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OBJECTIVE The aim: To study the role and place of bone grafting in the formation of bone stump after amputation. PATIENTS AND METHODS Materials and methods: 3 series of experiments were carried out on 44 rabbits with amputation of the thigh in the middle third and stump grafting using osteoplastic hermetic closure of the canal with a thin cortical plate (series I), closure of the canal with a spongy bone (series II), and loose closure of the canal with a cortical graft located at the entrance to the canal at an angle of 30° (ІІІ series). Observation period: 1, 3, 6 months. Histological examination method with vascular filling with 10% mascara-gelatin mixture. RESULTS Results: In series I, in the majority of observations, a stump of a cylindrical shape with a bone locking plate of an osteon-beam structure and normalization of intraosseous microcirculation was formed. A slight displacement of the graft caused a violation of microcirculation. In series II, organotypic stumps were formed in all observations. In series III, incomplete closure of the bone marrow cavity led to sharp microcirculatory disorders and the course of the reparative process with pathological bone remodeling. CONCLUSION Conclusions: The parameters of the favorable course of the reparative process and the formation of the organotypic bone stump are the safety of its cylindrical shape, the presence of a compact bone structure, normalization of intraosseous microcirculation.

OBJECTIVE The aim: To study the influence of biomechanical factors on the character of morphological disorders in the process of reparative regeneration at the end of the residual limb after amputation. PATIENTS AND METHODS Materials and methods: 10 series of experiments on 144 rabbits were conducted. We used myodesis with normal, insufficient and excessive muscle tension, their electrical stimulation, tight and leaky closure of the bone marrow canal. Terms of observation 1, 3, 6 months. The method of research - histological with the filling of vessels with inkgelatin mixture. RESULTS Results: Dense closure of the meduallary cavity and uniform muscle tension during plasty in the first three series of experiments allow to obtain a cylindrical residual limb with preservation of the cortical diaphyseal plate, formation of the bone closing plate, normalization of intraosseous microcirculation, completion of the reparative process. In the majority of observations of the IV-X series there was a reparative regeneration disorder connected with the incorrect tension of muscles and the absence of normalization of intraosseous circulation, the reparative process was not observed to be complete, which led to the pathological reorganization of bone tissue with the formation of stumps of various shapes. CONCLUSION Conclusions: Uneven muscle tension and lack of closure of the intramedually canal except for microcirculation disorders leads to increased periosteum bone formation, formation of periosteum cartilage exostases, clavate stumps, resorption and fractures of the cortical diaphyseal plate with curvature and stump axis disorders, formation of a conical stump.

The analysis of the spatial parameters of statograms in terms of the projection area of the common center of mass (CCM) in single and double support was performed, along with the magnitude of the total maximum area of the statogram and its relation to the area of the projection spot for each type of standing, and the area of the statogram according to the mathematical expectation. The high sensitivity of the spatial parameters of statograms is indicated by the values of the CCM spot plane in the case of single support, the ratio of the planes, and the angular asymmetry. The analysis of the parameters of statograms showed that for all types of standing volunteers of the control group, the area of the projection spot of the CCM was the smallest in both two-pronged standing, and in single support standing. In patients with osteochondrosis and with coxarthrosis (CA), the area of the spots was much larger, with a statistically significant difference observed in single support (p

