ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS

Mykola Ivanovych Khvysuk

Staff of "Orthopedics, Traumatology and Prosthetics" — Sun, 14 Apr 2024 00:00:00 +0300

The article is devoted to Khvysuk M. I.

PHYSICAL THERAPY IS AN INTEGRAL PART OF THE SURGICAL TREATMENT OF VALGUS DEFORMITY OF THE FIRST TOE

Borys Pustovoit, Pustovoit Pustovoit, Volodymyr Staude, Mykola Tokhtamyshev — Sun, 14 Apr 2024 00:00:00 +0300

Objective. Determining the effectiveness of physical therapy in the surgical treatment of valgus deformity of the first toe. Methods. The clinical material of the conducted study includes 38 observations, 34 patients (38 operative interventions, 4 patients — on 2 feet. In the control group (CG) there were 16 patients (16 interventions), and in the main group (MG) — 18 patients (22 interventions). All patients who participated in the study had the same
diagnosis — hallux valgus II–III degree. All patients received the same type of surgical intervention — a variant Z-shaped osteotomy of the first metatarsal bone according to the Scarf method or Chevron, which was supplemented with osteotomy of proximal phalanges of the I finger to Akin method. Patients were examined with the Visual-Analogue Scale (VAS), the Physiotherapy Clinical Outcome Variables (COVS) Motor Skills Testing Scale, and the American Orthopedic Foot and Ankle Society (AOFAS) Scale (module 2) for the Clinical Evaluation of Foot and Ankle Diseases of the American Foot and Ankle Association. Rehabilitation of MG patients consisted of developed physical therapy (PT) program, which included 4 periods. Rehabilitation included not only
massage and exercises for the muscles of the front part of the foot, but also a complex of rehabilitation methods aimed to restore the function of the muscles of both lower limbs, hips and buttocks. PT program for KG consisted only of morning hygienic gymnastics, classical massage and therapeutic exercises to restore function of muscles of the foot and lower leg. Results. Assessment of the condition of patients after the end of PT on the COVS scale
helped to conclude that the patients of MG have significantly better indicators of general physical activity than patients of CG. Analysis of the obtained results according to the (AOFAS) Scale confirmed that patients of MG after using developed PT program have statistically better results. Conclusions. The developed PT program significantly accelerate the clinical recovery of function not only the front part of the foot, but also general working capacity of patients.

Natalija Oleksandrivna Ashukina

Staff of "Orthopedics, Traumatology and Prosthetics" — Sun, 14 Apr 2024 00:00:00 +0300

The article is devoted to Ashukina N. O.

THE LIFE AND CREATIVE PATH OF MYKOLA PETROVYCH NOVACHENKO (TO THE 125TH ANNIVERSARY OF HIS BIRTH)

Mykola Korzh, Volodymyr Tankut, Inna Golubeva, Mykola Rykun — Sun, 14 Apr 2024 00:00:00 +0300

The article is devoted to the outstanding orthopedist-traumatologist, scientist and surgeon, talented organizer, wonderful
teacher Nikolai Petrovich Novachenko.

META-ANALYSIS OF RAVITCH AND NUSS PROCEDURES FOR THE TREATMENT OF FUNNEL-SHAPED CHEST DEFORMITY IN CHILDREN AND ADOLESCENTS

Olena Karpinska, Anatolii Levytskyi, Vlasii Pylypko — Sun, 14 Apr 2024 00:00:00 +0300

Funnel-shaped chest deformity is the most common anomaly of the chest wall development, occurring in 8 out of every 1 000 children. The defect is noticeable at birth in approximately 86 % of patients with chest deformity. Objective. To conduct a systematic review comparing the treatment of funnel-shaped chest deformity in children and young people under 20 years of age by surgical methods according to Ravitch and Nuss by the number of complications that occur in the short (up to 30 days) and long-term periods (2–3 years). Methods. A search of scientometric databases revealed 1 734 sources, of which 8 papers were selected for further analysis. Results. We evaluated systematic reviews and meta-analyses comparing methods
of treatment of lumbar deformity in children and adolescents. It was determined that there are currently no randomized trials comparing these procedures in children and adolescents. A comparative analysis of the risk of complications in the surgical treatment of the funnel-shaped sternum in children and young adults using the Ravitch and Nuss methods determined that there is no difference in the overall incidence of complications between the Nuss and Ravitch procedures when considering the pediatric population in terms of overall, early, and late complications. With the development of the Nuss technology, complications associated with plate mixing are practically non-existent, and the development of new methods of controlling
operations, anesthesia and further patient management has reduced the development of both postoperative and long-term complications. Conclusions. According to the results of the meta-analysis of the risk of early and late complications, it is impossible to definitively determine the advantage of any surgical method for the correction of lumbar deformity of the chest. The number of Nuss surgeries has been increasing over the years, which means that the minimally invasive approach is the method of choice for patients and surgeons, although questions remain about achieving structural stability and
the method of Nuss correction in severe deformities. The lack of definitive conclusions is more related to the methodological problems of the analyzed data, including a limited number of observations and a large age difference in the observation groups, the lack of a standard for presenting data to describe the patient's condition (magnitude and type of deformity, primary complications of the cardiac and respiratory systems, the presence of complicating factors).

