Object: burst fractures and vertebrae fractures with distraction and rotation of the thoracic and lumbar spine. Aim: to improve the results of treatment of patients with high-energy fractures of the thoracic and lumbar spine vertebrae through experimental and clinical substantiation of the concept of rational treatment on the basis of determining the residual fixation of the spinal motion segment, functional state of the spine and vertebral canal. Methods: clinical, X-ray, computer tomography, magnetic resonance imaging, biomechanical, mathematical and experimental modeling, histological, statistical. For the first time on the basis of biomechanical and clinical studies of vertebrae fractures of the thoracic and lumbar spine, the regularities of spine deformities were determined in conditions of different levels of anatomical structures destruction. The presence of residual fixed and residual spinal deformation has been proved, according to which the basic types of kyphotic deformity (elastic-plastic, controlled-plastic and uncontrolled-plastic), which determine the tactics of treatment, were established. For the first time, based on the developed biomechanical physical and mathematical models of burst fracture and fracture of the vertebral body with distraction and rotation, the mechanical efficiency of transpedicular devices with different numbers of fixed vertebral segments has been substantiated. It was established that the maximum stresses in transpedicular structures arise in the rods at the level of the upper and lower screws. At mathematical model has been determined reducing of stress in injured vertebral segments with an increasing in the number of fixed vertebrae. It is proved that the insertion of the screw into a broken vertebra reduced the stress in the rods to 20 %. For the first time in the animal experiment, the possibility of optimizing the regeneration of vertebrate bodies after traumatic injury by the introduction of fibrin-enriched platelets has been proved. Clinically, it has been proved that the the presence of fibrin-blood clot at the site of the anterior subligamentous hemorrhage promotes the formation of bone tissue along the anterior contour of the vertebral body, which improves the spine's support. Based on the retrospective analysis of the treatment results of patients with burst fractures and fractures with distraction and rotation, it was determined that restoration of the spinal canal gap is mainly due to remodeling of the spinal canal and only 10 % due to ligamentotaxis. It has been shown that patients with partial neurological symptoms of types B, C, D on the scale of ASIA, may have a favorable outcome in the case of surgical treatment. As a result of the functional spine analysis, it has been determined that the most effective method for correction of residual spinal deformation is a longitudinal fixation method – an eight-screw fixation (two vertebrae above and two below the injured area) with or without an intervertebral support. Short-acting fixation techniques – combined bisegmental anterior-posterior 360° spine fusion and bisegmental six-screw fixation – can be used in the treatment of incomplete or complete burst fractures. For the first time, the concept of treatment of patients with burst fractures and fractures with distraction and rotation on the basis of the principle of residual fixation of the spine was scientifically substantiated and developed. An algorithm for the treatment of burst fractures and fractures with distraction and rotation, taking into account residual fixed spine, namely undamaged anatomical structures and their influence on the development of deformity, allowed us to choose an effective method of treatment for this category of patients, to improve the results and quality of patient's life. The working classification of vertebrae fractures is developed, which is based on the principle of the residual spine fixation, namely on the signs of spinal deformation and spinal canal, and allows us to determine the criteria for the use of transpedicular devices, the length of the spine fusion, the necessity for intervertebrae support and bone grafts. The developed method (patent №120281 UА) and composite (patent №119623 UА) for reconstructive treatment of burst fractures of will help to optimize the regeneration process and improve the spine's support. The results of the study were introduced into the scientific process of the Department of Traumatology and Orthopedics of the Kharkiv Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine and the clinical practice in SI "Sytenko Institute of Spine and Joint Pathology National academy of Medical Sciences of Ukraine", Military Clinical Center of the Northern Region of the Ministry of Defense of Ukraine (Kharkov), KNP "City Clinical Hospital of Rapid and Emergency Medical Care named after Prof. O. M. Meshchaninov" of Kharkiv City Council. Тraumatology and Orthopaedics.
