4
AEAAeAI?ss IAAeE*IEO IAOE OE?A?IE
?INOEOOO IAE?IO??O?A??
?iai? aeaaeai?ea A.I.?IIIAeAIIAA
OAeE 616.711:616.833.53+616.833.24:616.8-089-072.1:615.849.19
Oaian?e/oe Ieaenaiae? Oae?eniae/
IOIEOe?EIA EACA?IA AeENEAEOII?ss I?E AeENEIAAIIEO IIIA?AEIAI-E?EAEIAEO
?AAeEEOE?OAO
(ooi/iaiiy iieac?a, oaoiieia??, iaeaeeae/? oa a?aeaeaeai? ?acoeueoaoe
e?eoaaiiy)
14.01.05 – iae?io??o?a?y
AAOI?AOA?AO
aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy
eaiaeeaeaoa iaaee/ieo iaoe
Ee?a – 1998
Aeena?oaoe??th ? ?oeiien
?iaioa aeeiiaia a ?inoeooo? iae?io??o?a?? ?i. aeaae. A.I.?iiiaeaiiaa AII
Oe?a?ie
Iaoeiaee ea??aiee:
*eai-ei?aniiiaeaio AII Oe?a?ie, aeieoi? iaaee/ieo iaoe, i?ioani?
Iaaea/aiei ?aaai Aai?a?eiae/, ?inoeooo iae?io??o?a?? ?i. aeaae.
A.I.?iiiaeaiiaa AII Oe?a?ie, ea??aiee a?aeae?eo /a?aiii-iiceiai? o?aaie
oa ?? iane?aee?a. Aieiaiee iae?io??o?a IIC Oe?a?ie
Io?oe?ei? iiiiaioe:
*eai-ei?aniiiaeaio AII Oe?a?ie, aeieoi? iaaee/ieo iaoe, i?ioani?
Iie?uoe I.?. caa?aeoaa/ eaoaae?ith iae?io??o?a?? Ee?anueei? iaaee/ii?
aeaaeai?? i?neyaeeieiiii? ina?oe, IIC Oe?a?ie.
Aeieoi? iaaee/ieo iaoe, Ci??i Ieeiea Ieaenaiae?iae/, aeioeaio eaoaae?e
iae?io??o?a?? Aei?i?iiao?ianueei? aea?aeaaii? iaaee/ii? aeaaeai??, IIC
Oe?a?ie.
I?ia?aeia onoaiiaa: Oa?e?anueeee iaaee/iee oi?aa?neoao IIC Oe?a?ie
Caoeno a?aeaoaeaoueny ”23” ethoiai 1999 ?. i 12 aiae. ia can?aeaii?
niaoe?ae?ciaaii? a/aii? ?aaee Ae.26.557.01 ii caoenoo aeena?oaoe?e ia
caeiaoooy a/aiiai nooiaiy aeieoi?a iaaee/ieo iaoe ca oaoii
“iae?io??o?a?y” i?e ?inoeooo? iae?io??o?a?? ?i. aeaae. A.I.?iiiaeaiiaa
(252050, Ee?a, aoe. Iaio?euenueeiai, 32)
C aeena?oaoe??th iiaeia iciaeiieoenue o a?ae?ioaoe? ?inoeoooo
iae?io??o?a?? ?i. aeaae. A.I. ?iiiaeaiiaa AII Oe?a?ie (252050, Ee?a,
aoe. Iaio?euenueeiai,32)
Aaoi?aoa?ao ?ic?neaiee 20. 01. 1999?.