Modern Technologies for Bone Defect Replacement (Literature Review)

Sun, 14 Apr 2024 00:00:00 +0300

Information is provided regarding the materials used to replace bone defects caused by gunshot wounds. Materials and various
techniques for replacing bone defects of the limbs are described. Goal. Conduct an analysis of surgical technologies and materials for the replacement of bone defects, by analyzing literary sources. Methods. In three reputable databases (PubMed, Scopus, and Web of Science), an analysis of the latest scientific studies devoted to the treatment of defects of long tubular bones in the period from 2015 to 2022 was carried out. The search was carried out using the keywords "bone defects", "autograft", "allograft", "Ilizarov method", "Masquelet method", "biocomposite materials". The results. Analysis of osteoinductive and osteoconductive properties of auto- and allografts, modern biocomposite materials. Established advantages and disadvantages. The contemporary analysis of literary sources does not provide an objective comparative assessment of the effectiveness of the treatment of bone defects according to the Masquelet and Ilizarov method due to the lack of a sufficient number of randomized studies, which is the basis for further targeted research. Conclusions. Treatment of bone tissue defects of various genesis is an urgent problem of modern orthopedics and traumatology. The wide range of treatment options is proof that no single strategy works for every patient, just as there is no perfect universal material to fill and ensure bone regeneration in the defect site. A promising direction is the search for new or a combination of known materials and methods, which are able to maximally provide compensation for these pathological conditions.

Comparative Characteristics of Patients Structure in the Orthopedics Department of a Clinical Hospital in a Region Remote from the Front Line during Peacetime and the First Year of a Full-Scale War in Ukraine

Sun, 14 Apr 2024 00:00:00 +0300

Objective. To analyze changes in the nosological structure of patients, treatment technologies, to outline the peculiarities
of surgical interventions in the trauma profile of a civilian clinical hospital during the war period and to emphasize the need
for relevant knowledge and skills of specialists in the treatment of combat trauma and its consequences.Methods. A comparative analysis of the clinical and nosological structure of 2,475 patients were treated during the year before the war and 3,838 patients during the full-scale war year. Among them, 83.1 % were civilians, 7.7 % were temporarily resettled, and 9.2 % were military personnel. The study utilized bibliosemantic, medical-statistical, and clinical methods. Results. During the active phase of the war, the Orthopedics Department of the civilian clinical hospital provided specialized medical assistance to both civilian populations and military personnel injured during hostilities. The relative number of hospitalized men increased by 4.83 %, and although the absolute number of those urgently hospitalized decreased. Despite the overall increase in the number of
operations per patient, surgical activity in the Orthopedics Department decreased from 86 to 80 %. The intensification
of inpatient treatment organization, patient preparation for subsequent stages of surgical interventions in the Rehabilitation
Department, and outpatient medicine work collectively reduced the average bed-day in the Orthopedics Department by 12.3 %.
Conclusions. Thus, during the war, the structure of patients in the Orthopedics Department of the civilian medical clinical
institution changed, with an increase in the relative number of male patients and those with multiple and combined injuries.
A notable feature of the treatment process organization during hostilities is the phasing of the treatment of the wounded not
only at the levels of medical evacuation but also within the clinical hospital. The intensification of the organizational component
and the outpatient link of the treatment process allowed for a reduction in bed-days and the provision of inpatient treatment to
a larger number of patients.

