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ÑÓÄÎÂÀ ÌÅÄÈÖÈÍÀ
© Ìèõàéëè÷åíêî Á. Â., *Ôðàí÷óê Â. Â., **Ãðèãîðîâ Ñ. Í., **Øêëÿð À. Ñ.
ÓÄÊ 340. 6:616. 711. 1-001. 5-079. 5
Ìèõàéëè÷åíêî Á. Â., *Ôðàí÷óê Â. Â., **Ãðèãîðîâ Ñ. Í., **Øêëÿð À. Ñ.
ÑÎ×ÅÒÀÍÍÛÅ ÒÅËÅÑÍÛÅ ÏÎÂÐÅÆÄÅÍÈß ØÅÉÍÎÃÎ
ÎÒÄÅËÀ ÏÎÇÂÎÍÎ×ÍÈÊÀ È ×ÅËÞÑÒÍÎ-ËÈÖÅÂÀß ÒÐÀÂÌÀ:
ÑÓÄÅÁÍÎ-ÌÅÄÈÖÈÍÑÊÈÉ ÀÑÏÅÊÒ
Íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò èì. Î. Î. Áîãîìîëüöÿ
(ã. Êèåâ)
Òåðíîïîëüñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò èì. È. ß. Ãîðáà÷åâñêîãî
*
(ã. Òåðíîïîëü)
**Õàðüêîâñêèé íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò (ã. Õàðê³â)
celavi2008@rambler.ru
Äàííàÿ ðàáîòà ÿâëÿåòñÿ ôðàãìåíòîì ïëàíîâîé
íàó÷íî-èññëåäîâàòåëüñêîé ðàáîòû «Ä³àãíîñòèêà òà
ë³êóâàííÿ çàõâîðþâàíü îðãàí³â òà òêàíèí ùåëåïíîëèöåâî¿ ä³ëÿíêè», ¹ ãîñ. ðåãèñòðàöèè 0113U002274.
Âñòóïëåíèå. Ïîñëåäíèå ãîäû îòìå÷åí ðîñò êîëè÷åñòâà ïîñòðàäàâøèõ ñ ñî÷åòàííûìè ïîðàæåíèÿìè – òðàâìàìè äâóõ è áîëåå àíàòîìè÷åñêèõ ñåãìåíòîâ îäíèì ïîðàæàþùèì ôàêòîðîì [9]. Ïîâðåæäåíèÿ
øåéíîãî îòäåëà ïîçâîíî÷íèêà (ØÎÏ) ñîñòàâëÿþò
äî 30 %, â ñòðóêòóðå ïîâðåæäåíèé ïîçâîíî÷íèêà, è
îòíîñÿòñÿ ê íàèáîëåå òÿæêèì òðàâìàì îïîðíî-äâèãàòåëüíîé ñèñòåìû. Ïîâðåæäåíèå íåðâíîé ñèñòåìû
ïðè òðàâìàõ ØÎÏ âîçíèêàåò â 50,0-60,0 % ñëó÷àåâ
[1, 6, 7]. Ïðè ýòîì ïîñòðàäàâøèå ñ òðàâìîé ØÎÏ è
ïàðàâåðòåáðàëüíûõ òêàíåé, ìîãóò ñòàòü îáúåêòîì
ñóäåáíî-ìåäèöèíñêîé ýêñïåðòèçû æèâûõ ëèö, êîòîðàÿ ïðîâîäèòñÿ â õîäå ñóäåáíîãî è äîñóäåáíîãî
ñëåäñòâèÿ [16-18]. Ó ïîñòðàäàâøèõ ñ ïîâðåæäåíèÿìè ëèöåâîãî ñêåëåòà (ËÑ) ÷àñòîòà ñî÷åòàííûõ òðàâì
äîñòèãàåò 10,0-12,0 % [10-12]. Òðàâìà øåéíîãî îòäåëà ïîçâîíî÷íèêà (ÒØÎÏ) è ÷åëþñòíî–ëèöåâàÿ
òðàâìà (×ËÒ), ÿâëÿÿñü îäíîâðåìåííî ôèçè÷åñêèìè
è ïñèõè÷åñêèìè ñòðåññîðàìè, ôîðìèðóþò ðàçâèòèå
ñòðåññ-ðåàêòèâíûõ èçìåíåíèé ñî ñòîðîíû îñíîâíèõ ãîìåîñòàòè÷åñêèõ ñèñòåì îðãàíèçìà (íåðâíîé,
èììóííîé, ýíäîêðèííîé) [4, 5]. Äàííûå ëèòåðàòóðû ñâèäåòåëüñòâóþò, ÷òî ó áîëüíûõ, êàê ñ ïðÿìîé,
òàê è ñ íåïðÿìîé ÒØÎÏ îòìå÷àþòñÿ âûðàæåííûå
ýíäîêðèííûå íàðóøåíèÿ, êîòîðûå ìîãóò îòðàæàòü
òÿæåñòü ïîðàæåíèÿ ãîëîâíîãî ìîçãà è èãðàòü ðîëü
ôàêòîðà âîçíèêíîâåíèÿ îñëîæí¸ííîãî òå÷åíèÿ ïîâðåæäåíèé, êàê øåéíîãî îòäåëà ïîçâîíî÷íèêà, òàê
è ËÑ [2, 3]. Íåñìîòðÿ íà ïîñòîÿííûé ïîèñê è âíåäðåíèå íîâûõ ìåòîäîâ äèàãíîñòèêè, êîëè÷åñòâî
âîçíèêàþùèõ îñëîæíåíèé îñòàåòñÿ äîñòàòî÷íî âûñîêèì, äîñòèãàÿ 36,5 % [3, 4]. Íå âûçûâàåò ñîìíåíèÿ, ÷òî ïðîáëåìà ëå÷åáíîé ïîìîùè ïàöèåíòàì ñ
ÒØÎÏ è òðàâìàìè ËÑ ÿâëÿåòñÿ ìóëüòèäèñöèïëèíàðíîé, îïðåäåëÿÿ ïîòðåáíîñòü â ñîâìåñòíûõ äåéñòâèÿõ ÷åëþñòíî-ëèöåâûõ õèðóðãîâ è âðà÷åé äðóãèõ
392
ñïåöèàëüíîñòåé: òðàâìàòîëîãîâ, íåéðîõèðóðãîâ,
îôòàëüìîëîãîâ, íåâðîïàòîëîãîâ [8-10, 13].
