Основные проблемы диагностики и лечения повреждений шейного отдела позвоночника

SUMMARY

Kirilenko Sergey Ivanovich

The diagnostics and tactics of treatment by the stenosis of the spinal canal

at the fractures and the dislocations of cervical vertebrae

The key words: the fractures, the dislocations, fracture-dislocations of the cervical vertebrae, vertebral canal, traumatic stenosis, compensated, subcompensated, decompensated form.

The object and the subject of the research. The object of the research is the results of clinical and instrumental examinations of 148 victims with fractures and dislocations in low cervical vertebrae which were conservative and surgical treated in orthopaedy-traumatologic and neurosurgical departments at Gomel regional clinical hospital from 1980 to 2008. The subject of the research is the peculiarities of clinical and roentgenomorphometric manifestations of traumatic stenosis in vertebral canal of victims with fractures and dislocations in low cervical vertebrae, and the appropriatenesses of their changes after using the conservative and surgical methods of treatment.

The aim of the research: the improvement of the result by administration medical care to patients with the fractures and the dislocations of the cervical vertebrae by force of working and introduction perfected methods by diagnostics and treatment of this pathology.

The methods of the research: clinical, radial (survey, slanting radiographs and with functional load, zonegrams, computer tomograms and magnetic-resonance images), roentgenomorphometry, statistical.

The results received and their novelty: for the first time the new roentgenological criteria estimating the injuries at the low cervical part of the spinal column were worked out to determinate the conservative or surgical therapeutic approach and to control the effectiveness of medical manipulations on the vertebrae which had been implemented. The types of traumatic stenosis at vertebral canal in the low cervical part of the spinal column were systematized and it was offered the whole complex of classification such injuries by stenosis criterion. The numerical values of degree at traumatic stenosis in vertebral canal were worked out, permissible for conservative and surgical treatment. Two simple methods defining the degree of stenosis in vertebral canal at survey radiographs were worked out and inculcated in, “The Marker for morphometry of cervical part of the spinal column on radiography”, the choice algorithm between conservative or surgical methods of treatment the injuries of cervical vertebrae depending on the degree of stenosis in vertebral canal, the preoperational technique in planning operations of anterior spondylosyndesis with using the ventral plate according to standard spondylograms, the cutter for surgical intervention in vertebral column for elimination the traumatic stenosis in vertebral canal.