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Частичный разрыв задней мышцы бедра

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17 августа 2019

Мышцы тела, обеспечивающие движение, соединены с костями сухожилиями. Если мышцы испытывают слишком сильную нагрузку, способны получить повреждения, к примеру, разрывы. Причём уязвимым местом выступают сухожилия.

Главной причиной, обуславливающей разрыв мышцы бедра, выступает резкое сокращение мышцы ноги, связанное с факторами:

  • Резкое начало движения;
  • Удар по перенапряжённой мышце;
  • Отсутствие разминки перед спортивными занятиями;
  • Чересчур продолжительные по времени тренировки.

Подобная травма предусматривает полное лечение.

Характеристика травмы

Известны виды травм мышц бедра, связанные с разрыванием тканей:

  • Неполный (частичный) разрыв либо надрыв – характерно частичное разрывание сухожилия, мышцы.
  • Полный разрыв – характерна потеря мышцей крепления с костью, мускул сокращается.
  • Ситуация, когда мышца в месте прикрепления сухожилием, отрываясь, отламывает кусочек кости (травму называют отрывным переломом).

Подобные травмы случаются вне зависимости от возраста. Однако отрывные переломы часто встречаются у молодых людей до 20 лет, у спортсменов, с развитыми дегенеративными процессами в сухожилиях. Правильное определение вида травмы позволяет быстро выбрать лечение.

Диагностирование разрыва

Надрыв либо разрыв мышцы бедра происходит из-за слишком интенсивной нагрузки. Для отрывания мышцы характерно возникновение острого болевого синдрома, у детей и подростков процесс сопровождается щелчком.

Специфика повреждения зависит от места происхождения отрыва. Классическая травма – отрыв мышцы в зоне седалищного бугра, связанный с тем, что разгибается нога в суставе колена и разгибается – в тазобедренном. Возникшие в области расположения подвздошной кости отрывы возникают, если разгибать бедра или сгибать голени, преодолевая сопротивление четырёхглавой мышцы бедра. Подобное случается, когда человек совершает пробежку на короткое расстояние либо производит удары ногами. Отрывание сухожилий в месте расположения подвздошной кости происходит, если происходило разгибание бедра и голени, производимое насильственно.

Мышечные разрывы, произошедшие в зоне расположения подвздошной кости (разрыв прямой мышцы бедра), выражены болевым синдромом, если пассивно разгибать и активно сгибать бедро и сгибать-разгибать голени. Травма связки надколенника сопровождается провисанием голени при поднятии бедра.

Симптомы болезни: незамедлительно после произошедшей травмы появляется болезненность, усиливающаяся при надавливании на место повреждения, либо если попытаться выполнить действие, предусмотренное сокращением травмированной мышцы. К примеру, отрыву в зоне лобковой кости характерно возникновение острой боли в паху.

Внешний вид поражённой зоны, пострадавшего аналогичен виду ушибов бедра, повреждения возможно легко спутать. Точно определить вид травмы способен исключительно квалифицированный медик.

В результате разрыва мышц ноги возникают гематомы (накопление крови в пространстве, возникшем из-за травмирования тканей), кровоподтёки – синяки (пропитывание тканей кровью). Для кровоподтёка характерно образование сине-красного пятна, по мере заживления становится зелёным, потом жёлтым.

Исключая наличие переломов, потребуется сделать рентгенографическое исследование. Важным становится исследование МРТ, благодаря процедуре часто удаётся увидеть место разрыва, оценить степень и наличие отёков и кровоизлияния. Симптомы разрыва мышц заключаются в появлении судорог, спазмов мышц. Судороги представляют самопроизвольное сжатие, спазм мышц, становятся защитной реакцией организма на травму. Возникает ощущение, что больную мышцу тянет, симптом характерен для растяжения.

Судороги и мышечный спазм способны указывать на растяжение, дополнительно подтверждая, что правильное определение состояния больного возможно только медицинским работником.

Особенности разрыва четырёхглавой мышцы бедра

При болезни часто страдает широкая мышца. Разрывы четырёхглавой мышцы встречаются у лиц старше 35 лет, в сухожилиях начинают протекать дегенеративные процессы, притом, что физические нагрузки остаются высокими. Если произошло полное отрывание сухожилия мышцы, происходит кровоизлияние в сустав колен (гемартроз).