COMPUTER NAVIGATION AND ROBOTIC SURGERY DURING TOTAL KNEE ARTHROPLASTY

Ihor Zazirnyi — Sun, 14 Apr 2024 00:00:00 +0300

Total knee arthroplasty (TKA) is a successful treatment for knee osteoarthritis. The emphasis on optimal sizing and alignment
of the components has led to an increase in the use of tools that allow for preoperative planning and verification of intraoperative steps. Computer navigation and robotic surgery have emerged as valuable tools for planning and performing surgery with greater precision and consistency. Objective. The aim of this paper is to organise information on the use of robotic systems in total knee arthroplasty based on own personal experience and analysis of contemporary literature sources. Methods. This study analysed professional articles that discussed the advantages and disadvantages of using robotic systems during knee arthroplasty. The information was obtained from electronic databases including PubMed, Scopus, Web of Science and Google Scholar, with a search span of over 20 years. Computerised or navigation devices allow the surgeon to enter anatomical data via an interface and receive feedback on the alignment of the implant and the knee as a whole, but cannot be programmed to perform additional tasks. Currently, several patented systems are available, and rapid technological advances in computer processing power have allowed for the rapid development of robotic surgical systems. Robotic systems usually provide feedback similar to navigation systems, but they can also be programmed to assist in specific surgical tasks. It is expected that these systems will become more reliable and accurate in the future, potentially leading to a reduced role for physicians in certain aspects of the surgical process, limiting their involvement to supervision, and thus improving the workflow of the operating room. The integration of new technologies, such as mixed reality, which overlays simulated images on real-life images, is expected to further expand the range of capabilities of these devices. But for now, it is crucial to establish the long-term outcomes of robotic-assisted total knee arthroplasty as a process to determine the viability of widespread adoption of these devices.

ПОПЕРЕКОВА ДИСКЕКТОМІЯ З ДЕКОМПРЕСІЄЮ КАНАЛУ ЗА СИСТЕМОЮ DESTANDAU ENDOSPINE

Kumar Sahu Dr. Santosh , Kar Dr. Dattatreya — Sun, 14 Apr 2024 00:00:00 +0300

Lumbar disc herniation is a common disease. There is severe pain in the buttock and leg, which may persist for more than 6 weeks even after conservative treatment. Currently, there are several surgical techniques for the treatment of lumbar disc herniation, ranging from laminectomy to microdiscectomy.
The main advantages of endoscopic discectomy include: cosmetic appeal, minimally invasive nature, better visualization, shorter hospital stay and faster recovery. Objective. This article reviews discusses the management of patients with degenerative diseases of the lumbar spine by Destandau Endospine system. The authors shares his experience of the surgical technique and the results of percutaneous endoscopic discectomy using the Destandau system during the treatment of 51 patients with herniated disc and canal stenosis in the lumbar spine. The main advantages of the Destandau endoscopic system are a small skin incision and minimal damage to soft tissues. This is a minimally invasive intervention, which is applied through a skin incision 1.5–2 cm long. In order to ensure the accuracy and safety of the patient both before and during the operation, fluoroscopy is used. Under the control of an endoscope, the herniated intervertebral disc, free fragments of the disc are removed and the pinched nerve is released. Thus, rapid recovery is achieved during postoperative rehabilitation. Conclusions. The endoscopic system can be used to treat all types of intervertebral disc herniations and associated canal stenosis. It is a relatively safe procedure, provided proper preoperative planning and an experienced team of doctors. Most lumbar pathologies that are
not related to instability can be successfully resolved with its help. The two main advantages of the Destandau endospinal system include minimally invasive surgery with minimal iatrogenic damage and excellent efficacy. In the case of its successful application, the recovery process is significantly shortened, without any restrictions for returning to everyday life.

THE USE OF A TRAINING 3D-MODEL IN THE TREATMENT OF A PATIENT WITH A PATHOLOGICAL FRACTURE OF THE PROXIMAL PART OF THE FEMUR (CASE FROM PRACTICE)

Oleg Drobotun, Sergii Konovalenko, Mykola Ternovyi — Sun, 14 Apr 2024 00:00:00 +0300