Annotation. Diabetes is one of the most common metabolic diseases in the world with a large number of complications. Threatening conditions that significantly reduce the quality of life and even lead to the death include a diabetic foot syndrome. The aim of the study was to investigate the effectiveness of combined ozone therapy in the treatment of patients with type 2 diabetes with chronic lower extremity trophic ulcers. A prospective study of the effectiveness of using the combined method of ozone therapy in the treatment of trophic ulcers of the lower extremities was conducted in the surgical and rehabilitation departments of the University Clinic of the National Pirogov Memorial Medical University. The study involved 52 patients with diadetes mellitus 2 type, who were randomly assigned to the main (n=26) and control (n=26) groups. Subjective and objective changes in the condition of patients were evaluated: an area of trophic ulcers (by A.V. Kuleshov's method), a rate of ulcer’s defect epithelization (by L. Popova's formula) and the quality of life parameters of patients (by the questionnaire SF-36) before and after the treatment. The endpoint of the study was a complete epithelization of the diabetic trophic ulcer. The treatment was carried out according to the generally accepted methodology in both observation groups, and the combination ozone therapy was additionally used for patients of the main group. The latter provided for the intravenous administration of an oxygen-ozonized 0.9% NaCl solution and local exposure of the trophic ulcer defect to the ozonized mixture by chamber aeration. The course of complex treatment was carried out after removal of necrotic tissue and wound cleansing, consisted of 10 local and general ozone therapy procedures, which were carried out every other day. The data obtained were processed using the SPSS for Windows 10.0 and STATISTICA 6.1 application software package (license number BXXR901E245722FA). One month after, the observation changes of the trophic skin defects and Quality of life indicators showed the significantly (p

The aim: To study the influence of biomechanical factors on the character of morphological disorders in the process of reparative regeneration at the end of the residual limb after amputation.Materials and methods: 10 series of experiments on 144 rabbits were conducted. We used myodesis with normal, insufficient and excessive muscle tension, their electrical stimulation, tight and leaky closure of the bone marrow canal. Terms of observation 1, 3, 6 months. The method of research - histological with the filling of vessels with inkgelatin mixture.Results: Dense closure of the meduallary cavity and uniform muscle tension during plasty in the first three series of experiments allow to obtain a cylindrical residual limb with preservation of the cortical diaphyseal plate, formation of the bone closing plate, normalization of intraosseous microcirculation, completion of the reparative process. In the majority of observations of the IV-X series there was a reparative regeneration disorder connected with the incorrect tension of muscles and the absence of normalization of intraosseous circulation, the reparative process was not observed to be complete, which led to the pathological reorganization of bone tissue with the formation of stumps of various shapes.Conclusions: Uneven muscle tension and lack of closure of the intramedually canal except for microcirculation disorders leads to increased periosteum bone formation, formation of periosteum cartilage exostases, clavate stumps, resorption and fractures of the cortical diaphyseal plate with curvature and stump axis disorders, formation of a conical stump.

The aim: To study the role and place of bone grafting in the formation of bone stump after amputation.Materials and methods: 3 series of experiments were carried out on 44 rabbits with amputation of the thigh in the middle third and stump grafting using osteoplastic hermetic closure of the canal with a thin cortical plate (series I), closure of the canal with a spongy bone (series II), and loose closure of the canal with a cortical graft located at the entrance to the canal at an angle of 30° (ІІІ series). Observation period: 1, 3, 6 months. Histological examination method with vascular filling with 10% mascara-gelatin mixture.Results: In series I, in the majority of observations, a stump of a cylindrical shape with a bone locking plate of an osteon-beam structure and normalization of intraosseous microcirculation was formed. A slight displacement of the graft caused a violation of microcirculation. In series II, organotypic stumps were formed in all observations. In series III, incomplete closure of the bone marrow cavity led to sharp microcirculatory disorders and the course of the reparative process with pathological bone remodeling.Conclusions: The parameters of the favorable course of the reparative process and the formation of the organotypic bone stump are the safety of its cylindrical shape, the presence of a compact bone structure, normalization of intraosseous microcirculation.

