The dissertation on competition of a scientific degree of the candidate of medical sciences on a specialty 14.02.01 - hygiene and occupational pathology. - State Institution "Institute of Occupational Medicine named after Y.I. Kundiev of the National Academy of Medical Sciences of Ukraine ", Kyiv, 2020.
The dissertation is devoted to the topical problem of occupational medicine - improving the system of diagnosis and prevention of occupational chronic lumbosacral radiculopathy (CLSR) by studying the features of the clinical and functional state of the nervous and musculoskeletal systems and determining the level of vitamin D, macro- and microelements concentrations (MaE and ME) in biological environments at workers in the conditions of influence of considerable physical activity.
It is established that static and dynamic load (slaughterer - 649.18 W, mining worker of a clearing face (MWCF)- 317.48 W, drifter - 416.67 W), stay for a long time in a fixed / uncomfortable working position (slaughterer - 57.25% of working time, MWCF - 50.66%, drifter - 42.27%) (p<0.05) are the main occupational risk factors for the development of CLSR in miners of the main professions of coal mines in Ukraine.
Low back pain (LBP) is defined as the main clinical symptom of occupational CLSR. The results of the Visual Analogue Scale (VAS) and the Numeric Pain Scale (NPS) showed the highest pain intensity in the slaughterer group (7.4 and 7.93 points, respectively) compared to the MWCF group (5.45). and 5, 73) and a group of drifter (5.87 and 6.37) (p <0.05).
The main signs of degenerative-dystrophic changes of the spine in the analysis of computed tomography and magnetic resonance imaging of patients with occupational CLSR identified osteochondrosis, spondyloarthritis, spondylolisthesis, spondylosis in above 90 % of examinated of all professions.
It is established that the most informative indicators for determining impulse conduction disorders by nerve fibers in patients with occupational CLSR according to electroneuromyography are: decrease in the amplitude of the M-response when stimulated at the distal point and pulse velocity by long nerves of the lower extremities. The average value of the amplitude of the M-response in the group of MWCF was recorded at 6.56 mV (at a normative value of 4-5.8 mV) (p<0.05), the average rate of pulse conduction was 38.46 m/s (at normative values of 40.00-50.00 m /s) (p<0.05). Most often these pathological indicators were registered in the group of drifter(41.5%) and slaughterer (50%).
It is proved that the value of T-score below -1 is an informative diagnostic indicator of the development of osteopenia, which was diagnosed in 20% of miners with occupational CLSR.
By the method of assessing the 10-year risk of femoral fractures and other major osteoporotic fractures (FRAX) was revealed that the most significant changes in bone tissue are diagnosed in miners aged 50 to 59 years, in which the rate is 3.78 (p<0,05).
Diagnostic risk criteria for the development of disorders of bone structure are: the concentration of vitamin D below 30 ng/ml (p <0,05), Ca - below 2,16 mmol/l (p<0,05), Mg - below 0,72 mmol/l (p<0.05), Al - above 3.3 μMol/l (p<0.05), B - below 62.90 μMol/l (p<0.05), P - above 3.2 mmol/l (p<0.05).
Key words: occupational chronic lumbosacral radiculopathy, musculoskeletal system, connective tissue, osteopenic syndrome.
