[The effect of age on the degree of strength restoration of the lower limb musles in the long-term period after surgical treatment of adult patients with spondylolisthesis.]

The purpose of the work was to study the effect of age on the degree of isometric strength restoration of the lower limb muscles in the long-term period after surgical treatment of adult patients with spondylolisthesis. 36 patients with spondylolisthesis of I and II displacement degree and 50 normal subjects at the age of 41-66 years were included in the study. Maximum moments of the femur and leg isometric strength were studied using dynamometric stands. The pain syndrome was evaluated in all the patients (VAS scale), as well as their functional condition (Oswestry scale). The investigations were performed before treatment and 75-99 months after surgical intervention. The presented reliable reverse correlation of the patient's age and the pattern and magnitude of changes in the strength of the lower limb muscles was identified in adult patients with spondylolisthesis in the long-term period after surgical treatment. At the younger age (41-59 years) positive dynamics of the muscle strength prevailed - an increase in 56,3% cases, conformity to the preoperative level was observed in 6,3% patients, a decrease in muscle function - in 37,4% cases. In the age-related group of 60-74 years the muscle strength growth was recorded only in 16,7% cases, there was no dynamics relative to the initial level in 8,3% patients, and a decrease in maximum moment of strength was observed in 75% cases. Thus, in case of large intervals of the follow-up period of the results of surgical treatment of adult patients with spondylolisthesis it is impossible to avoid evaluating the effect of age changes in muscles on the degree of restoring isometric strength of the lower limb muscles. As far as age increases, the reserves for muscle function improvement after surgical treatment are reduced significantly.

[Subclinical sensory-motor deficit after surgical correction of the spinal deformity]. / Subklinicheskii sensomotornyi defitsit posle khirurgicheskoi korrektsii deformatsii pozvonochnika.

AIM: A quantitative evaluation of the relationship between the level of postoperative motor deficit and the intensity of reaction of pyramidal tract to the correction of spinal deformity. MATERIAL AND METHODS: The correction of spinal deformities of different etiology was performed under neurophysiological control for 87 patients (30 men, 57 women), aged 15.6±0.6 years. Reaction intensity of pyramidal tract was evaluated using the scale developed by the authors. RESULTS: The relationship between the intensity of intraoperative reaction of somatic motor system and EMG-signs of postoperative subclinical motor deficit in temperature-and-pain sensitivity disorders was shown. CONCLUSION: EMG evaluation of the level of intensity of subclinical motor deficit in combination with changes in temperature-and-pain sensitivity after the spinal deformity correction complies the reaction intensity of somatic motor system to surgical aggression. Neurologists should pay more attention to the patients with V type reaction not only during postoperative period, but before the next stage of surgery.

[The Details of Thermoesthesia-and-Algesthesia State in Patients with Idiopathic Scoliosis of III-IV Degree].

Sensitivity in patients with adolescent idiopathic scoliosis remains insufficiently studied. The details of thermoesthesia-and-algesthesia state were studied in adolescent patients with III-IV Degree idiopathic scoliosis. Thermoesthesia-and-algesthesia was evaluated in Th1-S1 dermatomes on the right and on the left using an electric esthesiometer. Thermoesthesia-and-algesthesia disorders of different severity degree have been established to be observed in all patients in all the dermatomes studied, manifesting themselves as hypesthesia, hyperesthesia, and thermoesthesia absence. The disorders of thermoesthesia-and-algesthesia were not of local character; but they went beyond the level of the spine deformity. Maximum negative changes in thermoesthesia-and-algesthesia were registered in the dermatomes corresponding to the apex of thoracic spine deformity (Th8, Th9, Th10) where the lowest percentage of patients with normal algesthesia thresholds is observed being combined with the decreased number of patients with thermoesthesia thresholds within the norm.

[EVALUATION OF RENAL FUNCTION IN PATIENTS WITH SPINAL CORD INJURY].

A comprehensive evaluation of renal function in 59 patients with spinal cord injury was performed. Excretory urography, biochemical and ion-selective analysis of serum and daily urine were used. Excretory urography had showed a reduction in the cumulative and excretory renal functions, which was accompanied by an increase in glomerular filtration rate, regardless of the level of damage and the period of traumatic disease. Excretory renal function has undergone a number of changes: 1) decrease in clearance of nitrogenous components; 2) an increase in clearance of mineral components in acute phase; 3) decrease in the rate of calcium excretion. Spinal cord injury contributed to an increase in the stimulating effect of aldosterone on the distal tubules of nephrons function of the kidneys, manifested in the form of increased excretion of potassium in the urine. In case of injury of the cervical and thoracic spine, significant increase in the K/Na coefficient was determined in acute phase, in patients with lumbar spine injury - in the late period.

[State temperature-pain sensitivity and morphological features of the skin back in patients with idiopathic scoliosis with stage III-IV].

This study was aimed at revealing the features condition of thermal, pain sensitivity and morphological pattern of the skin of the human back at the apex of spinal deformity in the thoracic area in patients with idiopathic scoliosis with stage III-IV. The study included 41 adolescent with idiopathic scoliosis with stage III-IV. Temperature-pain sensitivity was studied in Th6-Th10 dermatomes on the right and the left. Biopsies (skin) for histological examination were taken intraoperatively in projection corresponding to the apex of the arc scoliosis of the spine. Significant disorders of the sensitivity to temperature and pain were found in the dermatomes to the apex of the thoracic spine deformity that were hyperesthesia, hypoesthesia, or absent thermal sensitivity. Histostrukturnye changes of the skin are significantly decreasing the thickness of the epidermis and dermis, reduction of capillaries and changing the structure of the small vessels, destruction of individual nerve fibers and free nerve endings.