Introduction: Bone is the basis of the stump. Aim: To study the impact of post-amputation pain syndrome on the nature of reparative processes in the bone residual limb. Material and methods: Three series of experiments were performed on 45 rabbits, 15 in each with mid-third thigh amputation and muscular plasty. In series 1, 2, a perineural catheter was attached to the sciatic nerve stump during amputation, and mechanical irritation of the nerve was performed daily for 20 minutes in series 1 for 20 days. In series 2, 0.3 mL of lidocaine (1%) was injected through the catheter into the circumference of the nerve twice daily for 20 days. Series 3 is a control. The follow-up periods were 1, 3, 6 months. The study method was histological with infusion of the vessels with ink-gelatin mixture. Results and discussion: In series 1, there was a sharp disturbance of the reparative process, which consisted in shape changes, resorption of the cortical diaphyseal plate, fractures, stump deformity, absence of bone closure plate formation, and microcirculatory disturbances. In the overall majority of experiments of series 2, the stumps retained the shape and structure characteristic of diaphysis with normalization of microcirculation. In series 3, the results of the residual limb formation were better than in series1, but worse than in series 2. Conclusions: When the pain syndrome is resolved within 20 days after amputation, a bone stump is formed with an organotypic shape and structure characteristic of the diaphysis, the formation of a compact closure plate of mature bone tissue, normalization of the medullary tissues and blood circulation. In post-amputation pain syndrome, organotypic formation of the residual limb does not occur.

In nowadays, an important area in medicine is the early preclinical identification of the parameters deviations from the norm, where mathematical modeling can help, which should be used to calculate individual linear parameters of internal structures based on external parameters of the body. The aim of the study was to calculate the individual total linear measures of the lumbar intervertebral discs in juniors and men of the first adulthood (17-28 years) in norm. The total size of the each intervertebral discs were calculated a sum of the anterior-posterior diameter, frontal diameter and vertical sizes of each lumbar intervertebral discs, which were measured by MRI. The next step was to calculate the relative proportional nonlinear somato-disc rates (based on body weight and body length) for each individual examined. Mathematical processing of the measured parameters and the relative values of the somato-disc relationships was carried out by the statistical data processing program “STATISTICA 6.1” using parametric methods. The correct distribution of the variational series indicators, mean values and their standard errors were evaluated. Based on relative values the mathematical model was created to obtain individual values of the TS of the lumbar intervertebral discs. Subsequently, we compared the measured total discs sizes of the anterior-posterior, frontal diameters and vertical sizes of the lumbar intervertebral discs with a mathematically calculated value for each lumbar intervertebral discs. The significant difference between the mathematically calculated and measured values of the total intervertebral discs’ sizes of the didn’t exceed 10%. Determination of the standard linear dimensions of the intervertebral discs of the lumbar spine using CT and MRI and comparison with theoretically calculated indices will make it possible to diagnose early manifestations of the lumbar intervertebral discs pathology.

Objective Introduction: According to present knowledge, hyperhomocysteinemia is one of the risk factors of cardio-vascular pathology. Patients with chronic kidney disease are known to develop hyperhomocysteinemia more often than those in general population. Іmportant cause of hyperhomocysteinemia is the deficiency of vitamins В6, В9 and В12 that are involved in homocysteine metabolism. Vitamins deficiency, we believe, can be one of the causes of hyperhomocysteinemia in the patients with chronic renal failure. The aim: To analyze the plasma homocysteine level in patients with chronic kidney disease and its assosiation with the levels of vitamins B6, B9, B12 in Ukraine. Patients and methods Materials and methods: The study involved 148 persons with different stagesis of chronic kidney disease who underwent immunoenzyme determination of total plasma homocysteine, B9, cobalamin and vitamin В6 status. Results Results: It was found that in ukrainian patient population with chronic kidney disease 58.7% of patients have hyperhomocysteinemia. Homocysteine level was shown to increase with the increase of chronic kidney disease stage. Supply of vitamins В6, В9 та В12 in the patients with chronic kidney disease was lower than in apparently healthy persons, but there was significant decrease of folic acid level proportionally to the increase of chronic kidney disease stage. There was close relationship between homocysteine level and folic acid status in the patients with chronic kidney disease, but it appeared to be independent on cobalamin and pyridoxin status. Conclusion Conclusions: The obtained data are promising for finding effective means of correction of hyperhomocysteinemia in patients with chronic kidney disease by normalizing the vitamin status of such patients.

