Аbstract. Factors predisposing to the development of osteoarthritis in military personnel are analyzed. The physical stress inherent in military labor, for example, in the airborne troops, creates a high load on the joints and can cause the early dismissal of military personnel from the ranks of the Armed Forces of the Russian Federation. Based on the pharmacodynamics of chondroprotectors (stimulation of chondrocyte function, cartilage tissue regeneration processes, inhibition of the synthesis of inflammatory mediators, etc.), it can be argued that they have a significant effect on the pathogenetic mechanisms of the development of osteoarthritis, i.e. the mechanism of action of chondrocytes is reduced to the suppression of catabolic and stimulation of anabolic processes in the joints. The main principles of therapeutic nutrition for osteoarthritis are, a decrease in calorie intake, limiting the amount of carbohydrates, animal fats and salt consumed. A balanced diet, including sufficient macro- and micronutrients, has a therapeutic effect in patients with complaints of joint pain, helping to restore the damaged structure of the elements of the musculoskeletal system. The inclusion of dietary supplements in the diets of patients with complaints of joint diseases ensures the intake of nutrients necessary for the synthesis of glycosaminoglycans. These factors accelerate the rehabilitation of patients after extreme physical exertion and injuries of the musculoskeletal system inherent in military labor. An analysis of the materials of a clinical study a comparative study of the effectiveness of the treatment of osteoarthritis of the knee joint at the initial stage of the disease with the help of a representative of the group of chondroprotectors Аrthra containing chondroitin sulfate, glucosamine and non-steroidal anti-inflammatory drugs, is carried out. The introduction of chondroprotectors as a means of preventing osteoarthritis in the diets of military personnel experiencing extreme joint loads will strengthen the ligamentous-articular apparatus by normalizing cartilage moisture saturation, inhibiting the action of proteolytic enzymes and stimulating the synthesis of glucuronic acid, which improves the elasticity of connective tissue.

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Objective. To assess the results of clinical approbation of individual finite-element biomechanical model of a patient’s spino-pelvic complex with subsequent modeling of the best option of surgical treatment. Material and Methods. A biomechanical modeling of changes in the sagittal profile of a patient with degenerative disease of the lumbosacral spine, bilateral spondylolysis, and unstable grade 2 spondylolisthesis of the L4 vertebra was performed. The developed biomechanical model made it possible to assess the characteristics of the stress-strain state of the spinal motion segments aroused due to development of the disease. Within the built biomechanical model of the patient’s spino-pelvic complex, a corrective operation was further modeled that assumed a preservation of harmonious profile of sagittal spino-pelvic relationships. Post-correction characteristics of the stress-strain state of spinal motion segments were studied and compared with preoperative parameters of the biomechanical model. Results. Using methods of biomechanics and computer modeling allowed to calculate the stress-strain state of the lumbosacral spine under static load for two options of fixation and intervertebral cage implantation at the L4–L5 level: four transpedicular screws (L4–L5 vertebrae) and six transpedicular screws (L3–L4–L5 vertebrae). The simulation results showed that neither metal implants, nor elements of the lumbosacral spine experienced critical stresses and deformations that could lead to the destruction and instability of the implant. Conclusion. The developed individual biomechanical finite-element solid model of the spine and pelvis allowed for biomechanical justification of prerequisites for the formation and further progression of degenerative changes in spinal motion segments associated with violations of the sagittal profile due to grade 2 spondylolisthesis of the L4 vertebra. The model built on the results of radiological examination biomechanically substantiated the best option of corrective spine surgery allowing to minimize stresses and deformations by choosing reasonable magnitude of correction of sagittal spino-pelvic parameters and configuration of transpedicular system.

Актуальность проблемы лечения паци-ентов с сочетанными дегенератив-но-дистрофическими поражениями тазобедренных суставов и позвоноч-ника определяется достаточно высо-кой частотой этой сложной пато-логии, составляющей, по данным научных исследований [1,2] The paper presents results of staged surgical treatment of patients with concomitant degenerative-dystrophic diseases of the hip and spine. The analysis of clinical observation suggests the possibility of decompensation of degenerativedystrophic disease of the lumbosacral spine accompanied by spinal canal stenosis and instability of spinal motion segments after total hip arthroplasty. Decompression surgery eliminating spinal canal stenosis allows to restore lumbar lordosis and manage the pain syndrome. Surgical decompression combined with correction and fixation of the lower lumbar motion segments allows to normalize sagittal spinalpelvic relationship by restoring both lumbar lordosis and anatomic pelvic anteversion.

The bilateral defect of the pars interarticularis (spondylolysis) is often the cause of low back pain syndrome and can lead to development of spondylolistesis. In some cases inefficiency of conservative treatment of this condition forces orthopedists to use surgical technologies. At the same time, in young patients with intact intervertebral discs, the rigid segmental fixation of the spine should be avoided. Where no neural decompression is needed, selective osteosynthesis of the pars defect is an optimal technique. The authors present the results of surgical treatment of 15 patients with single and two-level lumbar spondylolysis, 4 of which revealed minimal I degree lytic spondylolystesis of the L5 vertebrae. Localization of the pathological process in all patients was noted on both sides. In two patients spondylolysis defects of two vertebrae were detected (in one- adjacent L4 and L5, in the other - L2 and L4 vertebrae with sacralization of L5). The average period from the onset of symptoms ranged from 6 months to 2 years (an average of 14 months). All patients undergone bone autoplasty with iliac crest bone graft, and osteosynthesis of vertebral arches by a combined laminar-transpedicular system of the screw - rod - hook type. All patients had excellent and good anatomic and functional results. The used method of surgical treatment of patients of this category should be considered pathogenetically justified, as it is aimed at repair of spondylolytic defects as the main cause of segmental instability and forward displacement of vertebrae. The possibility to avoid fixation of intact segments of spine allows to categorize this operation as organ-preserving.