 äîñòóïíîé ñóäåáíî-ìåäèöèíñêîé ëèòåðàòóðå îòñóòñòâóþò îáùåïðèçíàííûå äèàãíîñòè÷åñêèå
êðèòåðèè, ïîçâîëÿþùèå îáúåêòèâíî îïðåäåëèòü
ñòåïåíü òÿæåñòè òåëåñíûõ ïîâðåæäåíèé ïðè âñåõ
âàðèàíòàõ òàêîé òðàâìû.  ëèòåðàòóðå íå îïðåäåëåí îïòèìàëüíûé îáúåì äèàãíîñòè÷åñêèõ èññëåäîâàíèé äëÿ îöåíêè èñõîäîâ òðàâì øåéíîãî îòäåëà
ïîçâîíî÷íèêà è ïàðàâåðòåáðàëüíûõ òêàíåé. Íå ðàçðàáîòàí àëãîðèòì ïðîâåäåíèÿ ñóäåáíî-ìåäèöèíñêîé ýêñïåðòèçû.
Öåëüþ ðàáîòû ÿâèëñÿ êîíòåíò-àíàëèç ïàòîãåíåòè÷åñêèõ ïðåäïîñûëîê ñîâåðøåíñòâîâàíèÿ ñóäåáíî-ìåäèöèíñêîé ýêñïåðòèçû òðàâì øåéíîãî îòäåëà ïîçâîíî÷íèêà (èçîëèðîâàííûõ è ñî÷åòàííûõ ñ
òðàâìàìè ËÑ) ó æèâûõ ëèö.
Îáúåêò è ìåòîäû èññëåäîâàíèÿ.  òå÷åíèå
ïîñëåäíèõ ëåò â îòäåëå ñóäåáíî-ìåäèöèíñêîé ýêñïåðòèçû ïîòåðïåâøèõ, îáâèíÿåìûõ è äðóãèõ ëèö
Îáëàñòíûõ áþðî ñóäåáíî-ìåäèöèíñêîé ýêñïåðòèçû
áûëî ïðîâåäåíî 83 ýêñïåðòíûõ èññëåäîâàíèé ïî
ïîâîäó òðàâì øåéíîãî îòäåëà ïîçâîíî÷íèêà è ïàðàâåðòåáðàëüíûõ òêàíåé, ÷òî ñîñòàâèëî îêîëî 2,3 %
îò îáùåãî êîëè÷åñòâà ïîâðåæäåíèé øåè.  õîäå
ïðîâåäåíèÿ èññëåäîâàíèÿ, èñïîëüçîâàëèñü òàêèå
ìåòîäû: ðåãèñòðàöèîííûé – ïîëó÷åííûå äûííûå
çàíîñèëèñü â ñïåöèàëüíî ðàçðàáîòàííûå ðåãèñòðàöèîííûå êàðòû; ìåòîä ñòàòèñòè÷åñêîãî àíàëèçà;
ìîðôîëîãè÷åñêèé ìåòîä – îïðåäåëÿëñÿ õàðàêòåð
ïîâðåæäåíèé; êëèíè÷åñêèé – àíàëèçèðîâàëîñü íàðóøåíèå ôóíêöèè, äëèòåëüíîñòü ðàññòðîéñòâà çäîðîâüÿ; ñóäåáíî-ìåäèöèíñêèé – àíàëèçèðîâàëàñü
óñòàíîâëåííàÿ ýêñïåðòàìè ñòåïåíü òÿæåñòè òåëåñíûõ ïîâðåæäåíèé.
Ðåçóëüòàòû èññëåäîâàíèé è èõ îáñóæäåíèå.
Óñòàíîâëåíî, ÷òî ôàêòîðîì, ïðåäîïðåäåëÿþùèì
ñî÷åòàíèå ÒØÎÏ è ×ËÒ, ÿâëÿåòñÿ àíàòîìè÷åñêîå, òîïîãðàôè÷åñêîå è ôóíêöèîíàëüíîå åäèíñòâî ìîçãîâîãî è ëèöåâîãî îòäåëîâ ÷åðåïà [11]. Îñîáåííîñòüþ
³ñíèê ïðîáëåì á³îëî㳿 ³ ìåäèöèíè – 2015 – Âèï. 2, Òîì 3 (120)
ÑÓÄÎÂÀ ÌÅÄÈÖÈÍÀ
ñî÷åòàííîé òðàâìû ÿâëÿåòñÿ òî, ÷òî ïîâðåæäåíèå
ÃÌ ìîæåò âîçíèêàòü è ïðè îòñóòñòâèè óäàðà ïî ìîçãîâîìó îòäåëó ÷åðåïà, ò. å. äàííûå ïîâðåæäåíèÿ
ìîãóò áûòü âûçâàíû âîçäåéñòâèåì òðàâìèðóþùåãî
àãåíòà, ëèáî íà ëèöåâîé è ìîçãîâîé îòäåëû ÷åðåïà
îäíîâðåìåííî [5, 8, 9]. Ñèëà äåéñòâóþùåãî ôàêòîðà, âûçâàâøåãî ïåðåëîì êîñòåé ËÑ, ïî èíòåíñèâíîñòè îáû÷íî ïðåâîñõîäèò ïðåäåë ýëàñòè÷íîñòè è
ïðî÷íîñòè îòäåëüíûõ êîñòåé [5] è ïåðåäàåòñÿ íåïîñðåäñòâåííî íà ØÎÏ, âûçûâàÿ ãåìîäèíàìè÷åñêèå,
ïàòîôèçèîëîãè÷åñêèå è ñòðóêòóðíûå èçìåíåíèÿ
ðàçëè÷íîé ñòåïåíè [13-15]; ïîâðåæäåíèÿ ËÑ ïðåäîïðåäåëÿþò âûñîêèé ðèñê òðàâìû ØÎÏ [29-32].