A/aiee nae?aoa?
niaoe?ae?ciaaii? a/aii? ?aaee
aeieoi? iaaee/ieo iaoe TH.I.I?eia
CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE
Aeooaeuei?noue oaie. O no/aniiio noni?euenoa? inoaioiiae?ic o?aaoa oa
aoi?eiii iei iaoiiaeai? aa?oaa?iiaa?ieia?/i? o?aaeaiiy a?aeiinyoueny
aei iaea?eueo iioe?aieo caoai?thaaiue (Iiiaeyinueeee ss.TH.,1989, Eooeee
A.A.,1998). No?ee? aie?, ni?e/eiai? inoaioiiae?icii, ? i?e/eiith
ao?aoe i?aoeacaeaoiino? oa ?iaae?ae?caoe?? aei 14 % ethaeae
iieiaeiai oa c??eiai a?eo. A aeayeeo noa?ao ae?iaieoeoaa e?euee?noue
aeiaaee?a caoai?thaaiiy, ye? i?eaiaeyoue aei ao?aoe i?aoeacaeaoiino?
eieeaa?oueny a?ae 14,5 aei 25,7 ia 100 i?aoe?aiee?a (Biering-Sorenson
F., 1983). A ca’yceo c oeei, inoaioiiae?ic o?aaoa ?icaeyaea?oueny ia
o?eueee ye iaaee/ia, aea ? ye nioe?aeueia i?iaeaia.
Iniiaieie iaoiaeaie e?eoaaiiy inoaioiiae?ico ? iaaeeeaiaioicia,
o?c?ioa?aiaaoe/ia oa naiaoi?ii-eo?i?oia e?eoaaiiy. Iaeiae, i?e ?yae?
oi?i oeueiai caoai?thaaiiy, caaaeii i?e aeeneiaaii?e iaoieia??,
eiina?aaoeaia e?eoaaiiy ia iiaea caaacia/eoe iie?auaiiy noaio oai?eo. A
ca’yceo c oeei ?ic?iaeai? iia?aoeai? iaoiaee e?eoaaiiy aeeneiaaiii?
iaoieia?? (Iie?uoe I.?. ? ni?aaao.; Eooeee A.A. ? ni?aaao.,1998 oa
?i.).
A 50 – 60 ?ieao iaoiai noi??//y aeiee iiaee iaoiae e?eoaaiiy
inoaioiiae?ico – ioieoe?eiee (Smith L., 1964, Inia A.?. ? ni?aaao.,
1966; *oaeiianueeee I.A., 1966; Eae?ie?i A.A., 1966 oa ?i.). C
e?eoaaeueiith iaoith ioieoe?th i?aeo?aaoeaaiai aeenea aeei?enoiaoaaee
Feffer H.J. (1956), Chapical H. (1957), Kek J. (1960), Leao K. (1960). A
1965 ?. Smith L., a iio?i Inia A.?., *oaeiianueeee I.A., Eae?ie?i
A.A. (1965,1966) ?ic?iaeee ioieoe?eia e?eoaaiiy inoaioiiae?ico iaia?iii.
A iiaeaeueoiio aoa cai?iiiiiaaiee ?yae ioieoe?eieo (/a?acoe??ieo)
iaoai?/ieo iaoiae?a aeaeaeaiiy ioeueiiciiai yae?a i?aeo?aaoeaaiai aeenea
(Hult L,1966).
Oaoi?/iee i?ia?an inoaii?o aeanyoee?oue cia/ii iioe?ea iiaeeeaino?
iae?io??o?a??. Iaeiei c iniiaieo aeinyaiaiue ? ai?iaaaeaeaiiy eaca?ieo
oaoiieia?e a iae?io??o?a?/io i?aeoeeo (Cicoey TH.I. ? ni?aaao. 1992;
?icoiaiei A.Ae.,1992), ye? ii/aee oe?iei canoiniaoaaoenue a
iae?iiieieia??, aiaeineii?/ieo oa noaeeiieo iia?aoe?yo.
