Introduction. The issues of dynamic and functional anatomy of the neck are of considerable practical and theoretical interest. This is due to the peculiarities of the displacement of the musculofascial layers when changing the position of the head in space, the description of which presents significant difficulties. Particular practical importance has therefore the study of dynamic phenomena of this area as well as the analysis of morphological and biomechanical changes leading to the development of somatic dysfunction of the neck. Aim. Based on the topographic and anatomical studies, as well as with the help of finite element modeling, to study the patterns of displacement of the muscular-fascial layers of the neck when turning the head by 20º and 50º. Materials and methods. The topographic and anatomical study used the results of 18 MRIs, the analysis of which was carried out using the Vidar Dicom Viewer software. To build a finite element model, data from a CT study of a patient were used, which has not any pathological changes in the organs and musculoskeletal system of the neck. As a result of the subsequent processing of the CT study data, a personalized anthropomorphic finite element model of the neck region was constructed, with the help of which a series of virtual topographic and anatomical studies were performed, repeating in general terms the topographic and anatomical part of the work. Results. 1. The values of rotational and angular displacement of all fascia of the neck are nonlinear. 2. The fascia of the neck are displaced relative to each other when turning the head due to the difference in the values of angular displacement. 3. The magnitude of the angular displacement of the 2nd fascia of the neck at the level C2-C3, C3-C4 and C4-C5 when turning the head 20º, as well as at the level C4-C5 when turning the head 50º exceeds the value of the angle of rotation of the head relative to the trunk. 4. The direction of rotational and angular displacement for all fasciae at the level C6-C7 corresponds to the direction of rotation of the head, with the exception of the dorsal part of the 4th fascia of the neck, which at this level, together with the esophagus, shifts in the opposite direction relative to the axis of symmetry. 5. Fasciae located at a greater distance from the center of the intervertebral disc are characterized by large values of angular and rotational displacement. 6. The rate of change in the ratio of rotational and angular displacements is higher at the level of the lower segments. 7. The results of measurements of the rotational displacement of the fascial layers of the anthropomorphic finite element model demonstrate a positive correlation with the data of the topographic and anatomical study. Conclusion. The patterns of displacement of the neck musculofacial layers should be taken into account when modeling somatic dysfunction of the neck, as well as in the process of diagnosis and planning of osteopathic effects.
Osteopathy is a branch of clinical medicine based on a holistic approach which uses manual methods on the stages of prevention, diagnosis, treatment and rehabilitation and is aimed at restoring the body's natural ability to self-correction. The article presents an overview of randomized controlled trials of the results of osteopathic treatment of children of different age groups presenting functional alterations. All the trials were held in the Russian Federation over the recent years. On the grounds of the presented data it is possible to draw a conclusion about the proven clinical effectiveness of osteopathic treatment in hypoxic-ischemic lesions of the central nervous system, in particular, in hypertension-hydrocephalic syndrome, in the mild form of bulbar dysarthria as a consequence of a birth injury of the craniovertebral junction, dysplasia and subluxation of the hip joint, low degree myopia with the accommodation spasm, neurogenic dysfunctions of the urinary bladder complicated by the chronic bullous cystitis and vesicoureteral reflux. The sooner osteopathic treatment starts, the better is the result. Osteopathic treatment is safe. It allows to reduce the medicinal load and the risk of polypragmasy in children. It goes well with other methods of treatment, which is especially important for children of the first year of life. Osteopathy can enrich the clinical medicine toolkit and occupy a rightful place in the system of healthcare delivery to children.
Osteopathic treatment of motor disturbances in children presenting perinatal affections of central nervous system of hypoxic ischemic genesis during the early rehabilitation period can help to reduce significantly the affections (occurrence and severity level), and to improve recovery time by choosing the best physiologically justified way of self-correction made by the body itself.
Introduction. The health status of children of the first year of life is primarily affected by the course of pregnancy and childbirth, as well as hereditary factors. During the newborn period, reversible disorders may occur, which can be estimated as somatic dysfunction (SD). The formation of SD in young children has its own causes and features, which have not been studied in detail until now.The goal of research — is to study the features of the osteopathic status in children of the first year of life with different patterns of pregnancy and delivery methods for their mothers.Materials and methods. Since 2015, for 5 years, a prospective multicenter study has been conducted to investigate the osteopathic status of children of the first year of life under a single protocol in 6 cities of Russia, organized by the Institute of Osteopathy (St. Petersburg) and the Department of Osteopathy of Mechnikov North-West State Medical University. A total of 360 full-term infants aged 1 to 12 months with perinatal hypoxic-ischemic lesions of the central nervous system, and practically healthy ones were examined. All children underwent an osteopathic examination, and a detailed history of pregnancy and childbirth was collected. Based on the results of the obstetric history analysis the following groups were selected: physiological course of pregnancy, ending in physiological childbirth through the natural birth canal — 62 people; physiological course of pregnancy, ending with operative delivery — 25 people; physiological course of pregnancy, ending in complicated labor through the natural birth canal — 20 people; pregnancy with complications, ending in physiological childbirth through the natural birth canal — 104 people. Statistical processing of the obtained results was carried out by nonparametric methods using the Statistica 10.0 software.Results. In children born by physiological childbirth with complicated pregnancy, a smaller number of local SD (p=0,04) and a larger number of global SD were detected, but the difference with the subgroup of the pregnancy physiological course did not reach the statistical significance. In children whose mothers had a physiological course of pregnancy, but childbirth proceeded with complications and required the use of obstetric assistance, the significantly more number of regional SD were revealed (p<0,0001) compared with children born in physiological childbirth. The latter had a greater number of local SD of the craniosacral system (p=0,035). In children born by caesarean section and in children born through the natural birth canal without complications, the number of global, regional and local SD did not differ statistically significantly. Osteopathic examination of children in the first year of life showed that the first three places in the structure of dominant SD were occupied by SD of the neck, head, and dura mater.Conclusion. Based on the data obtained as a result of the study, it can be assumed the presence of numerous factors that can lead to the formation of various SD in children of the first year of life during pregnancy and especially during childbirth. It is necessary to further study the features of the osteopathic state in children in the postnatal period.
The article presents an analysis of the regulating system, an experience of the expert evaluation and control of the quality and safety of the medical care in the Russian Federation and in its constituent units. The paper considers aims, targets, ways and criteria of the expert evaluation and control of the quality and safety of the medical care with regard to the osteopathic medical care. Authors also give recommendations concerning the organization of the internal control system of safety and quality of the medical care provided by the osteopaths.
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