В редких случаях происходит двухстороннее мышечное разрывание, травма локализуется на обоих бёдрах одновременно. В основном, подобное травмирование случается, когда у человека в организме протекают заболевания, требующие приёма стероидных препаратов. Случается, из-за заболевания разрыв происходит самопроизвольно, без влияния травмирующего фактора.

При разрывании надколенника будет видно и чувствуется западение, из-за сокращения оторванной мышцы, сухожилие поднимается вверх.

При диагностировании разрыва четырёхглавой мышцы либо сухожилия выполняются описанные диагностические процедуры, назначается УЗИ. При травме важно исключить повреждения надколенника, прочие болезни.

Лечение травмы

Неполные разрывы лечатся консервативным путём без проведения операции. Лечение потребует обездвижения ноги с фиксацией в прямом положении сроком 3-6 недель, окончательный период определяется врачом индивидуально, исходя из специфики разрыва.

Обездвиживание ноги будет прекращено, если больной способен самостоятельно, безболезненно держать пострадавшую ногу, лечить травму при помощи иммобилизации уже не нужно. После указанного этапа больной обязан пройти курс реабилитационных упражнений, восстанавливается сила и нормальное функционирование мышц.

Если произошёл полный разрыв, требуется обязательное операционное вмешательство, мышцы и сухожилие полагается пришить обратно к наколеннику. Отдельно придается внимание срокам проведения операции – чем раньше проведена, тем оптимистичнее прогноз выздоровления. Лучше операцию провести в течение 72 часов после травмирования. Максимальный срок проведения операции и начала лечения – 5-6 дней. Если прошёл больший срок, возникает риск сокращения мышцы настолько, что восстановить естественную длину невозможно, полагается использовать различные хирургические приспособления. Подобное удлиняет процессы выздоровления и восстановления функционирования повреждённой мышцы.

Подходящую методику операции выбирают индивидуально. Если произошёл разрыв в центре, и по краям остаётся достаточно тканей, концы разрывов сшивают стандартным способом.

Перед лечением двухсторонних разрывов обследуют организм для установления заболеваний, вызвавших дегенеративные процессы в тканях сухожилий.

Устаревшие разрывы лечить намного сложнее, особенно когда сухожилие уже сократилось. Для восстановления приходится рассекать спайки между сухожилием и бедренной костью. После допустимо сводить вместе края сухожилия и сшить. Если длины сухожилия не хватает, в проксимальной части четырёхглавой мышцы приходится вырезать небольшой лоскут, благодаря которому компенсируется недостающий размер ткани.

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Если игнорировать лечение либо пытаться справиться с проблемой самостоятельно, не обращаясь к врачу, возможно возникновение патологий: полная либо частичная утрата функционирования повреждённой конечности, постоянные судороги мышц, мышечный спазм. Ситуация затягивания с посещением доктора чревата для больного тяжёлыми последствиями со здоровьем.

Послеоперационный период, осложнения и профилактика

После операции на колено, находящемся в разогнутом состоянии, накладывается шина либо гипсовая повязка, пока не произойдёт полное сращивание тканей. На практике период занимает шесть недель. После снятия шины либо повязки больному разрешено немедленно начинать ходить. Для восстановления нормального функционирования мышц (включая четырёхглавую) повреждённой конечности потребуется заниматься физическими упражнениями, предполагающими постепенное увеличение интенсивности.

В избранных восстановительных программах предусмотрена постепенная нагрузка мышц четырёхглавой, задней поверхности бедра, заключается в применении системы сгибания и разгибания ноги. Окончательное восстановление движений происходит к двенадцатой неделе, однако двигаться в прежнем режиме люди начинают по истечении 4-6 месяцев после операции.

Чтобы восстановить кровоток и избежать в дальнейшем судорог и мышечного спазма, предлагается массаж.

Если судороги и мышечный спазм появляются, назначается новый курс массажа, а для приёма внутрь — препараты, включающие кальций и магний.

К сожалению, после проведения операции способны возникать осложнения болезни:

  1. Отсутствие возможности полностью развернуть ногу в колене;
  2. Слабость четырёхглавой мышцы бедра, задней и внутренней повреждённых поверхности;
  3. Инфицирование послеоперационной раны;
  4. Расхождение швов и краёв раны;
  5. Продолжительный гемартроз;
  6. Нарушение конгруэнтности суставов бедра и колена ноги.

