Doluda Y. Posttraumatic deformations subaxial segments of the cervical spine due to compression and flexion-distraction injuries: diagnosis, treatment strategy

Object: posttraumatic deformations of subaxial segments of the cervical spine. The purpose: to justify and to improve the range of diagnostic measures for further optimization of the treatment strategy in posttraumatic deformities of subaxial segments of the cervical spine. Methods: finite element method, clinical, radiographic, ultrasonic Doppler, electromyographic, statistical. For the first time using of finite element modeling was found that when the kyphotic deformity value at 10° of internal stress of the front region of the support structure of the complex is increased to 33.5 times, while increasing kyphotic deformity to 30 ° - the value 230 increases over time with intact model. Refined scientific data about the patterns and the relationship of clinical and radiological symptoms of posttraumatic deformities of the cervical spine showed that a long-term kyphosis adversely affected the results of treatment of such patients because of its progression by an average of 8,1° and development of persistent clinical symptoms, and poor results of treatment ranged from 40 to 75%. Supplemented by scientific knowledge about the relationship of features of structural and functional state of the vertebral artery with clinical symptoms, thus established the potential adverse types of post-traumatic deformities, which may be accompanied by cerebral blood flow in the vertebrobasilar basin in 52.1% of cases without the clinical manifestations of vascular disorders. The features of change of amplitude-frequency characteristics of the upper extremities muscles, which may indicate a change in their electrogenesis uncomplicated DF and CF types of posttraumatic deformities in 33.3% of patients. Improved classification stage-evaluation of disorders of the amplitude-frequency characteristics of the muscles of the upper limbs, which allows to quantify the degree of impairment of the muscles innervation. It is revealed characteristics evaluation of hemodynamic disturbances in the vertebrobasilar basin and changes the amplitude-frequency characteristics of the muscles of the upper combined with the data of the clinical and radiological examination allowed to improve the range of diagnostic activities in posttraumatic deformities of the cervical spine, and can be used to predict the course of the traumatic process, and posttraumatic changes in damaged cervical segments. On the basis of available data, indications and tactics of surgical treatment of posttraumatic deformities depending on the nature of the primary damage, terms of existence and the amount of deformation, as well as cardiovascular and neurological disorders. The systematization of typical pitfalls of diagnosis and treatment of the causes of unsatisfactory results, taking into account that the scheme of surgical treatment of posttraumatic deformities of the subaxial cervical spine that allowed in 78.6% of cases gets excellent and 7.1% good results of surgical treatment, as well as reducing the number of unsatisfactory results. The number of excellent results in 17% higher than by using modern techniques. Results of the study are introduced into clinical practice of the State Institution "Sytenko Institute for Spine & Joints Pathology of the National Ukrainian Academy of Medical Sciences", in the educational process at the Department of Traumatology and Orthopedics of Kharkiv National Medical University, Ministry of Health of Ukraine, Kharkov Academy of Postgraduate Education. Traumatology and Orthopedics.