[Potential biochemical factors for the development of urolithiasis in patients with spinal cord injuries].

A comparative analysis of biochemical parameters of blood serum and daily urine in patients with urolithiasis developed after spinal cord injury (study group--35 patients) and patients without development of the disease (comparison group--20 patients) was performed. It was found that patients after spinal cord injury have developed productive azotemia, which led to the disruption of renal excretory function (accumulation of urea and creatinine in blood, and lowering their clearance). Against this background, there is violation of excretion of uric acid, magnesium, decreased sensitivity of the renal tubules to aldosterone (in patients with nephrolithiasis K/Na ratio in urine was lower). As a result, patients have decreased reabsorption of sodium and water retention, increased urine osmolality; against the background of electrolyte imbalance in urine, this leads to the formation of stones. In patients with spinal cord injuries, main trigger mechanism of formation of urinary stones was excessive posttraumatic azotemia. The high concentration of the products of protein-nitrogen catabolism in the serum of patients in the acute and early periods of spinal cord injury may be unfavorable criterion determining the significant risk of developing of kidney stones.

[Thermoesthesia-and-algesthesia status in the dermatomes of cauda equina roots in patients with lumbar spine osteochondrosis].

Thermoesthesia-and-algesthesia disorders have been registered in the dermatomes of cauda equina roots of patients with lumbar spine osteochondrosis in all the cases. Negative changes in the sensitivity of this type are manifested themselves as follows: 1) 2-8-degree increases of thresholds; 2) 3-6-degree decreases of thresholds; 3) absence of thermal sense. In the presence of reflex syndromes (lumbalgia and lumbar ischialgia) the disorders in L4, L5, S1 dermatomes have been determined to the greatest degree. Thermoesthesia-and-algesthesia disorders are more pronounced in patients with the radicular syndrome than in those with the reflex syndromes. The most improvement ofthermoesthesia-and-algesthesia values is observed in L5 dermatome of patients with lumbalgia and lumbar ischialgia after complex conservative therapy. The treatment performed does not result in significant thermoesthesia-and-algesthesia improvement for the limb with radiculopathy events and in the dermatome of the root compressed in patients with the radicular syndrome. Positive changes in contralateral limb are more pronounced.

[The extent of temperature sense and pain appreciation recovery in the dermatomes of cauda equine roots after lumbar intervertebral dischernia elimination].

Temperature sense and pain appreciation has been studied in the dermatomes of cauda equine roots in patients with lumbar intervertebral disc hernia before treatment, in the immediate and long-term periods of observation after disc hernia elimination. Temperature sense and pain appreciation has been determined to be disordered not only in the dermatome of compressed root, but in the dermatomes located proximally and distally as well. The manifestation of negative changes was observed to a greater extent during temperature sense examination. After disc hernia elimination the recovery of temperature sense and pain appreciation in the dermatomes of cauda equine roots is rather limited, especially in the area of compressed root innervations. The positive shifts of temperature sense and pain appreciation values in different zones of examination in the immediate periods of observation after surgery were noted, on the average, in 55% of cases, those in the long-term periods of observation--in 36% patients only. The improvement of pain appreciation (heat pain) was noted to a greater extent both in the immediate and long-term periods of observation.

[Stimulation of lower extremity peripheral circulation in patients with obliterating arteriosclerosis by the wire insertion into the bone marrow canal].

The method of applying the Ilizarov apparatus on the injured segment of the lower extremities introduced from below into the marrowy cavity in 16 patients with a precritical degree of blood circulation impairment (II and III stages according to Pokrovsky classification) resulted in stable compensation of ischemic derangements.

[Evaluation of the gas regimen in the damaged tissues]. / Otsenka gazovogo rezhima povrezhdennykh tkanei.

Dynamics of CO2 and oxygen was studied in the skin of 35 patients with open fractures of the crural bones. The results were compared with homeostasis in the whole blood. It was found that immediately after surgery there is marked acydosis, gas regimen of the skin adjacent to the wound is characterized by hypoxia and hypercapnia. By month 2 after the trauma the excessive amount of organic acids was compensated by falling content of CO2, i.e. development of CO2 alkalosis. A complete compensation was not achieved within the treatment period and normalization of acid-base balance in patients was not observed.

[Transcutaneous determination of oxygen and carbon dioxide pressure in patients with obliterating atherosclerosis of blood vessels of the lower limbs]. / Chreskozhnoe opredelenie napriazheniia kisloroda i uglekislovo gaza u bol'nykh s obliteriruiushchim aterosklerozom sosudov nizhnikh konechnostei.

The method of transcutaneous determination of oxygen and carbon dioxide tension was used in examinations of healthy men (26 extremities) and 66 patients with obliterating atherosclerosis of the lower extremity arteries with different stages of the insufficient peripheral blood circulation. It was shown that oxygen tension in the foot skin was decreased in proportion to the decrease of the humero-malleolar index. In patients with obliterating atherosclerosis of the vessels and the II stage of insufficiency of blood circulation of the lower extremity the decrease of the humero-malleolar index and capillary blood flow of the foot skin did not result in a sharp disturbance of the gas regimen of the skin. In the III and IV stages of disturbances of blood circulation there occur failure of compensatory-adaptational mechanisms of tissue respiration accompanied not only by pronounced hypoxia but also by hypercapnia.