После проведения операции и реабилитации возникают ощущения, что мышцы ног «тянет», свидетельствующее о защемлении нервов либо нарушении кровообращения. Если мышцу тянет продолжительный период времени – подобное становится серьёзным поводом обратиться к врачу.

Однако при незамедлительном проведении лечения и своевременном операционном вмешательстве обнаруживаются высокие шансы полностью восстановить двигательную способность. После операционного вмешательства объём движений повреждённого сустава снижен примерно на пять градусов, силы мышцы ноги на десять процентов. Возникает риск повторного отрывания мышц. Способны возникать судороги, мышечный спазм. Лечить травму требуется под наблюдением врача и на протяжении положенного времени.

Избранных рекомендаций, которые полностью защитили бы мышцы передней и задней поверхности бедра от травмирования, к сожалению, не разработано. Выделяются распространённые советы:

  • Перед проведением занятий, связанным с физической подготовкой, спортом, показано проводить предварительную разминку.
  • Физические упражнения нужно делать, учитывая собственные возможности, правильно чередовать нагрузку с отдыхом.
  • Своевременное лечение и профилактика различных заболеваний позволит снизить риск возникновения дегенеративных процессов в сухожилиях.
  • Отказ от вредных привычек, правильное питание, витаминизация способствуют укреплению тканей.

Указанные общие меры помогут понизить вероятность возникновения разрыва мышц бедра.

Разрыв мышцы бедра является частой патологией. Она может возникать по ряду факторов и имеет яркую симптоматику. Надрыв мышцы бедра может произойти вследствие интенсивной тренировки без предварительной подготовки и в том случае, если возникла травма.

Что представляет собой патология и как проявляется

Разрыв задней поверхности бедра случается чаще всего. Если посмотреть на фото в любом источнике, то можно увидеть, что причинные волокна слегка надорваны и воспалены. Чаще всего с такой проблемой сталкиваются люди, желающие иметь хорошую растяжку и приступающие к упражнениям без предварительного разогрева. При резком движении или усилии может произойти даже разрыв связок бедра, что проявляется:

  • интенсивной болью;
  • ограниченной подвижностью.

Повреждение четырехглавой мышцы бедра может произойти в любом возрасте. С такой проблемой может столкнуться не только обычный человек, но и профессиональный спортсмен. Чаще всего травма возникает при наличии дегенеративных процессов в сухожилиях и мышцах.

Симптомы травмы могут быть различными, в зависимости от степени поражения. Если произошел частичный разрыв бедренной мышцы, то возникают болевые ощущения при попытке двигать причинной ногой, а также при надавливании.

Дифференцировать данную травму от перелома сложно. Разрыв сухожилий бедра также трудно отличить от сильного растяжения, которое характеризуется интенсивной болью. Признаки могут быть стертыми. В обоих случаях больному сложно наступать на причинную ногу. Могут появляться судорожные сокращения мышц, которые сопровождаются дискомфортом.

Поражения проявляются разными по характеру болевыми ощущениями. Надрыв прямой мышцы может приводить к потере подвижности причинной конечности. При полном разрыве без хирургического вмешательства не обойтись, поэтому пытаться самостоятельно ставить диагноз не рекомендуется. Иногда данное патологическое состояние можно распознать по наличию обширной гематомы и отека.

Методы лечения

Лечение разрыва двуглавой мышцы бедра проводится комплексно. Если травма необширная, то больную конечность фиксируют до полного восстановления. Дополнительно может применяться новокаиновая блокада с целью устранения острой боли. Если дискомфорт умеренный, то следует принять обезболивающие перорально.

Сразу же после получения травмы больной должен быть доставлен в клинику для диагностики и наличия сопутствующих повреждений. На период восстановления фиксирующую повязку снимать ни в коем случае нельзя. Человек должен соблюдать постельный режим в течение месяца. Срок зависит от интенсивности повреждения.

Если поражения передней мышцы сопровождаются повреждением сустава, то рекомендуется дополнительно использовать нестероидные противовоспалительные мази, которые помогут снять отек и устранить боль и воспаления.

Во время лечения следует соблюдать диету. Необходимо включить в рацион больше молочных продуктов, а также омега-3 кислот. Для этого следует употреблять больше рыбы. От говядины и свинины рекомендуется отказаться в пользу растительной клетчатки.

