01).

Sefaseba ,,warumatebeli” I jgufSi ar dafiq-

sirebula.

II jgufSi dafiqsirda - 4 pacientSi

(1.9%).

sakontrolo jgufSi ki 20 pacientSi

(9.9%).

Hhagland-Sincisa da keleris diagnoziT

sportsmenebSi, I jgufSi, pacientTa mkurnalobis

efeqturoba Sefasebuli iqna rogorc ,,Zalian

kargi’’ 115 pacientSi (84.6%),

II jgufSi 107 pacientSi (78.7%).

sakontrolo jgufSi 84 pacientSi (61.8%).

I da II jgufis monacebi statistikurad

sarwmunod aRemateba sakontrolo jgufis mo-

nacemebs (P>0.01).

Sefaseba ”warumatebeli” I jgufSi 2 pacien-

tSi (1.5%)dafiqsirda.

II jgufSi dafiqsirda 4 pacientSi (1.9%).

167

sakontrolo jgufSi - 16 pacientSi

(11.8%).

I da II jgufis ganmeorebiTi ultra-

sonografiis dadebiTi monacemebi sarwmu-

nod aRemateba sakontrolo jgufis Sedegebs

(P>0.01).osgud-SlateriT daavadebul sportsmenTa

ganmeorebiTi ultrasonografiuli gamokvlevis

Semdeg I jgufis pacientTa 87.7%-s (179 sports-

meni), ar aRmoaCnda kviristavis sakuTari iogis

distaluri nawilis paTologia da infrapate-

laruli Rrma bursitis suraTi. analogiuri

ultrasonografiuli gamokvlevis monacemebi

II jgufSi 162 pacientSi (79.4%) dafiqsirda,

xolo sakontrolo jgufSi ki 125 sportsmenSi

(61.3%). aRsaniSnavia, rom ultrasonografiuli

gamokvlevis monacemebiT sakontrolo jgufis 19

avadmyofSi (9.3%) dafiqsirda sxvadasxva zomis

momatebuli eqogenobis ubnis arseboba, apofizis

Zvlovani zedapiris araTanabarkonturianoba

calkeuli fragmentebis arsebobiT. kviristavis

sakuTar iogSi fragmentebis arseboba I jgufSi

ar dafiqsirebula, xolo II jgufSi, mxolod 5

pacientSi (2.45%) aRiniSna.

Hhagland-Sincisa da keleris diagnoziT

sportsmenTa ganmeorebiTi ultrasonografi-

uli gamokvlevis Semdeg I jgufis pacientTa

168

83.8%-s (114 sportsmeni), ar aRmoaCnda sino-

vitisa da bursitis suraTi. analogiuri ul-

trasonografiuli gamokvlevis monacemebi II

jgufSi 103 pacientSi (75.7%) dafiqsirda, xolo

sakontrolo jgufSi ki 78 sportsmenSi (57.4%).

(monacemi statistikurad sarwmunoa P>0.01) aR-saniSnavia, rom sonografiis monacemebiT sakon-

trolo jgufis 16 avadmyofSi (11.8%) dafiqsirda

sxvadasxva zomis momatebuli eqogenobis ubnis

arseboba, Zvlovani zedapiris araTanabarkon-

turianoba calkeuli fragmentebis arsebobiT.

fragmentaciis arseboba I jgufSi erT pacientSi

(0.7%) dafiqsirda, xolo II jgufSi mxolod 5

pacientSi (2.45%) aRiniSna.

miRebuli Sedegebidan Cans, rom mkurnalobis

Sedegebi, mkurnalobis efeqturobis Sefasebis

kriteriumebis gaTvaliswinebiT, osgud-Slat-

eriT daavadebul pacientebSi, maRalia Sedare-

biTHhagland-Sincisa da keleris diagnoziT

sportsmenebSi, rac literaturul monacemebSi

ar aris dafiqsirebuli. AaRniSnulis Seswavla

ar warmoadgenda kvlevis mizans da igi Semdgomi

kvlevebis Seswavlis sagania.

