The article analyzes the results of electromyography of the abdominal muscles in 189 patients with median postoperative hernia of the anterior abdominal wall of different sizes before and after the combined methods of hernioplasty, including considering the level of connective tissue failure. In the preoperative period, electromyography was performed in 69 (36,6%), after combined hernioplasty, 120 (63,4%) patients. The patients were divided into a group of 161 (85,1%) patients with clinically significant or histologically confirmed connective tissue insufficiency and into a group of 28 (14,9%) patients without it. The distribution of patients in the examination groups was carried out using an original method of assessing the degree of deviation of collagen fibers from the projection of the Langer lines in microscopic specimens of the skin areas excised during the operation and based on the results of a retrospective analysis of case histories with determination of the intraoperative adhesions of the adhesions in the abdominal cavity or hernial sac. In the formed groups, we studied the amplitude, frequency, front and area of electromyograms obtained from the direct and lateral muscles of the anterior abdominal wall. It was found that in patients with median postoperative hernias, mesenchymal dysplasia was the main reason for the decrease in functional activity and the imbalance of forces between the direct and lateral abdominal muscles. Optimal restoration of electroactivity of the abdominal muscles after combined hernioplasty occurred among patients without clinically significant connective tissue insufficiency. When reaching a giant postoperative hernia of gigantic size in patients with a clinically significant level of connective tissue dysplasia, the functioning of the abdominal muscles decreased by 26%, and in patients without it only by 15%. The pathology of collagen in skin grafts excised during surgery was detected in 91,5% of patients with mid-incisional hernias.

Relevance. Despite advances in the treatment of inguinal hernias are still being discussed, the issues of post-operative wound complications and disease recurrence. The inclusion in the list of risk factors for complicated postoperative course of systemic connective tissue dysplasia will allow a new look at the mechanisms of herniation in the groin area and develop morphologically adapted methods of surgical treatment. Objective. Study the characteristics of connective tissue dysmorphogenesis at hernia protrusions in the inguinal region. Results. In the main group absolutely reliable connection with all possible variants of hernia disease in the inguinal region possessed 6 (12 %) the morphological predictors, namely: dystonia dysfunction, curvature of the spine, hallus valgus, hypermobility joints, varicose disease of the lower limb and hemorrhoids. The curvature of a backbone and hyper mobility of joints occurred among manifestations of a dismorfizm at patients of control group. The area of electromyograms at reduction of muscles forming the torn down hernia the inguinal interval, on 20 % inferior area electromyograms reduction of similar muscles on contralateral from inguinal hernia to the side and on 61,4 % of area electromyograms contraction of the groin muscles of the control group patients. In a smaller proportion, but with similar characteristics reduced groups of lateral muscles, which is considered by us as local functional predictors of the implementation of systemic connective dysplasia in the hernia disease of the inguinal region. The density of the collagen fibers in the dermis of patients with inguinal hernias was 75.6 + 1.9%, which is 12,3 % lower than the result of such collagen metrics index of patients of the control group. Intensity of coloring of micropreparations of dermis of patients of control group was at the level of 36,33 + 2,1, that on 1,8 times less than this index in patients of the basic group. Conclusions. Thus, results of histology confirm reliability of the revealed morphological and local functional prerequisites of formation of inguinal hernias at connective dysplasia.

Приднестровский государственный университет им. Т.Г. Шевченко, Государственное учреждение «Республиканская клиническая больница», Тирасполь, Республика Молдова С целью улучшения результатов лечения обширных срединных грыж при выборе способа комбинированной герниопластики на этапе электромиографии внедрена бальная оценка обнаруженных при осмотре стигм дисплазии соединительной ткани, влияния мезенхимальной недостаточности на сократимость брюшных мышц и данных программной диагностики коллагеновых волокон в микропрепаратах кожи и апоневроза у 95 хирургических больных. В группе 25 (26,4%) пациентов с клинически значимым уровнем дисплазии обнаружено снижение электроактивности прямых мышц на 24,7% и группы боковых мышц живота-на 22,8%. Микроскопия участков апоневроза среди них выявила снижение плотности укладки коллагеновых волокон до 31,7% и увеличение интенсивности их окрашивания в 2 раза. В результате предпринятого усовершенствования разработан способ хирургического лечения срединных грыж обширных размеров, применение которого в клинической практике позволяет уменьшить долю дисплазии соединительной ткани среди причин рецидивов заболевания. Ключевые слова: срединная грыжа, дисплазия соединительной ткани, электромиография, микроскопия коллагена Ответственный за переписку: Райляну Раду Иванович-кандидат медицинских наук, доцент кафедры хирургических болезней медицинского факультета Приднестровского государственного университета им. Т.Г. Шевченко.