Чтобы ускорить выздоровление, желательно ввести в рацион фрукты, богатые аскорбиновой кислотой. Дополнительно показан прием витаминных комплексов. При разрыве, совмещенном с переломом, необходимо знать, как лечить данное патологическое состояние. Для этого дополнительно нередко прописывают препараты кальция, которые позволяют костям быстрее срастаться.

Оперативное вмешательство

Лечить полный разрыв в домашних условиях нельзя. Приступать к операции необходимо сразу же. Если отложить вмешательство на 5–6 дней, то в этот период поврежденная мышца деформируется и станет короче, и сшить ее будет практически невозможно.

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Никакие медикаментозные средства не смогут помочь, кроме как избавят от болезненных ощущений. Оперативное вмешательство проводится под общим наркозом. Затем хирург делает разрез в месте локализации разрыва. Захватывает поврежденные волокна и сшивает их. Реабилитация может длиться от месяца до полугода.

Если протянуть время и не обратиться к врачу, то причинная конечность может и вовсе потерять способность к движению.

На начальном этапе будут сильные судороги, но в скором времени мышца атрофируется. В запущенных случаях хирург отрезает лоскут от другой ткани и с помощью него компенсирует деформированный и укороченный участок. В данном случае операция длится намного дольше, чем если бы пациент обратился в медицинское учреждение сразу же.

Дополнительные способы лечения

На стадии выздоровления показаны методы физиотерапии.

  1. При этом важную роль играет ЛФК. Упражнения помогают восстановить мышцу, которая теряет свои способности при длительной иммобилизации.
  2. Дополнительно проводится электрофорез с глюкокортикоидами. Такая методика особенно полезна при интенсивных болях.
  3. Магнитотерапия позволяет ускорить кровоток, за счет чего срастание поврежденных волокон происходит за более короткий срок. Данный метод основан на воздействии магнитного поля определенной частоты.
  4. Иглоукалывание тоже дает хороший результат и ускоряет выздоровление. При этом к больной зоне возвращается чувствительность, боль становится не такой выраженной.
  5. Массаж можно проводить только после полного срастания тканей. При этом хорошо использовать мази, обладающие разогревающим действием. Массаж проводится 1 раз в день в течение 10–20 дней. Не следует возвращаться к занятиям спортом ранее чем через полгода после травмы. Некоторые виды повреждений требуют длительной госпитализации. Чем старше пациент, тем сложнее лечение.

Из народных методов можно применять растирания настойкой прополиса. Лекарственную жидкость нужно наносить непосредственно на зону поражения. Затем втирать мягкими массажными движениями. Внутрь рекомендуется употреблять продукты пчеловодства, которые помогут укрепить иммунитет и ускорят выздоровление. Особенно полезен мед с пчелиным маточным молочком.

Дополнительно могут быть назначены глюкокортикоидные мази, которые снимают отек, боль и ускоряют срастание. Целесообразность их применения определяет врач, так как препараты данной группы обладают рядом побочных действий.

Растяжение задней поверхности бедра может быть болезненной травмой, расположенной в мышцах ноги. Мускулы подколенного сухожилия состоят из трех задних мышц бедра, расположенных между бедром и коленом, иначе называемого задней частью бедра. Двуглавая мышца бедра, полусухожильная мышца и полуперепончатая мышца начинаются как сухожилие, которое вставляется в тазовую кость. Эти мышцы затем продолжают вниз по длине бедренной кости, пересекая заднюю часть колена, чтобы прикрепиться к костям нижней ноги, большеберцовой кости и малоберцовой кости. Кроме того, небольшая часть мышцы подколенного сухожилия простирается через тазобедренный сустав. В этой статье рассмотрим как лечить растяжение задней поверхности бедра.

Мышцы задней поверхности бедра работают вместе с четырехглавой мышцей и помогают контролировать силу и стабильность коленного сустава. Это позволяет нам легко выполнять такие движения, как ходьба, бег, прыжки и приседания. Знание того, где мышцы подколенного сухожилия прикрепляются к костям ноги и таза, может дать вам хорошее представление о том, как они могут получить травму. Что такое атрофия мышц?

