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| 29.05.2014, 09:43 | |
Резюме Summаry Рецензент: д.мед.н., проф. С.А. Усатов УДК 340.6:616.833.18-002-001-079.6 Харківський національний медичний університет Харьковский национальный медицинский университет проспект Ленина, 4, Харьков, 61022,Украина Kharkiv National Medical University, 4 Lenin Avenue, Kharkiv,61022,Ukraine serg_shklyar@ukr.net Introduction. Injuries of the cervical spine (CS) and respective perivertebral morphological structures can significantly affect the function of maintaining the vertical position of the body by forming disorders of the locomotors system (LMS), in particular, the spine, the basic cinematic chain system LMS. Multi-level biomechanical structure of the spine, at its loading optimally distributes the proposed static and dynamic loads. This is of particular importance in spinal injuries and related perivertebral morphological structures as the functional status of vertebral motor segment (VMS) depends on the loading conditions and the severity of bodily injuries (SBI). As at bodily injuries of CS the processes of compensation of VMS are violated, determining of informative biomechanical indicators is important in forensic practice. Despite the known and obvious morphological changes in injured structures of CS and its perivertebral tissues, forensic examination of SBI in the victims is still difficult. For a reasonable forensic determination of severity of bodily injuries of the victims with uncomplicated cervical injuries requires, a comprehensive study of the in juried structures of the cervical segments (intervertebral discs, capsules, ligaments) and perivertebral structures with the use of clinical, radiological and instrumental methods of examination and consideration of the violations of certain functions and overall health is reasonable. Most important at bodily injuries of the CS is to assess statolocomotor functions of the neuromuscular system. The condition of these functions can be seen as an integrative indicator of management of support area and promotion of the vertical position of the body with the neuromuscular system. The entity of all components affecting the fluctuations of GCM form a complex biomechanical structure of the static of movement. It is evident that the ability to maintain static equilibrium is a prerequisite for assessment of harmony of the locomotors act, which is of primary importance in forensic expertise with the purpose to assess SBI of the CS. Maintaining balance in damages of CS depends on the reliability of the mechanisms of position regulation. In particular, at uncomplicated injuries of the CS and perivertebral structures, including compensation and adaptive processes is "hidden" while systemic overstrain, especially perivertebral structures adversely affects the neuromuscular and vascular systems, gradually forming neurological vertebrogenic signs and symptoms. Within this problem, a significant factor of forming combined sensory and motor asymmetries has not been investigated in detail. In this regard, early diagnosis, especially assessment of severity of the injury in the early period is difficult. The purpose of the work was to examine the informative parameters of computer stabilography for forensic assessment of severity of cervical injuries and corresponding perivertebral structures. Materials and methods. A complex of stabilographic techniques was performed with statograph, a device which includes a computer with the corresponding software and special biomechanical platform. According to the procedure the position of the projection of the general center of mass (GCM) was recorded for 30-40 s, its displacement relative to rectangular coordinate system (frontal and sagittal planes) at free standing on two feet and the load on the frontal and dorsal portions of the lower extremities, coefficient of stability and coefficients of the body fluctuations were recorded. In addition, the dynamics of GCM movement on the area of support at opening and closing the eyes, standing at support on one extremity, when turning, and tilting the head, at Romberg test, at transition from standing to walking was investigated. In the process of research, the function of maintaining the vertical position was studied by computed stabilography in 82 people with injuries of the CS and perivertebral structures. Conclusions. When assessing SBI of the CS and the related perivertebral structures a significant (p ≤ 0,001) asymmetry in the position of projection of the GCM before the motion beginning was revealed (manifested by displacement of the GCM in the frontal plane at (14.0±2.1) mm in the sagittal (33.2±4.3) mm) and less distinct asymmetry in the transition from static vertical position to dynamics (walking), the ratio of the height of the trajectory accounted for an average of (0.74 ± 0.07) u. During this period functional rearrangement of LMS takes place, which manifests by displacement of whole GCM between the pit and the supporting limbs. When SBI of the CS and related perivertebral structures, asymmetry of statolocomotor locomotion process was revealed in primarily (before movement) more symmetrical position of the GCM. Thus, at the static upright body position, projection of GCM to area of support in the frontal plane was (12.6 ± 3.1) mm, while in the sagittal plane, moving projection of GCM was significantly (p ≤ 0.05) higher and made (21.0 ± 4.2) mm. However, we emphasize that the coefficient of ratio of height of trajectory growth of the parameter of GMC shift (h1) in the transition from static’s (standing) and dynamics (walking) is 0.88 ± 0.11 and is not different (p ≥ 0.05) from the persons with mild and severe bodily injuries of the CS (coefficient is 0.78 ± 0.09 and 0.90 ± 0.06). The coefficients of statolocomotor adaptation for different sides also demonstrates the tendency to asymmetry and, in general it is somewhat less pronounced than with severe degree (severe degree – 0.74 ± 0.07, moderate – 0.86 ± 0. 08, p ≥ 0.05). At light bodily injuries of the CS and perivertebral structures, slightly greater GCM displacement in the sagittal than in the frontal plane is seen (17.7 ± 5.4) mm and (10.2 ± 2/3) mm, p ≥ 0, 05, respectively). The displacement of GCM in saggital plane was significantly (p ≤ 0.05) lower than at severe injuries. The ratio of height growth trajectory of GCM displacement at transition from statics to dynamics is 0.90 ± 0.06 and does not differ (p ≥ 0.05) from the patients with mild and severe injury. Coefficient of statolocomotor spatial adaptation for different sides is symmetric and on the side of the damage it is different from that seen in the group of persons with severe injuries of the CS. The prospects for further research of forensic significance of statolocomotor disorders in persons with injuries of the CS are related to systematization of the known methods of non-invasive diagnosis (primarily radiocephalography, transcranial Doppler ultrasound) with their implementation in algorithms of forensic investigation of SBI. Література | |
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