Aaeineiiaeaiiy ioieoe?eii? aeeneaeoii?? iia’ycaii c aeei?enoaiiyi
eaca?iiai aei?ii?ithaaiiy aeey aeia?thaaiiy ioeueiiciiai yae?a
i?aeo?aaoeaaiai aeenea. Ioieoe?eia eaca?ia aeeneaeoii?y (IEAe),
?ic?iaeaia oa iienaia Asher P.W.o 1987 ?ioe?, a?aeiineoueny aei
iaei?iaaceaieo ioieoe?eieo ao?o/aiue. Aiie i?iaiaeyoueny, ye i?aaeei,
aiaoeaoi?ii, i?ae i?noeaaei ciaaiethaaiiyi, aeei?enoaiiy oe???
iai?ioeyoe?? ia iio?aao? aaeeei? e?eueeino? ?ino?oiaioa??th, i?e oeueiio
ia ii?ooo?oueny iii?ia ooieoe?y o?aaoa, i?i?i?co?oueny ?ene aeieeiaiiy
ai?aeo?aeueieo ?oaoeueiai – nia?/ieo i?ioean?a, cia/ii ciaioothoueny
no?iee ?aaa?e?oaoe?? oa ?aaaeaioaoe?? oai?eo.
?acii c oei, aei oeueiai /ano caeeoathoueny iaaea/aieie ieoaiiy iieac?a
aei i?iaaaeaiiiy ioieoe?eii? eaca?ii? aeeneaeoii??, aaniethoieo ?
a?aeiinieo i?ioeiieac?a aei ?? aeei?enoaiiy, ooi/iaiiy oaoiieia???
ao?o/aiiy. Iio?aaothoue aiae?co iaeaeeae/? ? a?aeaeaeai? ?acoeueoaoe
e?eoaaiiy, aeiaaeee oneeaaeiaiue ? iacaaeia?euei? ?acoeueoaoe.
Iiaeaeueoa aecia/aiiy ?ie?, cia/aiiy oa aoaeoeaiino? ioieoe?eii?
eaca?ii? aeeneaeoii?? a e?eoaaii? aeeneiaaiieo iiia?aeiai-e?eaeiaeo
?aaeeeoe?o?a aeicaieeoue ooi/ieoe iieace aei ?? canoinoaaiiy, e?eoa???
a?aeai?o oai?eo, oaoi?eo ao?o/aiiy, neoaoaaoe iie?auaiith oaeaeei?
nioe?aeueii? oa o?oaeiai? aaeaioaoe?? oai?eo ia aeeneiaaiiee
iiia?aeiai-e?eaeiaee ?aaeeeoe?o.
Iaoa aeine?aeaeaiiy: Ia iniia? ii??aiyeueiiai aiae?co ee?i?/ieo i?iya?a
? aeaieo ia’?eoeaieo iaoiae?a aeine?aeaeaiiy iaeaeeae/eo ? a?aeaeaeaieo
?acoeueoao?a e?eoaaiiy aecia/eoe iiaeeeaino? ioieoe?eii? eaca?ii?
aeeneaeoii?? a e?eoaaii? oai?eo c aeeneiaaiieie iiia?aeiai-e?eaeiaeie
?aaeeeoe?oaie, ooi/ieoe iieace ? iniaeeaino? ?? canoinoaaiiy.
Iniiai? caaaeaiiy aeine?aeaeaiiy:
1. Ooi/ieoe eiiieaen ianoaaeaiue, iaiao?aeiee aeey aecia/aiiy iieac?a oa
i?ioeiieac?a aei i?iaaaeaiiy ioieoe?eii? eaca?ii? aeeneaeoii?? i?e
aeeneiaaiieo iiia?aeiai-e?eaeiaeo ?aaeeeoe?oao.
2. Ooi/ieoe iieace aei ioieoe?eii? eaca?ii? aeeneaeoii??.
3. Aecia/eoe iniaeeaino? ioieoe?eii? eaca?ii? aeeneaeoii?? i?e
aeeneiaaiieo iiia?aeiai-e?eaeiaeo ?aaeeeoe?oao a caeaaeiino? a?ae
??aiy o?aaeaiiy ? nooiaith i?io?oc?? aeenea.
4. Aea/eoe aeeaei? oa a?aeaeaeai? ?acoeueoaoe e?eoaaiiy oai?eo c
aeeneiaaiieie iiia?aeiai-e?eaeiaeie ?aaeeeoe?oaie i?ney i?iaaaeaiiy
ioieoe?eii? eaca?ii? aeeneaeoii??.