Àíàëèç ÒØÎÏ ïðè ×ËÒ è åå ïîñëåäñòâèé ïîêàçàë,
÷òî ó ïîäàâëÿþùåãî áîëüøèíñòâà ïîñòðàäàâøèõ
íàáëþäàþòñÿ ðàçëè÷íûå èíòðàêðàíèàëüíûå ïðîÿâëåíèÿ: ïî äàííûì êîìïüþòåðíîé òîìîãðàôèè (ÊÒ),
äîìèíèðóþùèìè ÿâëÿþòñÿ î÷àãîâûå ïîâðåæäåíèÿ
ëîáíûõ è âèñî÷íûõ äîëåé ÃÌ, à òàêæå ïåðåëîìû
îñíîâàíèÿ ïåðåäíåé ÷åðåïíîé ÿìêè, ñîïðîâîæäàþùèåñÿ íàçàëüíîé ëèêâîððååé [33]. Êëèíè÷åñêè
ÒØÎÏ ïðîÿâëÿåòñÿ îáùåìîçãîâûìè è ëîêàëüíûìè
ñèìïòîìàìè; ê îáùåìîçãîâûì îòíîñÿò ïîòåðþ ñîçíàíèÿ, ãîëîâíóþ áîëü, ãîëîâîêðóæåíèå, òîøíîòó,
ðâîòó, àìíåçèþ, à ê ëîêàëüíûì – íàðóøåíèå ôóíêöèè ÷åðåïíûõ íåðâîâ [26-29]. Èññëåäîâàíèå
êëèíè÷åñêèõ ïðîÿâëåíèé îñíîâíûõ ôîðì ëåãêîé ×ÌÒ
ïîêàçàëî, ÷òî ìèíèìàëüíûìè äèàãíîñòè÷åñêèìè
êðèòåðèÿìè ñîòðÿñåíèÿ ÃÌ ñëåäóåò ñ÷èòàòü íàëè÷èå
êðàòêîâðåìåííûõ íàðóøåíèé ñîçíàíèé è/èëè
íåïðîäîëæèòåëüíûå íàðóøåíèÿ ïàìÿòè íà ñîáûòèÿ,
íåïîñðåäñòâåííî ïðåäøåñòâîâàâøèå òðàâìå èëè
ïîñëåäîâàâøèå âñëåä çà íåé. Ìèíèìàëüíûìè
äèàãíîñòè÷åñêèìè êðèòåðèÿìè óøèáîâ ÃÌ ëåãêîé
ñòåïåíè â ãðóïïå áîëüíûõ ñ ïðåäïîëàãàåìîé ëåãêîé
ÒØÎÏ ìîæíî ñ÷èòàòü íàëè÷èå ëåãêîé î÷àãîâîé
ñèìïòîìàòèêè ïåðåëîìîâ êîñòåé ñâîäà ÷åðåïà,
ñóáàðàõíîèäàëüíîãî êðîâîèçëèÿíèÿ, îãðàíè÷åííûõ
ÊÒ èçìåíåíèé âåùåñòâà ÃÌ [1-3].
Ê ñîæàëåíèþ, â ðÿäå ñëó÷àåâ, ÒØÎÏ, ñî÷åòàþùååñÿ ñ ïîâðåæäåíèÿìè ËÑ, äèàãíîñòèðóåòñÿ
ëèøü â ñëó÷àÿõ ñ ÿðêî âûðàæåííîé íåâðîëîãè÷åñêîé
ñèìïòîìàòèêîé [22-25]. Ìåæäó òåì, ÃÌ îòëè÷àåòñÿ âûñîêîé ÷óâñòâèòåëüíîñòüþ ê òðàâìàòè÷åñêîìó
âîçäåéñòâèþ äàæå ïðè ëåãêîé ÒØÎÏ [19-21]. Â òîæå
âðåìÿ, òÿæåëûå ×ËÒ íåðåäêî çàòðóäíÿþò îöåíêó òÿæåñòè ÒØÎÏ. Êðîâîòå÷åíèå â êëåò÷àòêó âåê è ñêëåðó ãëàç ñèìóëèðóåò ïåðåëîì îñíîâàíèÿ ÷åðåïà, çàòðóäíÿåò èññëåäîâàíèå ôóíêöèè ãëàçîäâèãàòåëüíûõ
íåðâîâ, îñìîòð ãëàçíîãî äíà. Ïîâðåæäåíèå òðîéíè÷íîãî, ëèöåâîãî, ãëàçîäâèãàòåëüíîãî íåðâîâ ìîæåò
ñèìóëèðîâàòü î÷àãîâóþ ñèìïòîìàòèêó. Ïîâðåæäåíèå
÷åëþñòåé, çàïàäåíèå ÿçûêà, îáòóðàöèÿ âåðõíèõ äûõàòåëüíûõ ïóòåé ñëèçüþ, êðîâüþ, îòëîìêàìè çóáîâ è
çóáíûõ ïðîòåçîâ âûçûâàþò îáòóðàöèþ âåðõíèõ äûõàòåëüíûõ ïóòåé, äûõàòåëüíóþ íåäîñòàòî÷íîñòü, óñóãóáëÿÿ ãèïîêñèþ ÃÌ. Ïîâðåæäåíèå ïðèäàòî÷íûõ ïàçóõ
íîñà, íàáëþäàþùååñÿ ïðè ïåðåëîìå ëîáíîé êîñòè,
âåðõíåé ÷åëþñòè, êîñòåé íîñà ñïîñîáñòâóåò âîñõîäÿùåé èíôåêöèè, à ïðè ëèêâîððåå – îáðàçîâàíèþ ëèêâîðíûõ ñâèùåé. Ðåàêòèâíûé îòåê, ñîïðîâîæäàþùèé
ïîâðåæäåíèå ëèöà è ÷åëþñòåé, ðàçâèòèå âîñïàëèòåëüíûõ èíôèëüòðàòîâ ïðèâîäÿò ê ñäàâëèâàíèþ ñîñóäîâ øåè, ãëóáîêèõ âåí ëèöà, âûçûâàþò âåíîçíûé
çàñòîé, ñïîñîáñòâóÿ íàðàñòàíèþ îòåêà ÃÌ [5, 10].
Íà ìíîãî÷èñëåííîì êëèíè÷åñêîì ìàòåðèàëå
óñòàíîâëåíî, ÷òî, òàê íàçûâàåìàÿ, ëåãêàÿ ÒØÎÏ
âûçûâàåò â îòäàëåííîì ïåðèîäå ïðàêòè÷åñêè ó êàæäîãî âòîðîãî ïàöèåíòà ðàçíîîáðàçíûå íàðóøåíèÿ:
îò ëåãêîé âåãåòàòèâíîé äèñòîíèè, àñòåíèçàöèè,
óìåðåííûõ îáùåìîçãîâûõ ðàññòðîéñòâ äî ýïèëåïòè÷åñêèõ, äèýíöåôàëüíûõ ïðèñòóïîâ, íàðóøåíèé
âèñöåðàëüíûõ ôóíêöèé è ïñèõè÷åñêîãî ñòàòóñà, ÷òî
îáóñëîâëåíî âûðàæåííîñòüþ ñòðóêòóðíûõ è ôóíêöèîíàëüíûõ íàðóøåíèé [12-15]. Ïðè ýòîì ó 50 %
áîëüíûõ ñ ëåãêîé ÒØÎÏ ïðîèñõîäèò ïðîãðåäèåíòíîå íàðàñòàíèå ïàòîëîãè÷åñêèõ ïðîÿâëåíèé, ïðè÷åì â ïîëîâèíå ñëó÷àåâ ïðîöåññû íå ñòàáèëèçèðîâàëèñü [12, 13].
