Неврологічні прояви системної дисплазії сполучної тканини у підлітків

Features of cerebral hemodynamics in teenagers with systemic dysplasia of connective tissue are characterized by significant disorders (vessels hypertone, instability of a vascular tone with the tendency to angiospasm, abnormalities of resilient properties of a vascular wall, increase of peripheral vascular resistance with difficulty of venous outflow from a cavity of the skull, asymmetry of blood circulation, attributes of pathological crimp of vessels), clearly manifested in the vertebrobasilar pool. These disorders are manifested by prevalence hypertonic ((41,5±5,4)%) and distonic ((37,7±5,4)%) types cerebral hemodynamics, respective alterations of duration anacrotic phases, the module of elasticity, dicrotic and diastolic indices, asymmetry factor, average linear speed of bloodstream, indices of circulatory resistance, pulsation, systolic-diastolic index significantly different from the control group (р<0,05). The above-listed changes of cerebral hemodynamics are characterized by the tendency of amplification at functional loadings.

The results of profound study of morphological, functional and biomechanical features of the cervical department of the spine in teenagers with systemic dysplasia have revealed, that (46,5±5,4)% of patients have dysplastic changes or anomalies of development, and (61,6±5,2)% of them have instability of vertebral motor segments (р <0,01). Signs of spondylarthrosis deformation in segments С2-С6 as subchondral osteosclerosis, irregular constriction of joint space, appearance of marginal overgrowth of articular processus among degenerate changes of cervical department of the spine took place most frequently ((66,3±5,1)%). Early manifestations of the spine osteochondrosis (thickening and incurvity of switching plates, constriction of the intervertebral spaces) are diagnosed, mainly at the С5-С6 level, in (31,4±5,0)% of investigated patients.

It is proved, that disorder of motor stereotype (static and dynamic components) is biomechanical equivalent of manifestation of connective tissue dysplasia complex influence that has been demonstrated by asymmetry of position of the general center of gravity projection to the beginning of movement (transient from standing to walking), increase in its fluctuations on the area of support in sagittal and frontal planes (at inflection and extension of the head), rise in factor of rocking by 60% and decrease of factor of stability by 90% in case of the visual control absence during execution of Romberg test. Conceptual and quantitative biomechanical models of intense deformed conditions of the cervical department of the spine in conditions of dysplastic process are elaborated. It is proved, that in conditions of hypermobility in vertebral-motor segments, in case of ventral displacement of intervertebral disk, there is an increase of pressure in upper-dorsal parts of the corpus vertebrae near roots of arches (in 2 times) and in dorsal part of the disk (in 15 times, at dorsal displacement - in 10 times), that forms preconditions of development of degenerate changes and chronic residual muscular tension. Devices and ways of estimation of supporting-coordination function of the organism with the purpose of screening-diagnostics of disorders of static-locomotor functions are offered, as well as spine pathology of dysplastic genesis.

On the basis of the analysis of neurologic frustration formation mechanisms the expediency of application of diagnostic and preventive clinical standards is substantiated in prophylactic medical examination of teenagers with systemic dysplasia of connective tissue.

The preventive measures directed at providing compensation of available individual features of connective tissue structure, improvement of such patients' quality of life, prevention of development of serious complications in advanced age are offered.

Key words: neurologic manifestations, dysplasia of connective tissue, vertebral-motor segment, static-locomotor disorders, teenagers.

ПЕРЕЛІК УМОВНИХ СКОРОЧЕНЬ

ДКІ - дикротичний індекс

ДСІ - діастоличний індекс

КАс - коефіцієнт асиметрії

МКЕ - метод кінцевих елементів

МП - модуль пружності

НДС - напружено-деформований стан

ОРА - опорно-руховий апарат

РІ - реографічний індекс

РЕГ - реоенцефалографія

СДСТ - системна дисплазія сполучної тканини

ХРС - хребтовий руховий сегмент

ТКДГ - транскраніальна допплерографія

ШВХ - шийний відділ хребта

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