Object: structural and functional state of skeletal muscles at the extremities trauma. Aim: to develop system of comprehensive evaluation and monitoring of state of structural and functional state of muscles in patients with extremities trauma for diagnosis and determination the pathological process, prognosis of function restore, optimize treatment strategies. Methods: clinical, electromyographic (machine "Neuroscreen", Toenis, German, 1995; "Viking Quest", Nicollet, USA, 2006), sonographic (machine ultrasonograph HDI 3500, Phillips, USA, 1999; HD 11XE, Phillips, USA, 2006), histological (microscope OLYMPUS CX-41, Olympus Corp., Japan, 2004). For the first time quantitative changes of electromyographic characteristics of introduction activity in the muscles of patients with denervation and ischemia after extremities trauma were found out. These indices together with other allow to determine the character of the pathological process. Quantitative changes of sonographic parameters (hypotrophy, echodensity of muscles in patients with nerves trauma during the treatment) were defined. It is proved that indicators of introduction activity, hypotrophy and echodensity of muscles have different degree and direction of changes in patients with different functional outcomes. First the threshold levels for these indicators for prognosis of recovery functions were detected, objective criteria for the formation of irreversible denervation atrophy and unfavorable prognostic signs for the effective recovery of muscles function were shown. For the first time features of clinical and electromyographic parameters of the initial structural and functional state of muscle at denervation, ischemia, tenotomy and their combination which allow their differential diagnosis in patients with extremities trauma were identified. For the first time three clinical and electromyographic variants of ischemic lesion of limb muscles were identified, features of their clinical course were revealed. Knowledge about the course of denervation-reinnervation process in patients with complete axonotmesis was expanded and separation into five clinical and electromyographic stages was proposed. First peculiarities of efficient and inefficient muscle recovery are defined based on an assessment term injury, the expected period of muscles' reinnervation, times of occurrence of the first electromyographic signals of recovery, temporal sequence of transition stages of denervation-reinnervation process. During histological analysis it was shown that morphological changes in denervation muscles of patients with limb trauma were varied widely. This is probably due to both the heterogeneity of the initial parameters lesions and different rates of development of atrophy, reinnervation and substitution processes. First the relationships between morphological, clinical and electromyographic parameters in the muscles of patients with nerve damage were discovered. Using the proposed integrated clinical and instrumental studies allows to improve diagnosis of muscle state in patients with injuries of extremities. In order to standardize ultrasound examination of muscles a new apparatus and methods of assessment of sonographic images were developed (patents 40039 UA, 40040 UA, 581187 UA). Developed diagnostic and prognostic system enables to justify the choice of treatment, to optimize terms and tactics of treatment of these patients. Results of the study are introduced to the work of Department of Hand Microsurgery of Research Institute of Traumatology and Orthopedics of M.Gorky Donetsk National Medical University, department of functional diagnostics SI "Institute of neurosurgery named after A.P.Romodanov National Academy of Medical Sciences of Ukraine", department of microsurgery and reconstructive surgery of the upper extremity of SI "Traumatology and Orthopaedics Institute National Academy of Medical Sciences of Ukraine". Traumatology and orthopaedics.