Êàê ïîêàçàë àíàëèç ñîáñòâåííûõ íàáëþäåíèé,
ïðåîáëàäàþò òðàâìû øåéíîãî îòäåëà ïîçâîíî÷íèêà è ïàðàâåðòåáðàëüíûõ òêàíåé ó ëèö ìóæñêîãî ïîëà
(67,0 % íàáëþäåíèé), áîëüøå ïîëîâèíû ñëó÷àåâ
ïðèõîäèòñÿ íà òðóäîñïîñîáíûé âîçðàñò 20-50 ëåò
(65,5 % íàáëþäåíèé). Ñðåäè ïðè÷èí âîçíèêíîâåíèÿ
ïîâðåæäåíèé øåéíîãî îòäåëà ïîçâîíî÷íèêà è ïàðàâåðòåáðàëüíûõ òêàíåé íà ïåðâîì ìåñòå – áûòîâûå
òðàâìû.  ñòðóêòóðå òðàâì øåéíîãî îòäåëà ïîçâîíî÷íèêà è ïàðàâåðòåáðàëüíûõ òêàíåé äîìèíèðóþò
ðîòàöèîííûå ïîäâûâèõè àòëàíòà – áîëåå 60,0 %
íàáëþäåíèé. Ïåðåëîìû ïîçâîíî÷íèêà ñîñòàâèëè
– 19,0 % íàáëþäåíèé, ïîñòòðàâìàòè÷åñêèé ìèîçèò,
ïîâðåæäåíèå ñâÿçî÷íîãî àïïàðàòà øåéíîãî îòäåëà
ïîçâîíî÷íèêà – 6,0 % íàáëþäåíèé, ïîñòòðàâìàòè÷åñêàÿ íåñòàáèëüíîñòü – 4,2 % íàáëþäåíèé, óøèá
øåéíîãî îòäåëà ïîçâîíî÷íèêà – 9,0 % íàáëþäåíèé.
Ïðè ñóäåáíî-ìåäèöèíñêîé ýêñïåðòíîé îöåíêå ê
òÿæêèì òåëåñíûì ïîâðåæäåíèÿ ïî êðèòåðèþ «îïàñíîñòü äëÿ æèçíè» «Ïðàâèë ñóäîâî-ìåäè÷íîãî âèçíà÷åííÿ ñòóïåíÿ òÿæêîñò³ ò³ëåñíèõ óøêîäæåíü» (Íàêàç
ÌÎÇ Óêðà¿íè ¹ 6 îò 17. 01. 95 ã.), ýêñïåðòàìè îòíåñåíû: â 12,0 % íàáëþäåíèé ïåðåëîìû øåéíîãî îòäåëà ïîçâîíî÷íèêà, â 3,0 % íàáëþäåíèé ðîòàöèîííûå
ïîäâûâèõè àòëàíòà; ê ïîâðåæäåíèÿì ñðåäíåé ñòåïåíè òÿæåñòè ïî êðèòåðèþ äëèòåëüíîñòü ðàññòðîéñòâà çäîðîâüÿ «Ïðàâèë…» ýêñïåðòàìè îòíåñåíû: â
56,0 % ñëó÷àåâ ðîòàöèîííûå ïîäâûâèõè àòëàíòà; â
7,0 % ñëó÷àåâ ïåðåëîìû øåéíîãî îòäåëà ïîçâîíî÷íèêà; â 2,6 % íàáëþäåíèé ïîâðåæäåíèÿ ñâÿçî÷íîãî
àïïàðàòà øåéíîãî îòäåëà ïîçâîíî÷íèêà. Ê ëåãêèì
òåëåñíûì ïîâðåæäåíèÿì, ïîâëåêøèì çà ñîáîé êðàòêîâðåìåííîå ðàññòðîéñòâî çäîðîâüÿ, ýêñïåðòàìè
îòíåñåíû: â 3,8 % íàáëþäåíèé ïîñòòðàâìàòè÷åñêàÿ
íåñòàáèëüíîñòü, â 5,4 % íàáëþäåíèé ðîòàöèîííûå
ïîäâûâèõè àòëàíòà. Äëèòåëüíîñòü ëå÷åíèÿ áîëüøèíñòâà ïîñòðàäàâøèõ â ýòèõ ñëó÷àÿõ, ñîñòàâèëà îò
7 äî 21 ñóòîê.
Ê ëåãêèì òåëåñíûì ïîâðåæäåíèÿì ýêñïåðòàìè
îòíåñåíû: â 9,6 % íàáëþäåíèé óøèá øåéíîãî îòäåëà ïîçâîíî÷íèêà, â 5,2 % íàáëþäåíèé ïîâðåæäåíèé
ñâÿçî÷íîãî àïïàðàòà øåéíîãî îòäåëà ïîçâîíî÷íèêà, ïîñòòðàâìàòè÷åñêèé ìèîçèò, â 3,8 % íàáëþäåíèé
³ñíèê ïðîáëåì á³îëî㳿 ³ ìåäèöèíè – 2015 – Âèï. 2, Òîì 3 (120)
393
ÑÓÄÎÂÀ ÌÅÄÈÖÈÍÀ
ðîòàöèîííûå ïîäâûâèõè àòëàíòà, â 2,4 % íàáëþäåíèé ïîñòòðàâìàòè÷åñêàÿ íåñòàáèëüíîñòü øåéíîãî
îòäåëà ïîçâîíî÷íèêà. Äëèòåëüíîñòü ëå÷åíèÿ ïîñòðàäàâøèõ â ýòèõ ñëó÷àÿõ, ñîãëàñíî ñóäåáíî-ìåäèöèíñêèõ äîêóìåíòîâ, ñîñòàâèëà äî 7 ñóòîê. Îòäåëüíûå òðàâìû øåéíîãî îòäåëà ïîçâîíî÷íèêà â ýòèõ
ñëó÷àÿõ, ïî íàøåìó ìíåíèþ äîëæíû áûëè áû îöåíåíû êàê áîëåå ñåðüåçíûå ïîâðåæäåíèÿ, ñ ó÷åòîì
îáû÷íîé äëèòåëüíîñòè òå÷åíèÿ òðàâìàòè÷åñêîé áîëåçíè è èñõîäîâ. Òàêèì îáðàçîì, ñóäåáíî-ìåäèöèíñêèìè ýêñïåðòàìè, â áîëåå ÷åì 15,0 % íàáëþäåíèé,
ïîâðåæäåíèÿ îöåíåíû êàê òÿæêèå; â 64,0 % íàáëþäåíèé êàê ñðåäíåé òÿæåñòè; 7,8 % íàáëþäåíèé, êàê
ëåãêèå òåëåñíûå ïîâðåæäåíèÿ, ïîâëåêøèå çà ñîáîé
êðàòêîâðåìåííîå ðàññòðîéñòâî çäîðîâüÿ; â 19,0 %
íàáëþäåíèé, êàê ëåãêèå òåëåñíûå ïîâðåæäåíèÿ.
