Features of vertebral arteries pathology at trauma

OBJECTIVE. The authors compared results of changes in clinical and radial studies of vertebral arteries in case of trauma of cervical spine. MATERIAL AND METHODS. An analysis of data of complex examination and treatment was made in 157 victims aged 38,5 ± 1,5 years old. RESULTS. Pathology of vertebral arteries was detected in 68,8 % cases. The main ultrasound syndromes were deformations of speed with local hemodynamic significance, compression with systemic deficiency of blood flow, irritative effects, extravasal changes on the level of V-3 segment, thrombosis and dissection. CONCLUSIONS. The development of hemodynamically significant local effects on the vertebral artery depended on degree of stenosis and cross-section area of its canal

INSTABILITY AT CHRONIC DAMAGES OF A BACKBONE AND SPINAL CORD

By means of mathematical modeling studying influence of angular deformation of a body on development of a spinal stenosis was performed. It is proved, that the increase in a corner of deformation promotes development of narrowing of the channel. The given law on an example of treatment of 10 patients with chronic damages of a backbone and a spinal cord is studied. At all patients the progression of deformation that has demanded surgical treatment was observed. The lead treatment has reduced a painful syndrome, has improved social adaptation, but has not affected a level of neurologic deficiency

FEATURES OF MEDICAL AID FOR NEUROTRAUMA IN REGION WITH LOW POPULATION DENSITY

The system of medical aid for neurotrauma in the region with low population density in the case of the Komi Republic was studied. Neurosurgical care to the population of the republic last decade had an intense focus of development. Currently, neurosurgical service is based entirely in Syktyvkar, and is represented by three neurosurgical departments. Due to the low population density (2.3 people 1 km2), the centralization of specialized medical care and inadequate equipment of district and regional hospitals, special significance remote consultation, as well as adequate ways of evacuation with neurotrauma

THE RESULTS OF EXAMINATION OF MEDICAL CARE QUALITY FOR ASSOCIATED VERTEBRO-SPINAL-CORD INJURY

Medical care quality assessment for patients with vertebro-spinal-cord injury at different stages in St.-Petersburg during year was performed. The first aid in the most cases (74,8%) was rendered by emergency service. A vertebro-spinal-cord injuries were not diagnosed by a staff of line and special medical aid brigades in 31,6-51,9%. The causes of incorrect diagnostics at hospital stage: insufficient and delayed patient examination, underestimation of injury severity in consequence of delayed use of neuro-imaging methods. Surgical operations for vertebro-spinal-cord injuries were performed in 59 (8%) cases. 43 (73%) patients needed in vertebral fixation

ALGORITHM OF DIAGNOSTICS AND SURGERY OF TRAUMA AND DEGENERATIVE DISEASES OF CERVICAL SPINE

A retrospective analysis of diagnostics and surgery in 240 patients was made. The vertebral spinal trauma took place in 168 patients (average age 31±5 years), degenerative dystrophic diseases of spine were in 72 patients (average age 52±7 years). The clinicodiagnostic complex included survey and functional radiography of the spine, magnetic resonance image and helical computer tomography of the spine with spondylometric measurements and color duplex scanning of the vertebral artery. Stabilization of the spine was performed in 137 (57%) cases. The variants were determined on the basis of predominate injury of 1 out of 3 supporting complexes. The rigid and dynamic methods and their combination were used for fixation of the spine. More favorable results were registered using dynamic fixation and the arthroplasty of intervertebral disks with nitinol constructions. An algorithm of radiodiagnostics and surgery methods were proposed

ASSESSMENT OF MEDICAL CARE QUALITY IN CRANIOCEREBRAL TRAUMA ON THE BASE OF DATA ANALYSIS

An analysis of 658 medical records of inpatient treatment from 15 hospitals of St. Petersburg was made using a computer-aided technology of the assessment of medical care quality. It was revealed that a proper quality of medical care in craniocerebral trauma was only in 52,9% cases. Different defects of medical care were noted in the rest of observations. It influenced on the condition of the patients (1,0%), the delivery and assessment of health care (40% and 38%, respectively), health resources (18%), social resources (1,0%). Defects of medical records were indicated in 38% patients. It caused a reduction of medical care. Risks of occurrence of medical care defects are low in children hospitals in the case of combined craniocerebral trauma

SURGICAL CORRECTION OF CIRCULATORY DISTURBANCE OF THE VERTEBRAL ARTERY IN TRAUMA AND DEGENERATIVE DISEASES

The article presents the results of examination and surgery of 185 patients with degenerative diseases as well as with a cervical spine trauma. The circulatory disturbance of the vertebral artery took place in all patients. A different degree of changes was observed in color duplex scanning. There were minor circulatory disturbances, course deformations (angular, C, S,Vshaped twists) and dissection of the vertebral artery. Color duplex scanning allowed estimating of local and system hemodynamic significance of extravasal influences. The strategy of treatment and volume of surgical interference were defined by the degree of circulatory disturbance in the vertebral artery

CHANGES FACETS JOINTS IN TRAUMA AND DEGENERATIVE DISEASES OF THE LUMBAR SPINE

Produced spondilometric measurements of the lumbosacral spine is normal (20 cases) and in patients with spinal cord injury and degenerative-dystrophic diseases of the spine (43 cases). The width of the facet joint space joints on both sides, its relation to the longitudinal axis of the body in degrees and another on the same level were studied. The width of the facet joint space at the lumbosacral level of 3.5–4.0 mm, the area of the intervertebral foramen varies from 96–132 mm2. Among the changes in the parameters of the vertebral-motor segment can distinguish moderate, marked and significant extent that is important in determining the amount of the alleged operation

Diagnostics and surgical treatment of vertebral osteoporosis

The retrospective analysis of clinical and radiological diagnostics of 76 patients with vertebral osteoporosis among which women prevailed (82.9%) is carried out. The average age was 57,7 ± 5,3 years. The complex diagnostics consists of the survey x-ray,the x-ray absorptiometry, the quantitative computed tomography, spiral computed tomography and magnetic resonance imaging procedure. The quantitative computed tomography is characterized by the highest diagnostic information value (sensitivity - 99.4%, specificity - 99.5% and the accuracy - 99.3%). Surgical treatment consisted in rigid (7.9%) and dynamic (10.5%) vertebral fixation and puncture vertebroplasty (81.6%), which was consist in a dereception of underlying facet joints with introduction into it the solution consisting in equal quantities of local anesthetic and alcohol 70° (1.5-2.0 ml). The optimized technique of vertebroplasty with an additional dereception of facet joints allows to increase the level of social rehabilitation of patients by 10.2% with full regress of a pain syndrome

VALUE OF ANATOMICAL INTRACRANIAL RESERVE IN SURGICAL TREATMENT OF INJURIES AND DISEASES OF THE BRAIN

The authors proposed to evaluate the quantity of anatomical intracranial reserve according to morphometric measurements in axial projection by means of helical computer tomography data of bitemporal distance, width of the tentorial opening, diameter of the foramen magnum and mutual correlation of these parameters in points. This method showed a high accuracy (92%) and predictive value (85%) in determination of terms and volume of complex treatment of 140 victims with craniocerebral injury, 120 patients with primary tumors of the brain and 110 patients with acute disorder of cerebral circulation