Prostate cancer is the second most common cause of malignancy in men, with bone metastases being a significant source of morbidity and mortality in advanced cases. Objective. To give a clinical example of a patient with a pathological transtrochanteric fracture of the right femur with displacement
of fragments, the presence of metastasis at the fracture site, to emphasize the importance of 3D-training before surgery. Methods. A clinical example with a significant impairment of the function of the right lower extremity against the background of a significant pain syndrome is given. The diagnosis was established: pathological transtrochanteric fracture of the right femur with displacement of fragments, the presence of metastasis at the fracture site. Pre-surgical training was carried out using a 3D-model and total endoprosthetics of the right hip joint with a revision individual implant of the cement fixation
type was carried out. The patient fully recovered the function of the right lower limb and hip joint, the pain syndrome was eliminated, and sleep normalized. The use of a 3D-model for preoperative training of surgeons made it possible to rationally limit traumatization of healthy tissues during tumor removal,
prevent possible complications and optimize the time of surgical intervention and thus minimize blood loss. Conclusions. The use of a training 3D-model before surgery followed by prosthetics with a special oncological endoprosthesis provided satisfactory functional results and restoration of the patient's quality of life in the given clinical case. The use of a 3D-model is the key to careful preparation for surgical intervention, taking into account the individual anatomical features of the pathological process and adjacent tissues, which allows you to significantly optimize the terms of the operation and reduce blood loss, and also provides valuable experience for further surgical practice.

EARLY RESULTS OF SHOULDER ARTHRODESIS WITH 3D-TITANIUM IMPLANTS FOR TREATMENT OF SEVERE GUNSHOT WOUNDS OF THE SHOULDER GIRDLE

Stanislav Bondarenko, Oleksandr Fomin, Iurii Lazarenko — Sun, 14 Apr 2024 00:00:00 +0300

As a result of large-scale war in Ukraine, the frequency of gunshot wounds of the upper extremities has increased dramatically, accompanied by massive damage to soft tissue, neurovascular plexuses, and significant bone deficiency, so their treatment with traditional methods is risky. This leads to the development of new treatment methods, in particular, techniques for shoulder arthrodesis. Objective. To investigate the effectiveness of shoulder arthrodesis using an individual 3D-titanium implant and or a locked compression plate (LCP) with bone autoplasty for the treatment of severe combat trauma of the upper extremity. Methods. In 2022–2023, 19 men aged 36.2 (24–52) years with severe combat trauma of the upper extremity underwent shoulder arthrodesis using individual 3D-titanium implants (n = 9) or LCP with bone autoplasty (n = 10). The follow-up period was 18 months. Individual 3D-implants were created in the CAD program Autodesk Fusion 360 and made of Ti6AI4V alloy by three- dimensional metal 3D-printing. The functional status of the shoulder joint was assessed by the Oxford Shoulder Score, VAS at 6 and 12 months after surgery. Fusion was checked radiographically at 1, 3, 6 and 12 months. Results. The average follow-up period was 12 months. Ankylosis of the shoulder joint was formed in 18 (95 %) patients, and clinical consolidation without final restructuring with a positive tendency to bone fusion was detected in one patient (5 %). Radiologically confirmed fusion in 8.5 months (6–12). After 12 months, a decrease in pain (VAS: 5 to 1 points; p < 0.001) and improvement in the condition of the shoulder (Oxford Shoulder Score: 25 to 40 points, p < 0.001) were found compared with 6 months. Conclusions. Treatment of severe combat trauma of the upper extremity by shoulder arthrodesis allows to eliminate pain and restore sufficient function to perform daily tasks one year after surgery. The combination of shoulder arthrodesis with individual 3D-implants resulted in the restoration of upper limb function in all 9 patients with massive bone and muscle defects.

ANALYSIS OF THE RESULTS OF PERCUTANEOUS VERTEBROPLASTY OF COMPRESSION FRACTURES OF BODIES OF CHEST AND LUMBAR VERTEBRAE ON THE BACKGROUND OF OSTEOPOROSIS

Andrii Popov, Mykyta Moloduk — Sun, 14 Apr 2024 00:00:00 +0300

It is well known that the most frequent complication of osteoporosis is compression fractures of vertebral bodies. In addition to brittleness of the bones and mechanical stress, more and more evidence approving that compression fractures of vertebral bodies are related to many risk factors, such as aging, sex, concomitant morbidities of cardiovascular and cerebrovascular diseases and lifestyle (chronic smoking and alcohol consumption) are collected. Objective. Analyzing the condition of spines of the patients suffering from compression fractures of vertebral bodies on the background of osteoporosis after the performed Percutaneous vertebroplasty (PV). Methods. 553 patients who underwent hospital treatment at the spine pathology clinic of the Sytenko Institute of Spine and Joint Pathology (2005–2022) and underwent PV were examined. Results. The patients were divided into three groups depending on the number of damaged vertebrae. The 1st group included the patients with compression fractures of one vertebra (185 — 33.4 %); the 2nd group included the patients having 2 or 3 deformed vertebrae (216 — 39 %); and the 3rd group included the patients with 4–5 damaged vertebrae (152 — 27.4 %). Stages of compression of vertebral bodies during the X-ray morphometry was as follows before the surgery: I — 349 (24 %) vertebrae; II — 494 (34 %); III — 552 (38 %); and IV — 58 (4 %). We achieved the reduction of the level of compression of vertebral bodies as a result of PV in 20 % of cases (patients who noticed the manifestation of the pain syndrome within 2 weeks mostly suffered from these deformations). Conclusions. The results of analysis of PV of 553 patients
with composite material and bone cement in the near and far future provide us an opportunity to state that this surgical treatment is an efficient and safe treatment method (despite the materials used). 40 (24 %) patients out of 165 patients of the group I, 52 (33 %) patients out of 157 patients of the group II and 54 (44 %) patients our of 133 patients of the group III were diagnosed with repeated compression fractures. Summarizing all the above, we should note that the more compression fractures the patient has, the higher the risk of further augmentation of other deformations of vertebral bodies is.