Ïî-âèäèìîìó, â çàâèñèìîñòè îò ìåõàíèçìà
ÒØÎÏ öåëåñîîáðàçíî èñïîëüçîâàòü äîïîëíèòåëüíûå ïðîåêöèè, ÷òî ïîçâîëèò îáúåêòèâèçèðîâàòü õàðàêòåð ïîâðåæäåíèé àíàòîìè÷åñêîé öåëîñòè òêàíåé
øåéíîãî îòäåëà ïîçâîíî÷íèêà ó ïîñòðàäàâøèõ. Ïðè
«õëûñòîâûõ» òðàâìàõ íåîáõîäèìî ïðîâîäèòü ôóíêöèîíàëüíóþ ñïîíäèëîãðàôèþ â áîêîâîé ïðîåêöèè
äëÿ âèçóàëèçàöèè ðàçðûâîâ íàä- è ìåæîñòèñòûõ
ñâÿçîê, è â êîñûõ (3/4) ïðîåêöèÿõ – äëÿ äèàãíîñòèêè ïîâðåæäåíèé êàïñóëüíî-ñâÿçî÷íîãî àïïàðàòà
äóãîîòðîñòêîâûõ ñóñòàâîâ. Ïðè ñãèáàòåëüíî-âðàùàòåëüíûõ òðàâìàõ öåëåñîîáðàçíî ïðîâîäèòü ðåíòãåíîãðàôèþ â ïåðåäíå-çàäíåé ïðîåêöèè ÷åðåç ðîò äëÿ
âûÿâëåíèÿ ðàçðûâîâ ñâÿçîê â ñóñòàâå Êðþâåëüå.
Àíàëèç ðÿäà ýêñïåðòèç ïîêàçàë, ÷òî â ñëó÷àÿõ
ïîâðåæäåíèé ïàðàâåðòåáðàëüíûõ òêàíåé ïîçâîíî÷íèêà, íå ïðîâîäÿòñÿ ñîíîãðàôèÿ, ïîâåðõíîñòíàÿ ñòèìóëÿöèÿ, ýëåêòðîìèîãðàôèÿ, ïîçâîëÿþùèå
îáúåêòèâíîãî îöåíèòü õàðàêòåð òàêèõ ïîâðåæäåíèÿ. Îáðàùàåò íà ñåáÿ âíèìàíèå, ÷òî â òåõ ñëó÷àÿõ,
êîãäà ó ïîñòðàäàâøèõ èìåþòñÿ ïîâðåæäåíèÿ òîëüêî
ìÿãêèõ òêàíåé øåè, è îíè íå íàõîäèëèñü íà ëå÷åíèè, ýêñïåðòû íå íàïðàâëÿþò èõ íà êîíñóëüòàöèþ
ê òðàâìàòîëîãó, íåâðîïàòîëîãó. Íå ïðîâîäÿòñÿ äîïîëíèòåëüíûå èññëåäîâàíèÿ, äàæå â òåõ ñëó÷àÿõ,
êîãäà ïîñòðàäàâøèå ïðåäúÿâëÿþò ñîîòâåòñòâóþùèå æàëîáû.
Òàêèì îáðàçîì, äàííûå ëèòåðàòóðû ñâèäåòåëüñòâóþò, ÷òî ×ËÒ ñîïðîâîæäàåòñÿ ÒØÎÏ, îäíàêî â
ëèòåðàòóðå íåò îäíîçíà÷íûõ äàííûõ î ÷àñòîòå ýòîé
ïàòîëîãèè è âåðèôèêàöèè åå ñ ïîìîùüþ ëàáîðàòîðíûõ è èíñòðóìåíòàëüíûõ èññëåäîâàíèé, â òîì
÷èñëå, ÊÒ, òîãäà êàê êðèòåðèè äèàãíîñòèêè íåâðîëîãè÷åñêèõ íàðóøåíèé ïðè, òàê íàçûâàåìîé ëåãêîé
ÒØÎÏ, ÷àñòî ñîïðîâîæäàþùåé ×ËÒ, íå ðàçðàáîòàíû.  òîæå âðåìÿ, îöåíêà ñòåïåíè òÿæåñòè òåëåñíûõ
ïîâðåæäåíèé, çà÷àñòóþ íå ó÷èòûâàåò ñîñóäèñòîðåôëåêòîðíûõ ðàññòðîéñòâ, íàðóøåíèé ôóíêöèé
îïîðíî-äâèãàòåëüíîãî àïïàðàòà è íåêîòîðûõ äðóãèõ
ïàòîãåíåòè÷åñêè âçàèìîñâÿçàííûõ ôóíêöèîíàëüíûõ è ñòîéêèõ ðàññòðîéñòâ çäîðîâüÿ.
Âûâîäû.
1. Òðàâìû ØÎÏ çà÷àñòóþ èìåþò ñî÷åòàííûé
õàðàêòåð ñ òðàâìàìè ËÑ è, íàîáîðîò òðàâìû ËÑ,
âñëåäñòâèå îáùåãî áèîìåõàíè÷åñêîãî ôàêòîðà, ñîïðîâîæäàþòñÿ ïàòîãåíåòè÷åñêèìè íàðóøåíèÿìè â
ØÎÏ, ÷òî â ïðàêòèêå ñóäåáíî-ìåäèöèíñêèõ èññëåäîâàíèé ïðåäîïðåäåëÿåò êîìïëåêñíîñòü îáñëåäîâàíèÿ ïðè ýêñïåðòèçå æèâûõ ëèö.