Как лечить растяжение задней поверхности бедра

Повреждение мышц подколенного сухожилия, скорее всего, приведет к отеку, болезненности и боли. В результате все действия, которые требуют эту группу мышц, вызовут боль, например, когда вы идете или бегаете. Чтобы способствовать заживлению и восстановлению мышцы подколенного сухожилия, выполнение следующего может оказаться полезным:

  • Отдых: Постоянное напряжение на ваших мышцах затруднит процесс восстановления. Не выделяя времени на отдых, часто усугубляет боль подколенного сухожилия.
  • Лед: это можно сделать, просто нанеся лед на пораженный участок, чтобы уменьшить боль и опухоль. Использование пакета со льдом идеально, но кубики льда используйте в полотенце или мешке с замороженными овощами. Рекомендуется как лечить растяжение задней поверхности бедра, пораженную часть тела примерно 15 — 20 минут каждые два — четыре часа.
  • Сжатие и подъем: обертывание пораженного бедра компрессионными повязками помогает уменьшить отек и боль. Кроме того, приподняв ногу, она поможет уменьшить набухание, предотвращая скопление крови.
  • Лечение боли: использование нестероидных противовоспалительных препаратов (НПВП) может быть полезным дополнением для дальнейшего уменьшения боли и отека. Общие НПВП включают ибупрофен, напроксен и ряд других. При использовании этих препаратов важно следовать указаниям врача, так как они также могут иметь побочные эффекты. Тендиноз.

Физиотерапия для вытягивания задней поверхности бедра

Физическая терапия является одним из наиболее распространенных методов как лечить растяжение задней поверхности бедра, что помогает увеличить диапазон движения и укрепить мышцы. Программы физической терапии и реабилитации могут проводиться с помощью практических занятий с физиотерапевтом или научится выполнять их на дому. Однако физическая терапия эффективна только в том случае, если она проводится регулярно. Цель состоит в том, чтобы как можно больше восстановить уровень функционирования пациента, одновременно минимизируя риск переусердствовать.

Из-за высокого уровня заболеваемости, медленного исцеления и постоянных симптомов травмы подколенного сухожилия могут быть довольно сложной задачей для пострадавших и лечащих врачей. По оценкам, почти третья часть травм задней поверхности бедра повторяется в течение первого года после возвращения к спорту или физической активности, при этом последующая травма становится более тяжелой, чем исходная.

Одна такая физиотерапевтическая техника, известная как глубокий зачищающий массаж, может использоваться в сочетании с другим широко используемым лечением. Эффект глубокого зачищающего массажа приводит к увеличению длины подколенного сухожилия менее чем за три минуты, что повышает гибкость, но не влияет на силу мышц.

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Использование кинезиологической ленты, типа липкой эластичной, также оказалось эффективным для повышения гибкости мышц и снижения риска получения травмы. Это устройство почти идентично коже человека, как по толщине, так и по эластичности и обычно используется спортсменами для лечения травм и различных физических расстройств. Причины боли под коленом сзади, при сгибании.

Упражнения и растяжки

Выполнение целенаправленных растяжек и усиленных упражнений может помочь в процессе восстановления. Важно определить, является ли ваше конкретное растяжение незначительным или тяжелым, поскольку оно диктует уровень интенсивности, с которым вы должны начинать. Со временем ваши мышцы станут сильнее, что позволит вам восстановить способность выполнять предыдущую физическую активность. Рекомендуется выполнить пятиминутную разминку с легким кардио.

Эффективные растяжки на стульях: начните, сидя в кресле, согнув колени на 90 градусов. Теперь поднимите поврежденную ногу с пола и выпрямите ногу, насколько возможно, но чтобы было комфортно. Держите ногу в течение как минимум 20 секунд, прежде чем вернуть ее на землю. Повторите это растяжение пять раз с обеих сторон, чтобы получить ровный уровень гибкости в обеих ногах.

Упражнения для укрепления ног: используя свой вес тела, вы можете укрепить мышцы подколенного сухожилия. Начинайте лежать лицом вниз, вытянув обе ноги. Теперь согните одно колено и принесите пятку к ягодицам в течение пяти секунд. Выполните два набора из 15 повторений для каждой ноги. Как только эта часть упражнения будет завершена, оставайтесь лицом вниз, обе ноги вытянуты прямо и поднимайте одну ногу с земли как можно выше. Повторяйте это дополнительное упражнение 15 раз перед переключением на противоположную ногу. В конечном итоге вы можете добавить веса к этому упражнению, так как ваши подколенные сухожилия становятся сильнее.