THE USE OF LABORATORY CRITERIA IN THE RISK ASSESSMENT OF POSTOPERATIVE COMPLICATIONS AFTER TRANSPEDICULAR FIXATION OF THE LUMBAR SPINE

Oleksandr Barkov, Vladyslav Tuliakov, Valerija Aplevich — Sun, 14 Apr 2024 00:00:00 +0300

Objective. To investigate the peculiarities of the development of postoperative complications after surgical treatment of degenerative diseases of the lumbar spine with transpedicular fixation of the vertebrae and their relationship with changes in preoperative laboratory parameters. Methods. A retrospective analysis of the biochemical examination data of 35 patients with degenerative diseases of the lumbar spine who underwent discectomy with
transpedicular fixation was performed. In four groups of patients with postoperative complications: 10 patients — inflammation of the what fabrics around metal structures and 5 patients — instability of the metal structure. The results of the examination of 20 people without specified complications served as a comparison group. Comparison was made with a control group (20 practically healthy people). Results. Patients have a significant increase in serum ALT activity by 42.29 and AST by 63.55 %, by 38.37 % of the level of CS content, by 37.21 % of total glycoproteins compared to those in the control group. In patients with soft tissue inflammation around the serum instrument zone, the content of LDLP was recorded by 29.27 %, by 23.53 % of the UA, by 12.34 % of TP results higher by 32.01 % ALT activity and 83 %, 49 % AST, 54.96 % AlP activity, 31.40 % — AlP/AcP, 60.47 % — concentration of CS, 95.57 % — total glycoproteins than in persons in the control group. In the serum of patients with the development of instability of metal structures, 28.55 % was observed by activity of the ALT, AlP — by 38.47 %, AcP — by 48.84 %, less by 58.35 % of AlP/AcP, the CHOL content of 13 88 %, higher by 25.43 % of the LDLP content than such persons in the control group. Content of the P was lower by 31.51 % and the Ca/P ratio was higher by 38.95 %, the content of CS by 83.72 %, total glycoproteins — by 48.83 %. Conclusions. Comparative analysis of the results of preoperative clinical and laboratory examination of patients with degenerative spinal diseases with transpedicular fixation which is reflected in the deviations of their preoperative laboratory parameters from such persons with uncomplicated course of the postoperative period after similar surgery.

USING THE PIPKIN CLASSIFICATION IN DETERMINING THE TREATMENT TACTICS OF FEMORAL HEAD FRACTURES

Sun, 14 Apr 2024 00:00:00 +0300

Femoral head fractures are a rare injury with limited information in the literature. Recent studies have been based on small case series, indicating that the incidence of fractures in hip dislocation varies from 7 to 18 %. Fractures of the femoral head are classified according to Pipkin. Treatment is often accompanied by significant complications, and the choice of the optimal treatment method remains a matter of debate. The choice of treatment tactics affects the duration of treatment and functional outcome. The article presents the results of treatment of patients whose treatment tactics were based on the Pipkin classification. Objective. To substantiate the use of the Pipkin classification of femoral head fractures in the selection of treatment and diagnostic tactics. Methods. The study was performed by evaluating the results of treatment in 44 patients. The Pipkin classification was used to determine the treatment tactics. The results were evaluated according to the HHS scale. The results were statistically analysed by comparing the median scores for different groups using the Mann-Whitney U test. Results. The worst prognosis was for patients with Pipkin III and Pipkin IV fractures. HHS scores for patients with complicated outcomes are worse than for patients with uncomplicated outcomes. Treatment outcomes for Pipkin type III fractures are statistically significantly lower than for other types. Conclusions. Pipkin fractures are a rare and severe injury that can cause significant limb dysfunction with proper treatment. Treatment of Pipkin type I and type II includes immediate reduction of the dislocation and conservative treatment in case of satisfactory fragmentation or open reduction with metal osteosynthesis for displaced fractures; for type III and IV, open reduction and osteosynthesis are possible for young patients, and primary arthroplasty is recommended for patients over 60 years of age or with concomitant metabolic diseases.