2. Îòñóòñòâèå åäèíûõ ñóäåáíî-ìåäèöèíñêèõ
êðèòåðèåâ äëÿ îöåíêè ñòåïåíè òÿæåñòè ÒØÎÏ îïðåäåëÿåò ïåðñïåêòèâíûå íàïðàâëåíèÿ íàó÷íûõ ðàáîò
ïî äàííîé òåìå, êîòîðûå äîëæíû áàçèðîâàòüñÿ íà
êîìïëåêñíîì ó÷¸òå ôóíêöèîíàëüíûõ è ñòîéêèõ ðàññòðîéñòâ çäîðîâüÿ.
3. Ñðåäè ìåòîäîâ êëèíè÷åñêîé äèàãíîñòèêè è
êëèíèêî-ìîðôîëîãè÷åñêîé âåðèôèêàöèè ïðè îöåíêå ñòåïåíè òÿæåñòè òåëåñíûõ ïîâðåæäåíèé ïðè
ÒØÎÏ ïåðñïåêòèâíûìè ÿâëÿþòñÿ îöåíêà ñîñòîÿíèÿ öåðåáðàëüíîé ãåìîäèíàìèêè, ðåàêòèâíîñòè
ÃÌ, ìåòîäû îöåíêè îïîðíî-äâèãàòåëüíûõ ôóíêöèé
ïîçâîíî÷íèêà.
Ïåðñïåêòèâû äàëüíåéøèõ èññëåäîâàíèé â
ýòîì íàïðàâëåíèè ñâÿçàíû ñ îïðåäåëåíèåì èíôîðìàòèâíîñòè êðèòåðèåâ íåèíâàçèâíîé äèàãíîñòèêè
äëÿ ïîâûøåíèÿ òî÷íîñòè ñóäåáíî-ìåäèöèíñêîé
îöåíêè ñòåïåíè òÿæåñòè ïîâðåæäåíèé.
Ëèòåðàòóðà
1.
2.
3.
4.
5.
6.
7.
8.
9.
Àâäååâ Ì. È. Ñóäåáíî-ìåäèöèíñêàÿ ýêñïåðòèçà æèâûõ ëèö / Ì. È. Àâäååâ. – Ì. : Ìåäèöèíà, 1968. – 376 ñ.
Àëåêñååíêî Þ. Â. Ñòðóêòóðà êëèíè÷åñêèõ ïðîÿâëåíèé è ìèíèìàëüíûå äèàãíîñòè÷åñêèå êðèòåðèè ëåãêèõ ÷åðåïíîìîçãîâûõ ïîâðåæäåíèé / Þ. Â. Àëåêñååíêî // Âåñòí. Âèòåá. ãîñ. ìåä. óí-òà. – 2002. – Ò. 1, ¹ 1. – Ñ. 90–95.
Àëèìîâà Ì. ß. Ðàçâèòèå ìåæäèñöèïëèíàðíûõ âçàèìîäåéñòâèé ïðè ëå÷åíèè ïàöèåíòîâ ñòîìàòîëîãè÷åñêîãî ïðîôèëÿ / Ì. ß. Àëèìîâà, Ì. Ê. Ìàêååâà, À. Â. Àëèìîâà // Àííàëû õèðóðãèè. – 2006. – ¹ 5. – Ñ. 23–26.
Àëü Àëàâíè Ñ. Â. Âëèÿíèå ðàñòèòåëüíûõ ïîëèôåíîëîâ íà èììóíîëîãè÷åñêèå è áèîõèìè÷åñêèå ïîêàçàòåëè ñëþíû ïðè
÷åðåïíî-ìîçãîâîé è ëèöåâîé òðàâìàõ / Ñ. Â. Àëü Àëàâíè, Î. Â. Äåíüãà // ³ñíèê ñòîìàòîëîã¿. – 2005. – ¹ 4. – Ñ. 39–41.
Áåðíàäñêèé Þ. È. Òðàâìàòîëîãèÿ è âîññòàíîâèòåëüíàÿ õèðóðãèÿ ÷åðåïíî-÷åëþñòíî-ëèöåâîé îáëàñòè / Þ. È. Áåðíàäñêèé. – 3-å èçä., ïåðåðàá. è äîï. – Ì. : Ìåä. ëèò., 2006. – 456 ñ.
Äìèòðèåâà À. Ì. Íåéðîðåíòãåíîäèàãíîñòèêà çàêðûòîé òðàâìû øåéíîãî îòäåëà ïîçâîíî÷íèêà (ìåòîäè÷åñêèå ðåêîìåíäàöèè) / À. Ì. Äìèòðèåâà, Â. Ä. Êðèâîùåêîâ, Ë. È. Áîðèñîâà. – Ïåðìü : ÏÃÌÀ, 2003. – 18 ñ.
Åîë÷èÿí À. Ñ. Ìóëüòèäèñöèïëèíàðíûé ïîäõîä ê õèðóðãèè êðàíèîôàöèàëüíîé òðàâìû / À. Ñ. Åîë÷èÿí // Ìàò-ëû 3-é
ñúåçäà íåéðîõèðóðãîâ Ðîññèè. – Ñïá. : 2002. – Ñ. 21–22.
Çàõàðîâ Â. Î. Èíòðàêðàíèàëüíàÿ ïàòîëîãèÿ ïðè êðàíèîôàöèàëüíîé òðàâìå / Â. Î. Çàõàðîâ // Ìàò-ëû III Ñúåçäà íåéðîõèðóðãîâ Ðîññèè, 4-8 èþëÿ 2002. – Ñàíêò-Ïåòåðáóðã, 2002. – Ñ. 26-27.
Êàëèíîâñêèé Ä. Ê. Ïðîôèëàêòèêà è ëå÷åíèå îñëîæíåíèé òðàâìàòè÷åñêèõ ïîâðåæäåíèé ÷åëþñòíî-ëèöåâîé îáëàñòè /
Ä. Ê. Êàëèíîâñêèé // Âåñòíèê íåîòëîæíîé è âîññòàíîâèòåëüíîé ìåäèöèíû. – 2004. – ¹ 2 – Ñ. 253-255.
394
³ñíèê ïðîáëåì á³îëî㳿 ³ ìåäèöèíè – 2015 – Âèï. 2, Òîì 3 (120)
ÑÓÄÎÂÀ ÌÅÄÈÖÈÍÀ
10. Êâàñíèöüêèé Ì. Â. Ðåàá³ë³òàö³ÿ õâîðèõ ³ç íàñë³äêàìè ëåãêî¿ ÷åðåïíî-ìîçêîâî¿ òðàâìè / Ì. Â. Êâàñíèöüêèé // Ìàòåð³àëè
II ç’¿çäó íåéðîõ³ðóðã³â Óêðà¿íè (Îäåñà, 14-18 âåðåñíÿ 1998ð.). – Ðåæèì äîñòóïó: http://www.intermag.kiev.ua/uan/bulet/
num6/4-40. html.
