Российский научный центр «Восстановительная травматология и ортопедия» им. акад. Г. А. илизарова МЗ РФ (директор-д-р мед. наук А. В. Губин), г. Курган ЦеЛь. Систематизация наблюдаемых в процессе интраоперационного нейромониторинга электрофизиологических феноменов, с последующей разработкой оценочной (балльной) шкалы результатов нейрофизиологического тестирования пирамидного тракта, удобной для восприятия хирурга. МАтеРиАЛ и МетОды. 288 больным 1-27 лет под интраоперационным нейрофизиологическим контролем произведена инструментальная коррекция деформации грудного/грудопоясничного отдела позвоночника. РеЗуЛьтАты. Произведена оценка в баллах изменений моторных вызванных потенциалов, наблюдаемых в процессе оперативного вмешательства. Показано, что частота встречаемости изменений их параметров, указывающих на опасность возникновения ятрогенных повреждений, зависит от возраста пациента и не превышает 10 % от всего массива наблюдений. ЗАКЛючеНие. интраоперационный нейрофизиологический контроль позволяет хирургу и анестезиологу своевременно скорректировать свои действия, что минимизирует опасность возникновения ятрогенных неврологических расстройств.

Design Presentation of clinical cases and literature analysis. Material and methods Clinical observation of patients with congenital cervical spine and shoulder girdle anomalies operated on with neuromonitoring was performed. Operative treatment of Sprengel's deformity was produced with the use of neuroimaging. Results Surgical treatment resulted in good clinical outcomes without neurological adverse events and good aesthetic and radiological appearance at the descended scapula. Discussion Consideration for intraoperative neuromonitoring should be given to prevent neurological complications at lowering the elevated scapula. Conclusion Review of outcomes showed efficacious application of the most valid methods used to descend the scapula with neuromonitoring. This was supported by clinical and radiological findings of the extent of cranial transposition after appropriate correction and absence of neurological adverse events early postsurgery and at a longterm follow-up. No recurrence of scapular dislocation was observed at a long-term follow-up.

AIMTo determine peculiarities of tissue responses to manual and automated Ilizarov bone distraction in nerves and articular cartilage.METHODSTwenty-nine dogs were divided in two experimental groups: Group M - leg lengthening with manual distraction (1 mm/d in 4 steps), Group A - automated distraction (1 mm/d in 60 steps) and intact group. Animals were euthanized at the end of distraction, at 30th day of fixation in apparatus and 30 d after the fixator removal. M-responses in gastrocnemius and tibialis anterior muscles were recorded, numerical histology of peroneal and tibialis nerves and knee cartilage semi-thin sections, scanning electron microscopy and X-ray electron probe microanalysis were performed.RESULTSBetter restoration of M-response amplitudes in leg muscles was noted in A-group. Fibrosis of epineurium with adipocytes loss in peroneal nerve, subperineurial edema and fibrosis of endoneurium in some fascicles of both nerves were noted only in M-group, shares of nerve fibers with atrophic and degenerative changes were bigger in M-group than in A-group. At the end of experiment morphometric parameters of nerve fibers in peroneal nerve were comparable with intact nerve only in A-group. Quantitative parameters of articular cartilage (thickness, volumetric densities of chondrocytes, percentages of isogenic clusters and empty cellular lacunas, contents of sulfur and calcium) were badly changed in M-group and less changed in A-group.CONCLUSIONAutomated Ilizarov distraction is more safe method of orthopedic leg lengthening than manual distraction in points of nervous fibers survival and articular cartilage arthrotic changes.

The paper presents recommendations on the assessment and treatment of vertebral pathology in patients with various types of mucopolysaccharidosis. The recommendations are based on literature data and the authors’ own experience. The purpose of the publication is an invitation to the discussion in the format of an expert consensus.

In orthopedic patients, the formation of the motor skill of rapid and precise reproduction of an effort by the anterolateral muscles of the shin of the elongated extremity was significantly decelerated as compared to the intact one when tested at 5-50% of the maximum muscular force of the intact extremity. A correlation was observed between the tracking square error, which is an index of precision of instrumental motor reactions, and the dynamic activation indices (the ratios between the electromyogram integrals and the force momentum impulse), which characterize energy expenses, and was assumed to reflect specific optimization of sensorimotor reactions at different power loadings. Both with the elongated and the intact extremities, the interactive search for and fixation of the optimal motor program was most effective in a certain range of muscular loading. The results can serve as a basis for choosing specific rehabilitation programs for orthopedic patients.

Reactive and adaptive changes in mechanically uninjured nerves during fracture healing have not been studied previously although the status of innervation is important for bone union and functional recovery. This study explores whether subclinical nerve fibre degeneration occurs in mechanically uninjured nerves in an animal fracture model and to quantify its extent and functional significance. Twenty-four dogs were deeply anaesthetized and subjected to experimental tibial shaft fracture and Ilizarov osteosynthesis. Before fracture and during the experiment, electromyography was performed. In 7, 14, 20, 35–37 and 50 days of fixation and 30, 60–90 and 120 days after fixator removal, the dogs were euthanized. Samples from sciatic, peroneal and tibial nerves were processed for semithin section histology and morphometry. On the 37th postoperative day, M-response amplitudes in leg muscles were 70 % lower than preoperative ones. After fixator removal, these increased but were not restored to normal values. There were no signs of nerve injuries from bone fragments or wires from the fixator. The incidence of degenerated myelin fibres (MFs) was less than 12 %. Reorganization of Remak bundles (Group C nerve fibres—principally sensory) led to a temporal increase in numerical nerve fibre densities. Besides axonal atrophy, the peroneal nerve was characterized with demyelination–remyelination, while tibial nerve with hypermyelination. There were changes in endoneural vessel densities. In spite of minor acute MF degeneration, sustained axonal atrophy, dismyelination and retrograde changes did not resolve until 120 days after fracture healing. Correlations of morphometric parameters of degenerated MF with M-response amplitudes from electromyography underlie the subclinical neurologic changes in functional outcomes after tibial fractures even when nerves are mechanically uninjured.

Comparison of electrophysiological and morphological parameters of shin muscles of experimental animals during shin elongation by Ilizarov's method indicates involvement of muscle spindles into reconstruction of the skeletal muscular tissue in response to its dosed distraction, which results in temporary deficit of specific somatosensory afferentation.

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