INFERIOR VENA CAVA COLLAPSIBILITY INDEX AS A NON-INVASIVE METHOD OF ASSESSING THE VOLEMIC STATUS OF PATIENTS DURING SPINE INTERVENTIONS

Mykhailo Ivachevskij, Andriy Rusyn, Vitalina Ivachevska — Sun, 14 Apr 2024 00:00:00 +0300

Objective. To prove the possibility of using non-invasive diagnostics of the volemic state of postoperative patients using ultrasound assessment of inferior vena cava collapsibility index. Methods. The study included 67 patients who underwent transpedicular fixation of the spine with laminectomy. Volemiс status
was determined for all participants in two ways: by catheterization of the central vein and determination of central venous pressure, as well as by ultrasound examination of the inferior vena cava and calculation of inferior vena cava collapsibility index. Results. According to the results of the invasive assessment
of central venous pressure, patients were divided into 3 groups: group I (patients in hypovolemic state, n = 31), group II (patients in euvolemic state, n = 25) and group III (patients in hypervolemic state, n = 11 ). The average values of central venous pressure indicators in patients of these groups were statistically significantly different from each other (p < 0.01). The difference between the mean values of the inferior vena cava collapse index in the respective groups was statistically significant (p < 0.01). A reliable inverse correlation of very high strength was found between the indicators of inferior vena cava collapsibility index and central venous pressure (p < 0.05). Conclusions. Determination of the patient's volemic state is an extremely important tool for the correct selection of the fluid volume management. Ultrasound assessment of volemic status has a number of advantages, such as the non-invasiveness of the method, wide availability, low price and speed of execution. According to the results of our study, the possibility of using inferior vena cava collapsibility index to assess the volemic status of patients has been demonstrated.

Systemic and cerebral hemodynamic changes in patients undergoing shoulder arthroscopy in the beach chair position

Kseniia Lyzohub, Mykola Lyzohub — Sun, 14 Apr 2024 00:00:00 +0300

Поєднання таких факторів як загальна анестезія та зміна положення тіла після індукції мають вплив на системну та церебральну гемодинаміку. Мета. Bиявити вплив зміни положення тіла та загальної анестезії на пікову систолічну швидкість внутрішньої сонної артерії (ПСШВСА) у пацієнтів під час проведення артроскопії. Методи. 85 пацієнтів із фізичним статусом за ASA I–II, середнього віку (33,0 ± 11,3) років, проведено артроскопію плечового суглоба під загальним наркозом. Основними вимірюваннями були систолічний артеріальний тиск (САТ), діастолічний артеріальний тиск (ДАТ), середній артеріальний тиск та ПСШВСА. Основні вимірювання: в положенні лежачи на столі перед індукцією, через 3 хв після введення в наркоз в положенні лежачи та в положенні пляжного крісла (ППК). Індукцію та забезпечення загальною анестезію проводили сибазоном, пропофолом і фентанілом. Дані проаналізовано статистично. Методи описової статистики використовували для розрахунку середнього, стандартного відхилення, мінімального і максимального значень вибірки. Порівняння проводили за допомогою Т-тесту для повторних порівнянь з розрахунком різниці середніх зі стандартним відхиленням (M ± SD), критичного значення критерію (t) та його статистичної значущості (p). Для порівняння динаміки зміни параметрів було проведено загальний лінійний аналіз з визначенням значення критерію Піллаї та його
значення. Аналіз проводився в пакеті IBM SPSS Statistics 20.0. Результати. Початкові дані САТ, ДАТ та середнього артеріального тиску достовірно знижувались після індукції та після позиціонування, але індукція не вплинула на показник ПСШВСА. Після позиціювання до ППК було констатовано значне зниження показників ПСШВСА. Висновки. Констатовано достовірне зниження САТ, ДАТ, середнього артеріального тиску після индукції та подальшого позиціювання хворих у ППК. Постіндукційна гіпотензія не впливає на динаміку ПСШВСА, але виявлено достовірне її зниження після позиціювання.