11. Êîðæ Ã. Ì. Ëå÷åíèå îðî-ôàöèàëüíûõ ïîâðåæäåíèé ïðè îñòðîé ìåõàíè÷åñêîé ÷åðåïíî-÷åëþñòíî-ëèöåâîé òðàâìå /
Ã. Ì. Êîðæ // Ìàò-ëû III Ñúåçäà íåéðîõèðóðãîâ Ðîññèè, 4-8 èþëÿ 2002. – Ñàíêò-Ïåòåðáóðã, 2002. – Ñ. 36-37.
12. Ëèìáåðã À. À. Ñïåöèàëèçèðîâàííîå ëå÷åíèå ïîâðåæäåíèé ëèöà ïðè ñî÷åòàííîé è ìíîæåñòâåííîé òðàâìå / À. À. Ëèìáåðã // Ñîâ. Ìåä. – 1987. – ¹ 10. – Ñ. 58-60.
13. Ìèðîíåíêî Ò. Â. Êë³í³êî-ä³àãíîñòè÷íà õàðàêòåðèñòèêà òà îñîáëèâîñò³ ë³êóâàííÿ íàñë³äê³â ëåãêî¿ ÷åðåïíî-ìîçêîâî¿
òðàâìè: àâòîðåô. äèñ. . . äîêòîðà ìåä. íàóê / Ò. Â. Ìèðîíåíêî. – Õàðê³â, 2001. – 22 ñ.
14. Ìîèñååíêî Â. À. Îñîáåííîñòè äèàãíîñòèêè è ëå÷åíèÿ ìåõàíè÷åñêèõ ïîâðåæäåíèé øåéíîãî îòäåëà ïîçâîíî÷íèêà: àâòîðåô. äèñ. íà ñîèñêàíèå íàó÷íîé ñòåïåíè äîêòîðà ìåä. íàóê: ñïåö. 14.00.22 «Òðàâìàòîëîãèÿ è îðòîïåäèÿ» /
Â. À. Ìîèñååíêî. – Ì., 1997. – 40 ñ.
15. Ïåðåäêîâ Ê. ß. Ùåëåïíî-ëèöüîâ³ ïîøêîäæåííÿ, ïîºäíàíàí³ ³ç ÷åðåïíî-ìîçêîâîþ òðàâìîþ : àâòîðåô. äèñ. íà çäîáóòòÿ íàóêîâîãî ñòóïåíÿ êàíä. . ìåä. íàóê: ñïåö. 14.01.22 «Ñòîìàòîëîã³ÿ» / Ê. ß. Ïåðåäêîâ. – Êè¿â, 1993. – 20 ñ.
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«Ñóäîâà ìåäèöèíà» / Å. Å. Ðîìàíîâà – Ì., 2006. – 24 ñ.
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ñïåö. 14.01.15 «Òðàâìàòîëîã³ÿ ³ îðòîïåä³ÿ» / Ä. Þ. Ñàéêî. – Õàðê³â, 2007. – 21 ñ.
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ÓÄÊ 340. 6:616. 711. 1-001. 5-079. 5
ÏΪÄÍÀͲ Ò²ËÅÑͲ ÓØÊÎÄÆÅÍÍß ØÈÉÍÎÃΠ²ÄIJËÓ ÕÐÅÁÒÀ ÒÀ ÙÅËÅÏÍÎ-ËÈÖÜÎÂÀ ÒÐÀÂÌÀ:
ÑÓÄÎÂÎ-ÌÅÄÈ×ÍÈÉ ÀÑÏÅÊÒ
Ìèõàéëè÷åíêî Á. Â., Ôðàí÷óê Â. Â., Ãðèãîðîâ Ñ. Í., Øêëÿð À. Ñ.
Ðåçþìå. Âèçíà÷åíî, ùî òðîàâìè øèéíîãî â³ää³ëó õðåáòà ÷àñòî ìàþòü ïîºäíàíèé õàðàêòåð ç óøêîäæåííÿì ëèöåâîãî ÷åðåïà, óíàñë³äîê ñï³ëüíîãî á³îìåõàí³÷íîãî ôàêòîðà, ùî â ïðàêòèö³ ñóäîâî-ìåäè÷íèõ
äîñë³äæåíü âèçíà÷ຠïîòðåáó ó êîìïëåêñíîìó îáñòåæåíí³. Ñåðåä ìåòîä³â êë³í³÷íî¿ ä³àãíîñòèêè òà êë³í³êîìîðôîëîã³÷íî¿ âåðèô³êàö³¿ ïðè îö³íö³ ñòóïåíÿ òÿæêîñò³ ò³ëåñíèõ óøêîäæåíü ïðè òðàâìàõ øèéíîãî â³ää³ëó
ïåðñïåêòèâíèìè º: îö³íêà ñòàíó öåðåáðàëüíî¿ ãåìîäèíàì³êè, ðåàêòèâíîñò³ ÃÌ, ìåòîäè îö³íêè îïîðíî-ðóõîâèõ ôóíêö³é õðåáòà.
Êëþ÷îâ³ ñëîâà: øèéíèé â³ää³ë õðåáòà, ëèöüîâèé ñêåëåò, ñóäîâî-ìåäè÷íà åêñïåðòèçà, ò³ëåñí³ óøêîäæåííÿ.
³ñíèê ïðîáëåì á³îëî㳿 ³ ìåäèöèíè – 2015 – Âèï. 2, Òîì 3 (120)
395
ÑÓÄÎÂÀ ÌÅÄÈÖÈÍÀ
ÓÄÊ 340. 6:616. 711. 1-001. 5-079. 5
ÑÎ×ÅÒÀÍÍÛÅ ÒÅËÅÑÍÛÅ ÏÎÂÐÅÆÄÅÍÈß ØÅÉÍÎÃÎ ÎÒÄÅËÀ ÏÎÇÂÎÍÎ×ÍÈÊÀ È ×ÅËÞÑÒÍÎËÈÖÅÂÀß ÒÐÀÂÌÀ: ÑÓÄÅÁÍÎ-ÌÅÄÈÖÈÍÑÊÈÉ ÀÑÏÅÊÒ
Ìèõàéëè÷åíêî Á. Â., Ôðàí÷óê Â. Â., Ãðèãîðîâ Ñ. Í., Øêëÿð À. Ñ.