169

daskvna_rekomendaciebidaskvna_rekomendaciebi

osteoqondropaTiebis kompleqsurma Seswav-osteoqondropaTiebis kompleqsurma Seswav-

lam saSualeba mogvca gamogvetana saTanado lam saSualeba mogvca gamogvetana saTanado

daskvnebi da migveca rekomendaciebi:daskvnebi da migveca rekomendaciebi:

osteoqondropaTiebis (osgud-Slateris, 1.

hagland-severis, keler – I-II daavadebebis) kom-

pleqsuri mkurnalobis kursSi antihomotoqsi-

kuri preparatebis CarTva zrdis mkurnalobis

efeqturobas.

osteoqondropaTiebis kompleqsur 2.

mkurnalobis kursSi antihomotoqsikuri pre-

paratebis CarTviT SesaZlebelia mkurnalobis

vadebis mkveTri Semcireba.

osteoqondropaTiebis diagnostikaSi 3.

Tanamedrove instrumentuli gamokvlevebis

(ultrasonografia, densitometria) Sedege-

bis safuZvelze mizanSewonilia mkurnalobis

kursSi kveba-vitaminizaciis daregulireba da

kalciumis Semcvleli preparatebis (Osteohee-Sl-is) CarTva.

osteoqondropaTiebis gamomwvevi risk-4.

faqtorebidan yvelaze xSiri maprovocirebeli

faqtorebia organizmis swrafi zrda da ara

racionaluri fizikuri datvirTva.

osgud-SlateriT daavadebul pacientebSi 5.

mkurnalobis efeqturoba arasarwmunod aRemate-

170

boda mkurnalobis Sedegebs hagland-severis

daavadebiT diagnostirebul pacientebSi.

osgud-Slateris daavadebis diagnos-6.

tikasa da mkurnalobis efeqturobis SefasebaSi

gamoyenebuli unda iyos Cvens mier miwodebuli

specialuri testi fizikur datvirTvasTan

dakavSirebiT.

mkurnalobis efeqturobis SefasebisaTvis 7.

SeiZleba gamoyenebuli iqnes Cvens mier SemuSave-

buli tkivilis warmoSobis mixedviT special-

uri Skala, tkivilis warmoSobis mixedviT.

kompleqsuri mkurnalobis kursSi fizi-8.

kuri reabilitaciis mizniT kinezoTerapiis

fizikuri varjiSebis CarTviT mkveTrad izrdeba

aRdgeniTi mkurnalobis efeqturoba da Semcire-

bas ganicdis recidivebis raodenoba.

mkurnalobis efeqturoba 9. Traumeel-S-is malamos CarTviT sarwmunod aRemateba Voltaren-is malamoTi Catarebul Terapiis efeqts.

kompleqsuri mkurnalobis kursSi 10. Traumeel-S-is malamosTan erTad Osteoheel -S-is tablete-

bisa da Placenta compositum-is ineqciebis

CarTviT izrdeba am mkurnalobis efeqturoba.

171

praqtikuli rekomendaciebipraqtikuli rekomendaciebi

osteoqondropaTiebis mkurnalobis efeqtur-

obis gazrdisa da vadebis mkveTri Semcirebis

mizniT mizanSewonilia antihomotoqsikuri

preparatebis CarTva kompleqsuri mkurnalobis

kursSi (lazeroTerapia, ultrabgera, vitamini-

zacia, kveba, samkurnalo varjiSebi).

osteoqondropaTiebis diagnostikisa da

mkurnalobis efeqturobis gansazRvrisaTvis

SemuSavebuli iqna specialuri fizikuri testi,

romelic sakmaod martivi Casatarebelia da ar

moiTxovs gansakuTrebul aparaturas an aqse-

suarebs da Tavisuflad SeiZleba Catarebuli

iqnas saeqimo-pedagogiuri dakvirvebis dros.

SemuSavebuli iqna osteoqondropaTiebis

dros tkivilis specialuri Skala, romelic

korelaciaSia specialur fizikur testTan.

SemuSavebuli iqna samkurnalo varjiSebis

specialuri kompleqsi, romelic saSualebas

iZleva sportsmeni swrafad daubrundes spor-

tul datvirTvebs.

172

gamoyenebuli literaturagamoyenebuli literatura

gogelia a. WabaSvili n. maTiaSvili m. dabalin-1.

tensiuri lazeroTerapiis meTodebis optimizaciisaTvis.

2003. t 39. g 91-93.

gogelia a. WabaSvili n. maTiaSvili m. kasraZze 2.

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