Скручивания: эти упражнения рекомендуются после того, как вы набрали силу в ногах. Начинайте скручивания, привязывая один конец упражнения к неподвижному объекту, а другой конец к вашей лодыжке. Затем сядьте на стул с расширенным коленом. Теперь поверните или согните колено на землю. Это растянет группу и активирует подколенное сухожилие. Ускорение может быть сделано просто шагая вверх и шагать вниз от платформы достаточно высокой, для того чтобы активировать подколенные сухожилия, как крепкий стул. Для каждого упражнения выполните два набора из 15 повторений.

Растяжка стоя: начните сгибать одну ногу перед собой, вторая нога вытянута сзади. Согните немного колено другой ноги, откидываясь назад. Держите таз наклоненным вперед и медленно наклоняйтесь, чтобы достичь ваших изгибов пальцев. Вы должны почувствовать растяжение задней части расширенной ноги через икру и бедро. Удерживайте это растяжение 20 — 30 секунд, а затем повторите два — три раза, прежде чем переключиться на противоположную ногу. Эта растяжка идеально подходит для тех, кто любит бегать, спринтерский забег или заниматься спортом на поле.

Сидящая растяжка: начните сидя на полу, обе ноги вытянуты перед собой, колени прямые. Медленно наклонитесь вперед и приложите все усилия, чтобы достичь пальцев ног. Старайтесь не сгибать колени, чтобы получить хорошее растяжение в ваших подколенных сухожилиях. После того, как вы достигли, насколько вы можете растянуться, удерживайте эту позицию в течение 20 — 30 секунд.

Растяжка с партнером: с помощью друга вы можете получить глубокое растяжение подколенного сухожилия. Начните лежа спиной к земле. Пусть ваш партнер поднимет одну ногу, пока вы держите ее прямо. Теперь ваш партнер должен мягко поднять ногу, растягивая ее вверх. Важно не перенапрягать и поддерживать контакт со своим партнером, чтобы этого не происходило. Повторите это упражнение два — три раза на обеих ногах.

Упражнение с пенным валиком: с помощью пенного валика вы можете выполнять самомассаж и миофасциальный выпуск. Начните в сидячем положении на полу, и обе ноги вытянуты прямо. Поместите пенный валик под свою ягодицу и начните катиться назад и вперед и слегка в бока. Причины боли в ноге выше колена.

Время восстановления и советы

Восстановление от растяжения задней поверхности бедра будет зависеть от тяжести травмы, а также от способности вашего организма исцелятся. Кроме того, ваша приверженность рекомендованным физиотерапевтическим режимам и планам как лечить растяжение задней поверхности бедра станет решающим фактором для быстрого восстановления подколенного сухожилия.

Обычно рекомендуется не заниматься какой-либо физической нагрузкой до тех пор, пока вы не почувствуете, что ваша поврежденная нога может двигаться так же свободно, как ваша неповрежденная нога, и она восстановила свою силу. Применение чрезмерного использования, прежде чем ваша травма полностью выздоровеет, может привести к травмированию или даже постоянной мышечной дисфункции.

Важно помнить, что каждый пациент восстанавливается по-разному, поэтому дайте себе правильное количество времени, прежде чем вы начнете любые виды напряженных упражнений.

Предотвращение растяжения

Чтобы дать себе наилучший шанс предотвратить травмы подколенного сухожилия, в первую очередь, рекомендуется прогревать и растягивать мышцы перед любым видом физической активности. Увеличьте интенсивность упражнений медленно, так как слишком много усердия увеличивает шансы травмы мышц экспоненциально. Прекратите упражняться, как только почувствуете, что вы, возможно, навредили себе. Наконец, сосредоточьтесь на усилении упражнений, чтобы помочь увеличить выносливость мышц.

Исцеляющие травмы подколенного сухожилия или большинство мышечных травм в этом отношении могут быть намного сложнее, чем предотвращать их в первую очередь. Придерживаясь советов и рекомендаций как лечить растяжение задней поверхности бедра, изложенных в этой статье, вы можете быть уверены, что выполняете все возможное, сохраняя при этом свою безопасность. Причины боли в бедре и ягодицах.

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