Ðåçþìå. Ïîêàçàíî, ÷òî òðàâìû øåéíîãî îòäåëà ïîçâîíî÷íèêà çà÷àñòóþ èìåþò ñî÷åòàííûé õàðàêòåð ñ
òðàâìàìè ëèöåâîãî ñêåëåòà è, íàîáîðîò òðàâìû ëèöåâîãî ñêåëåòà, âñëåäñòâèå îáùåãî áèîìåõàíè÷åñêîãî ôàêòîðà, ÷òî â ïðàêòèêå ñóäåáíî-ìåäèöèíñêèõ èññëåäîâàíèé ïðåäîïðåäåëÿåò êîìïëåêñíîñòü îáñëåäîâàíèÿ ïðè ýêñïåðòèçå æèâûõ ëèö. Ñðåäè ìåòîäîâ êëèíè÷åñêîé äèàãíîñòèêè è êëèíèêî-ìîðôîëîãè÷åñêîé
âåðèôèêàöèè ïðè îöåíêå ñòåïåíè òÿæåñòè òåëåñíûõ ïîâðåæäåíèé ïðè òðàâìàõ øåéíîãî îòäåëà ïåðñïåêòèâíûìè ÿâëÿþòñÿ îöåíêà ñîñòîÿíèÿ öåðåáðàëüíîé ãåìîäèíàìèêè, ðåàêòèâíîñòè ÃÌ, ìåòîäû îöåíêè îïîðíî-äâèãàòåëüíûõ ôóíêöèé ïîçâîíî÷íèêà.
Êëþ÷åâûå ñëîâà: øåéíûé îòäåë ïîçâîíî÷íèêà, ëèöåâîé ñêåëåò, ñóäåáíî-ìåäèöèíñêàÿ ýêñïåðòèçà,
òåëåñíûå ïîâðåæäåíèÿ.
UDC 340. 6:616. 711. 1-001. 5-079. 5
Combined Injuries of the Cervical Spine and Ma x illofacial Trauma: Forensic Medical Aspects
Mikhaylichenko B. V., Franchuk V. V., Grigorov S. N., Shkliar A. S.
Abstract. The aim of the work is the content analysis of pathogenetic preconditions of improving forensic
e x pertise of the cervical spine injuries (isolated and combined with injuries of the facial skeleton) in living persons.
Results and discussion. It has been found out that the factor, determining the combination of the cervical spine
injuries (CSI) and ma x illofacial trauma, is an anatomical, topographical and functional unity of cranial and facial
parts of the skull. The specific feature of the combined trauma is that the brain damage can occur in the absence of
impact on the cranial vault as well, i. e. such injuries can be caused by the traumatic agent`s intervention, or by the
influence on the cranial and facial parts of the skull simultaneously. The analysis of CSI when having a ma x illofacial
trauma and its consequences has shown that the vast majority of victims have various intracranial manifestations:
due to computed tomography (CT), focal damage of the frontal and temporal lobes of the brain is dominant, as well
as fractures of the base of the anterior cranial fossa, accompanied by nasal cerebrospinal fluid. Minimal diagnostic
criteria for mild brain injuries in patients with suspected mild CSI can assume the presence of mild focal symptoms
of fractures of the cranial vault, subarachnoid hemorrhage and changes of brain matter.
At the same time, heavy ma x illofacial traumas bother to assess the severity of CSI. Bleeding in the eyelid fiber
and eye sclera simulates a fracture of the skull base and makes it difficult to study the function of oculomotor nerves
and e x amine the eyeground. The trigeminal, facial, oculomotor nerve damage can simulate focal symptoms. Jaw
injury, falling back of tongue, obstruction of the upper airway with mucus, blood, and bone fragments, teeth debris
and dentures cause obturation of the upper respiratory tract, respiratory failure, worsening brain hypoxia. Sinus
damage, being observed while fracture of the frontal bone, ma x illa or nasal bones, contributes to ascending
infection; when liquorrhea it leads to the formation of cerebrospinal fluid fistula. Reactive edema, accompanied the
facial and jaw injuries, the development of inflammatory infiltrates lead to compression of the neck vessels, deep
facial veins, causing venous stasis and promoting the rise of brain edema.
Due to analysis of our own observations, the CSI and traumas of paravertebral tissues in males (67.0 % of cases)
are dominated, more than half of cases occur in working age of 20-50 (65.5 % of cases). Among the causes of
the CSI and traumas of paravertebral tissues household injuries are on the first place. In the structure of the CSI
and traumas of paravertebral tissues rotary sublu x ation of the atlas are dominated − more than 60.0 % of cases.
Vertebral fractures are 19.0 % of cases; post-traumatic myositis, damage of ligamentous apparatus of the cervical
spine cover 6.0 % of cases; post-traumatic instability − 4.2 % of cases, the cervical spine contusion − 9.0 % of cases.
Noteworthy is that the forensic diagnosis is not always carried out with additional investigations and involving
necessary professional consultants. Thus, only in 11.5 % of cases of rotary sublu x ation of the atlas computed
tomography was carried out allowing to diagnose this type of injury objectively indeed. Only in 34.0 % of cases
the victims with such injuries were consulted by a neurologist, who established the corresponding neurological
symptoms. We should like to draw your attention of the fact that the x -rays of the cervical spine in most e x aminations are performed in standard projections; additional projections − functional lateral projection, oblique projections, the anteroposterior projection through the mouth − are not carried out. Radiography of traumatic changes
of the intervertebral discs, joint capsules, ligament apparatus and paravertebral tissues is carried out at a scoping
study only in two projections, which in some cases can be uninformative.
It has been shown that the CSI are often combined with injuries of the facial skeleton, and vice versa injuries
of the facial skeleton, due to the general biomechanical factors, are accompanied by pathogenic abnormalities
in the cervical region, that in the practice of forensic research determines the comprehensive e x amination of
living persons. Among the methods of clinical diagnosis, and clinical and morphological verification in evaluating
the severity of injuries in case of the CSI the assessment of cerebral hemodynamics, brain reactivity, methods of
assessment of locomotor spine function are considered to be prospective.
Keywords: cervical spine, facial skeleton, forensic e x pertise, injuries.
Ðåöåíçåíò – ïðîô. Àâåò³êîâ Ä. Ñ.
Ñòàòòÿ íàä³éøëà 27. 02. 2015 ð.
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