Optical density index can be a criterion of bone mineral saturation, both at the stage of primary diagnosis and in the dynamics of observation of patients with shoulder periarthrosis and osteoarthritis of the shoulder joint.

Despite the significant prevalence of shoulder-scapular periarthrosis, methods of its early diagnosis remain insufficiently developed. The study aims to clarify the possibility of using osteodensitometry for early diagnosis of shoulder-scapular periarthrosis. We examined 70 men (the main group) with a diagnosis of shoulder-scapular periarthrosis without disorders of the function of the shoulder joints, which corresponded to the initial stage of the disease. The comparison group consisted of 78 patients with diagnosed osteoarthritis of the shoulder joints with moderate recurrent algic syndrome without limitation of the volume of movements; the control group consisted of 112 practically healthy men. The age of all examined men were 30-50 years. In addition to clinical and functional examination with neuro-orthopedic examination and radiography of the shoulder joints, the researchers conducted the mineral density of the bone tissue of the head of the humerus according to the results of digital radiography with a wedge-standard density. This method has a high accuracy in determining the mineral density of bone tissue, does not have an additional load and allows you to get the desired information. In the examined main group, in the absence of bone changes on the shoulder joint radiographs, experts have identified a significant decrease in the mineral density index in all zones of the upper sector, maximally expressed in the lateral zone of the humerus head in relation to the results of the control group. Patients in the comparison group also showed a significant decrease in this indicator in relation to the indicator of the control group. The decrease in bone mineral density in patients with osteoarthritis exceeded the decrease in similar indicators in individuals with shoulder-scapular periarthritis, however, there was no significant difference in these cases. The obtained results of the study allow us to conclude that the applied osteodensitometry makes it possible to detect a local decrease in bone mineral density in articular structures at the early stages of their formation, resulting from damage to the soft tissues of paraarticular structures, due to the unity of the response of the ligamentous-articular apparatus. Ethics. This study did not require the conclusion of the Ethics Committee.

Introduction. Timely and adequate diagnosis and treatment of degenerative-dystrophic diseases of the bone and joint apparatus, which include epicondylitis (epicondylosis), including professionally caused, continues to be a serious health problem today, since they cause significant economic damage associated with temporary and persistent disability of the active part of the world’s population. In this regard, the search for methods and methodological approaches to improve the radiation diagnosis of this disease remains relevant. The study is devoted to solution of important medical problems, including occupational diseases-optimization of X-ray of the ulnar epicondylitis based on the use of new methodological approaches quantifying the density of pathological remodeling of bone structures in the subject area, that allow to objectify the direction of changes in monitoring intensity changes in the estimated structures.The aim of the study is to improve the quality of x-ray diagnostics of ulnar epicondylitis based on a precision assessment of the optical density of bone and periarticular tissues using digital radiography.Materials and methods. A comparative analysis of the results of a comprehensive clinical and radiological examination of patients, workers of the main group (fitters and laborers machine-building plants) working age range of 30–50 years with a clinical picture of subacute phase of the ulnar epicondylitis in the absence of a pathognomonic ultrasound findings and x-ray morphological signs of the disease. X-ray studies were performed using digital low-dose x-ray diagnostic devices. Visualization, processing, analysis of medical images and comparison of results in the dynamics of research were carried out using the programs «Lins machaon doctor’s workstation». To measure the conditional optical density of bone and soft tissues, we used the ROI tool (zone of interest), which allows us to determine the desired value in areas of different dimensions. Measurements were performed on digital radiographs and computer monitor screens in the areas of interest: the lateral parts of the humerus condyles and adjacent periarticular tissues with the calculation of the average values of the optical density index (ID) and optical density gradients (IDG) relative to the density of periarticular soft tissues.Results. Analysis of the results of a posteriori osteodensitometry of the distal humerus within the framework of the developed algorithm, which includes the use of absolute and relative indicators of conditional optical density after preliminary color correction of digital x-ray images of bone and paraossal tissue structures, allowed us to expand our understanding of the topography of the distribution of mineral saturation in the condyles of at-risk individuals relative to those of the control group. It was found that the indicators of optical density of bone and paraossal tissues can be a kind of (conditional), sometimes the only indicators of the degree of severity of changes, positive or negative dynamics of pathophysiological processes. Density differences in the distal parts of the right and left humerus (bony and soft -tissue paraossal structures of the condyles) in the control group (conditional norm) in terms of absolute optical density and its gradient, regardless of the assessment area, were insignificant (statistically unreliable), although they were multidirectional. In patients with clinical signs of epicondylitis in the absence of x-ray morphologically detectable structural changes, a decrease in ID and the dynamics of its recovery at various stages of observation were revealed. Even when the ID of the actual bone structure is relatively equal, the IDG differs in different people, since it is largely determined by metabolic processes that are dynamically more labile than in the bones, and thus serve as a kind of indicator of their intensity. Taking into account the relative torpidity of perestroika processes in the structures of the bone tissue of the condyles in epicondylitis, IDG should be considered a more informative indicator of their dynamics. The importance of optical density indicators as predictors of the considered pathology is particularly evident in the process of analyzing the results of its diagnosis and development in the dynamics of observations not so much at the collective as at the individual level of assessment.Conclusions. The application of the developed methodological approach allows us to significantly expand our understanding of the topographical distribution of the density of bone and soft tissue structures of the distal humerus at various stages of examination of patients, including the early subclinical phases of possible pathology, even in the absence of visually detectable x-ray morphological changes. The use of an original algorithm for evaluating tissue density will reduce the negative role of the so-called «human factor» and thus significantly ensure the objectivity of the interpretation of research results.Funding. The study had no funding.Conflict of interests. The authors declare no conflict of interests.