The purpose of the study was to determine the most effective methods of amputation plasty, which provide adequate blood circulation in the bone stump. Three series of experiments were performed on 75 dogs with closure of the sawdust with myodesis, a combination of myodesis with bone plasty with a thin cortical plate taken from the part of the limb to be removed (main groups), fascioplastic and myoplastic, with the cross-linking of the antagonist muscles under the sawdust (control group). The observation period was1, 3, 8 months. The advantage of dense closure of the medullary cavity with the help of myodesis and its combination with bone plasticity by a thin cortical plate has been proved. Restoration of intraosseous pressure disturbed during amputation during a month period occurs only with myodesis with tight closure of muscles and bone plastic with a thin cortical plate tightly laid at the edge of the open bone marrow cavity. With fascio- and myoplasty in the next time (1–3 months), it is low, and in the distant (8 months) – high, due to pronounced venous stasis. Restoration of the impaired closure of the medullary cavity is achieved already during the operation, which ensures complete compression of the lumen of the feeding artery along with the venous sinus, and rapid formation of the osseous occlusal plate with restoration of normal intraosseous circulation. With fascio- and myoplastic amputation, incomplete closure of the medullary canal with tissues is an obstacle to powerful blood flow along the intraosteal main vessels, which under its influence become convoluted and form vascular conglomerates. The latter, occupying the lumen of the medullary canal, create a mechanical obstacle to the restoration of the closed bone marrow cavity necessary for normalization of intraosseous microcirculation.

Проведено аналіз 340 ампутації і реампутації гомілки. У 206 хворих (дослідна група) здійснювали кістково-м'язову пластику із закриттям кістковомозкового каналу тонкою кортикальною пластинкою, формуванням синостозу між усіченими кістками і м'язовою пластикою з фіксацією м'язів до кістки і трансплантата. В контрольній групі проводили традиційну міопластику із зшиванням м'язів-антагоністів під опилом кістки (134 хворих). Термін спостереження – 2–10 років. Методи дослідження: клінічний, рентгенологічний, СКТ, УЗД, тонусометрія, тензометрія, вимірювання внутрішньокісткового тиску, морфологічний. Закриття кістковомозкової порожнини приводило до відновлення внутрішньокісткового тиску, швидкого (1–2 міс) формування кісткової замикальної пластинки, збереження форми і структури кісткової кукси. Синостозування кісток дозволяло запобігти балотуванню малогомілкової кістки. Фіксація м'язів до кістки забезпечувала добре закриття опилів і формування витривалої м'язової кукси. Кукси після кістково-міопластичної ампутації витривалі, функціональні, безболісні і довговічні. У жодному випадку не було проведено реампутації. У контрольній групі формування кісткової замикальної пластинки в більшості спостережень порушувалось, відбувалась резорбція кортикального шару кістки, значно більшою була атрофія м'язів, виникав больовий синдром різної інтенсивності. У ряді випадків необхідна була реампутація або реконструктивна операція.

Проведено три серии опытов на 66 собаках с ампутацией в средней трети бедра и пластикой культи с использованием миодеза, фасцио- и миопластики со сшиванием мышц-антагонистов. Сроки наблюдения – 30, 90 и 240 дней. Метод исследования гистологический с наливкой сосудов тушь-желатиновой смесью. Установлено, что в серии с миодезом через 1 мес после ампутации по торцевой поверхности культи формировалась замыкательная пластинка, сохранялась цилиндрическая форма культи кости, нормализовалась внутрикостная циркуляция. Характерной особенностью была завершённость репаративных процессов. Такой тип заживления конца опила является рациональным. В сериях с фасцио- и миопластикой в большинстве наблюдений форма культи кости отличалась от формы диафиза, закрытие костномозговой полости происходило путём заращения костномозгового канала регенератом из незрелой костной или фиброзно-костной ткани на фоне нарушения микроциркуляции, что тормозит завершение репаративных процессов даже в отдалённые сроки – до 8 мес. Оценено влияние плотного закрытия костномозговой полости при миодезе, обеспечивающее сдавление просвета питающей артерии вместе с венозным синусом. Охарактеризованы закономерности, обеспечивающие рациональный и нерациональный типы заживления культи кости.

