To study results of surgical treatment for spinal canal stenosis in patients with degenerative-dystrophic diseases of the cervical and lumbar spine. Material and Methods. Complex pre-and postoperative examination of 56 patients with congenital and/or acquired spinal canal narrowing was performed. Clinical diagnosis was based on findings of neurological and orthopedic examination, X-ray investigation, spiral CT, MRI, Doppler sonography, and electroneuromyography. Treatment results were assessed at discharge and at 6 months after surgery. Immediate and longterm indices of pain syndrome intensity, vertebroneurological semiology, and scores of Oswestry Low Back Pain Disability Questionnaire and of Neck Disability Index were compared. Results. We succeeded in significant decrease in pain intensity in most patients; the score of pain sense at discharge was 1 to 3. At follow-up after 6 months 30 patients had no radicular pain, 26-had unpleasant pain senses, though transient, with intensity score of 3 to 4. Conclusion. The choice of access, volume and nature of surgical exposure should be planned based on consideration of all factors promoting development of myeloradiculopathy. The cervical spine is operated using predominantly anterior decompression and stabilizing procedures, the lumbar spine-using posterior procedures. The choice of spine stabilization method depends on instability causes, degree of displacement and mobility of vertebrae.

Background. The maximum duration of vascular access for hemodialysis functioning rarely exceeds 4 years. The main tool for diagnosing access dysfunction is duplex ultrasound. Dynamic ultrasound examination of vascular access is not included in the standard examination of patient undergoing hemodialysis in Russia.Objective. To study the structure of complications and changes in hemodynamics in the vascular access for hemodialysis and to determine the risk factors contributing to its development.Design and methods. Ultrasound, clinical and laboratory examination was performed in 550 patients undergoing program hemodialysis, 517 (94.0 %) of them had arteriovenous fistula, 33 (6.0 %) patients had arteriovenous graft.Results. Vascular access complications occurred in 26.7 % (147 patients), there was no significant difference in the detection rate of thrombosis (26.5 %), stenosis (23.8 %), and aneurysm (21.1 %). A combination of two complications was observed in 20.4 %, the steal syndrome — in 8.2 %. A correlation was established between the presence of significant stenosis, aneurysm of the outflow vein and the development of thrombosis, between the presence of concomitant diseases of the peripheral arteries and the development of steal syndrome and stenosis of the inflow artery and the anastomosis zone.Conclusion. Duplex ultrasound allows to diagnose complications of vascular access for hemodialysis and determine its causes.

Introduction. The most common complication of the vascular access for hemodialysis, that can lead to its loss, is thrombosis. The method of choice in diagnosing fistula thrombosis is duplex ultrasound. Purpose: to study the ultrasound signs and changes in hemodynamics data in thrombosed fistulas and to determine the risk factors contributing to its development. Materials and methods. Duplex ultrasound was performed in 550 patients with vascular access for hemodialysis. Access thrombosis was detected in 12,0%, non-occlusive thrombosis was observed in 60,6%, occlusive thrombosis — in 39,4%. Thrombosis was significantly more common in women than in men (p=0,025). In patients with graft, thrombosis was more common (24,2%) than in those with arteriovenous fistula (11,2%), p=0,026. A correlation was found between the presence of significant vascular access stenosis, aneurysm of the outflow vein or graft, and the development of thrombosis (p<0,02). Duplex ultrasound allows to diagnose vascular access thrombosis and to determine the causes of its development.

Introduction. Successful hemodialysis is impossible without effective vascular access. However, the average duration of its normal functioning is 2.53.0 years that is associated with complications, one of them is steal syndrome of the hand. Objective. To examine hemodynamic parameters in vascular access and forearm arteries in hemodialysis patients with hand ischemia. Methods. Duplex ultrasound was performed in 550 patients, 517 of which (94.0%) had an arteriovenous fistula, 33 (6.0%) had an arteriovenous graft. The inflow artery, anastomotic zone, outflow vein and arteries distal to the anastomotic zone were assessed during ultrasound examination, linear and volumetric speed indicators, peripheral resistance indices were measured. Results. Steal syndrome was detected in 2.7% of cases. The main reasons are the inflow artery alterations due to diabetes and atherosclerosis that lead to insufficient growth of blood flow through the artery (20,0%); huge anastomosis diameter that causes a vein dilation and significant increase in access flow (13,3%); insufficient blood flow through the ulnar, anterior interosseous arteries and the absence of collateral branches that did not compensate for retrograde blood flow in the radial artery distal to anastomosis (40,0%); microcirculatory dysfunction of the hand and alterations of the regulation mechanisms of the resistive vessels tone (26,7%). Conclusion. Dynamic ultrasound examination of vascular access can detect adverse changes in hemodynamics and avoid severe ischemic complications. The main reason of steal syndrome is the condition of the forearm arteries not participating in the fistula formation and the hand microvasculature.

Хирургия повреждений44 В в е д е н и е. Позвоночно-спинномозговая трав ма (ПСМТ) была и остаётся серьезной меди косоциальной проблемой в связи с травмированием в основном людей молодого возраста и частым наступлением стойкой утраты трудоспособности. Существенные потери в связи с лечением, в том числе высокотехнологичным, временной и стойкой утратой трудоспособности обусловливают экономическую значимость ПСМТ. По данным разных авторов [1-4, 10, 12-14], среди ПСМТ повреждения шейного отдела позвоночника (ШОП) составляют не менее 35-40 %, из которых 2 / 3 -травмы нижнешейного отдела. Топогра-ЦЕЛЬ ИССЛЕДОВАНИЯ. Провести клинико-лучевые сопоставления результатов изменений позвоночных артерий при травме шейного отдела позвоночника. МАТЕРИАЛ И МЕТОДЫ. Анализ результатов комплексного обследования и лечения 157 пострадавших в возрасте (38,5 ± 1,5) года. РЕЗУЛЬТАТЫ. Поражения позвоночных артерий обнаружены у 68,8 % пациентов. Основными ультразвуковыми синдромами являлись деформации хода с локальной гемодинамической значимостью, компрессия с системным дефицитом кровотока, ирритативные влияния, экстравазальные изменения на уровне сегмента V3, тромбоз и диссекция. ЗАКЛЮЧЕНИЕ. Развитие гемодинамически значимых локальных влияний на позвоночную артерию зависит от степени стеноза, площади поперечного сечения её канала.Ключевые слова: позвоночно-спинномозговая травма, шейный отдел позвоночника, поражения позвоночной артерии, ультразвуковое исследование OBJECTIVE. The authors compared results of changes in clinical and radial studies of vertebral arteries in case of trauma of cervical spine. MATERIAL AND METHODS. An analysis of data of complex examination and treatment was made in 157 victims aged 38,5 ± 1,5 years old. RESULTS. Pathology of vertebral arteries was detected in 68,8 % cases. The main ultrasound syndromes were deformations of speed with local hemodynamic significance, compression with systemic deficiency of blood flow, irritative effects, extravasal changes on the level of V-3 segment, thrombosis and dissection. CONCLUSIONS. The development of hemodynamically significant local effects on the vertebral artery depended on degree of stenosis and cross-section area of its canal.