Introduction. Varicose disease of the lower limbs (VDLL) is an independent disease and is an important medical and social problem due to its widespread and tendency to progress among people of working age and mainly in the female half of the population. Features of professional activity are risks in the form of static loads of a constant nature or weightlifting and other risk factors (for example, genetic predisposition, hormonal imbalance during pregnancy and menopause, obesity, diabetes mellitus, hypercoagulation, treatment with hormonal drugs, irrational nutrition, alcohol abuse, the presence of osteopenia and osteoporosis (OP). A feature of the disease is the presence of concomitant (often combined) pathology of the musculoskeletal system, which is characterized, as a rule, by early manifestation, relatively rapid progression, and complicated course. Radiologically, relatively often revealed pathology of the feet (flat feet, hallux valgus and deformity of the 1st finger) and degenerative-dystopian changes in the spine (osteochondrosis, spondyloarthritis, spondylosis, scoliosis, kyphosis). The most pronounced combined pathology of the musculoskeletal system is observed in patients with active trophic disorders. Considering the comorbidity of the disease, changes in regional hemodynamics and microcirculation in the lower limbs undoubtedly affect the indicators of hemostasis, carbohydrate, lipid and mineral metabolism. Therefore, a significant interest to improve the diagnosis of OP are often present in the form of a clinical syndrome, which is characterized by decrease in bone density, a violation of their micro-and increased fragility, due to the metabolic disorders of bone tissue with a predominance of catabolism over the processes of bone formation and increased risk of fractures. The state of bone mineral saturation, in particular in the female half of the population, depending on the severity of venous insufficiency remains insufficiently studied. Treatment of VDLL and its concomitant OP syndrome is not always a solvable problem, so the optimization of the diagnosis of this disease, especially at the initial stages, as well as in the process of dynamic monitoring and control of the effectiveness of therapeutic and preventive measures remains relevant. The aim of the study was to study the diagnostic possibilities of using radiometry (radiocomparametry and digital osteodensitometry) for precision assessment of mineral saturation of the spongy structure of the calcaneus in patients at risk for the appearance and development of VDLL. Materials and methods. As part of the general clinical examination, special comparative X-ray studies of the state of mineral saturation and dimensional characteristics of bone trabeculae of the spongy structure of the calcaneus were performed in 129 women with clinical signs of VDLL, which in accordance with the international classification of CEAP were divided into stages: C1 - 36 people, C2 - 32 people, C3 - 39 people, C4 - 30 people, C5 - 22 people. The comparison group included 119 practically healthy women, comparable to the main group by age, work experience and morbid history. The X-ray diagnostic complex included, in addition to convective (routine) radiography of various parts of the osteoarticular apparatus, performed only according to indications, the following methods: interactive radiography (digital low-dose radiography) of the foot with a calibrated wedge-a standard of density, a posteriori testometric X-ray parametry of bone trabeculae of spongy structures of the calcaneus. Modern equipment was used: digital X-ray diagnostic complexes DR-GEBrivo), AXIOMLuminas (Siemens), dichromatic osteodensitometer "PRODIGY" (Lunar). Results. As part of the general clinical examination, X-ray examinations were performed before the implementation of therapeutic measures and after 24 months. Radiometric indicators of mineral saturation and thickness of trabeculae of the spongy structure of the calcaneus showed a direct dependence on age, reaching maximum values in the age category of 25-30 years with a clear tendency to decrease in older age groups. The mineralization parameters relative to the control were initially reduced, revealing variability depending on the severity of the main pathological process (from relatively high at C1 to relatively low at C5). There was also a pattern of increasing levels of mineralization and thickness of bone trabeculae depending on the period of observation (in fact, on the volume of complex therapeutic and preventive measures) in almost all patients, but mainly in groups C4, C5. Subjective symptoms and objective clinical picture of the condition of the examined patients with the presence of VDLL and OP syndrome correlated with the data of osteorentgenometry. Conclusions. The examined women, whose production activity makes them belong to the risk group for the appearance and development of VDLL, have a opioid structure of the calcaneus. The use in complex clinical and radiological diagnostics of the methodical technique of precision assessment of mineral saturation in (mg/mm2) and thickness of bone trabeculae (mm) makes it possible to objectify the reconstruction of the bone structure at the submacroscopic level of its visualization. Quantitative densitometric indicators of changes in the spongy structure of the calcaneus can be considered as markers of the severity of the condition and the direction of the course of VDLL with concomitant OP. Postprocessing radiometry the calcaneus performed on digital radiographs and the screens of computers using programs "LINS MAKHAON workstation of the DOCTOR" available, not associated with additional radiation exposure and, therefore, can be widely applied both at the stage of primary diagnosis of the health status of the studied patients and in monitoring the effectiveness of remedial measures.

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