To study the features of the formation of osteochondral exostoses on the lateral surface of the amputation stump of the bone. There were 8 series of experiments performed on 116 dogs, which had the amputation of the thigh with the subsequent plasty by myodesis, myodesis with different degrees of muscle tension, osteoplasty, fascio- and myoplasty, as well as myodesis, which in the postoperative period was accompanied by the electrical stimulation of the muscles. The observation periods included – 1, 3, 8 months. In the postoperative period the muscle tone of all animals was daily measured. The method of investigation was histological with filling of the vessels with ink-gelatin mixture. Totally 36 exostoses were studied. The vast majority of them arose after fascio- and myoplastic amputation and myodesis with the excessive muscle tension. The causes of the appearance of exostoses were the excessive tension of the muscles created during the plastic surgery, and their contracture contractions in the postoperative period. There was a resorption of the cortical diaphyseal plate along the inner and outer surfaces, intraosseous circulation and reparative osteogenesis were disrupted.

Introduction: According to present knowledge, hyperhomocysteinemia is one of the risk factors of cardio-vascular pathology. Patients with chronic kidney disease are known to develop hyperhomocysteinemia more often than those in general population. Іmportant cause of hyperhomocysteinemia is the deficiency of vitamins В6, В9 and В12 that are involved in homocysteine metabolism. Vitamins deficiency, we believe, can be one of the causes of hyperhomocysteinemia in the patients with chronic renal failure. The aim: To analyze the plasma homocysteine level in patients with chronic kidney disease and its assosiation with the levels of vitamins B6, B9, B12 in Ukraine.Materials and methods: The study involved 148 persons with different stagesis of chronic kidney disease who underwent immunoenzyme determination of total plasma homocysteine, B9, cobalamin and vitamin В6 status.Results: It was found that in ukrainian patient population with chronic kidney disease 58.7% of patients have hyperhomocysteinemia. Homocysteine level was shown to increase with the increase of chronic kidney disease stage. Supply of vitamins В6, В9 та В12 in the patients with chronic kidney disease was lower than in apparently healthy persons, but there was significant decrease of folic acid level proportionally to the increase of chronic kidney disease stage. There was close relationship between homocysteine level and folic acid status in the patients with chronic kidney disease, but it appeared to be independent on cobalamin and pyridoxin status.Conclusions: The obtained data are promising for finding effective means of correction of hyperhomocysteinemia in patients with chronic kidney disease by normalizing the vitamin status of such patients.

The given paper analyzes principles of interaction and analysis of the reflected optical radiation from biotissue in the process of assessment of regional hemodynamics state in patients with local hypertensive- ischemic pain syndrome of amputation stumps of lower extremities, applying the method of photoplethysmography. The purpose is the evaluation of Laser photoplethysmography (LPPG) diagnostic value in examination of patients with chronic ischemia of lower extremities. Photonic device is developed to determine the level of the peripheral blood circulation, which determines the basic parameters of peripheral blood circulation and saturation level. Device consists of two sensors: infrared sensor, which contains the infrared laser radiation source and photodetector, and red sensor, which contains the red radiation source and photodetector. LPPG method allows to determined pulsatility of blood flow in different areas of the foot and lower leg, the degree of compensation and conservation perspectives limb. Surgical treatment of local hypertensive –ischemic pain syndrome of amputation stumps of lower extremities by means of semiclosed fasciotomy in combination with revasculating osteotrepanation enabled to improve considerably regional hemodynamics in the tissues of the stump and decrease pain and hypostatic disorders.

In the work the hybrid expert system for stroke diagnosis was presented. The base of expert system consists of neural network and production rules. This program can quickly and accurately set to the patient preliminary and final diagnoses, get examination and treatment plans, print data of patient, analyze statistics data and perform parameterized search for patients.