5. I?iaanoe aiae?c oneeaaeiaiue ? iacaaeia?eueieo ?acoeueoao?a
e?eoaaiiy.
Iaoeiaa iiaecia iaea?aeaieo ?acoeueoao?a:
1. I?aeoaa?aeaeaia aoaeoeai?noue canoinoaaiiy eaca?ieo oaoiieia?e a
e?eoaaii? aeeneiaaiieo iiia?aeiai-e?eaeiaeo ?aaeeeoe?o?a.
2. Ooi/iaia ?ieue ioieoe?eii? eaca?ii? aeeneaeoii?? ye iaei?iaaceaiiai
o??o?a?/iiai ao?o/aiiy.
3. Ooi/iai? iieace aei i?iaaaeaiiy ioieoe?eii? eaca?ii? aeeneaeoii??,
iniaeeaino? ?? i?iaaaeaiiy a caeaaeiino? a?ae ??aiy o?aaeaiiy ? nooiaith
i?io?oc?? aeeneo.
4. Anoaiiaeai? i?iaiinoe/i? e?eoa??? ia?aa?ao caoai?thaaiiy i?ney
i?iaaaeaiiy ioieoe?eii? eaca?ii? aeeneaeoii??.
I?aeoe/ia cia/aiiy iaea?aeaieo ?acoeueoao?a: Ai?iaaaeaeaiiy a
iae?io??o?a?/io i?aeoeeo ioieoe?eii? eaca?ii? aeeneaeoii?? aeey
e?eoaaiiy oai?eo c aeeneiaaiiith iaoieia??th a?aee?eaa? iia?
iiaeeeaino? ?o o??o?a?/iiai e?eoaaiiy. Aeei?enoaiiy ioieoe?eii? eaca?ii?
aeeneaeoii?? aeicaiey? aeeiioaaoe ao?o/aiiy aiaoeaoi?ii, cia/ii
ciaioeoe /an ia?aaoaaiiy oai?eo o noaoe?iia??, ia e?ea?iyiiio eenoeo.
ssaeyth/enue ioieoe?eiei, aace?iaiei, ia iio?aaoth/ei ia?eico iaoiaeii,
ioieoe?eia eaca?ia aeeneaeoii?y aeicaiey? iie?ioeoe ?acoeueoaoe
e?eoaaiiy oai?eo c aeaiith iaoieia??th.
Ioieoe?eia eaca?ia aeeneaeoii?y ai?iaaaeaeaia o i?aeoe/io ?iaioo
a?aeae?eaiiy aiaeineii?/ii? iae?io??o?a?? ?inoeoooo iae?io??o?a?? ?i.
aeaae.A.I.?iiiaeaiiaa AII Oe?a?ie, oa Aei?i?iiao?ianueeiai iaeaniiai
iae?io??o?a?/iiai a?aeae?eaiiy.
Iniaenoee aianie caeiaoaa/a: Aaoi?ii naiino?eii i?iaiae?ciaaia
e?oa?aoo?a ca oaiith aeena?oaoe?eii? ?iaioe, i?iaaaeaii ?ioi?iaoe?eiee
iiooe ca aeiiiiiaith aace aeaieo “MEDLINE”. ?acii c iaoeiaei ea??aieeii
/e.ei?.i?io. Iaaea/aieii ?.A. noi?ioeueiaai? iaoa ? caaaeaiiy
aeine?aeaeaiiy, iaaiai?ai? ? noi?ioeueiaai? aeniiaee. Ee?i?/ia
ianoaaeaiiy oai?eo i?iaaaeaii aaoi?ii ?acii ?c ni?a?ia?oieeaie
a?aeae?eaiiy aiaeineii?/ii? iae?io??o?a?? ?inoeoooo iae?io??o?a??
?i.A.I.?iiiaeaiiaa AII Oe?a?ie. Ia?iaea iaea?aeaieo ?acoeueoao?a,
iaienaiiy iaeyaeo e?oa?aoo?e, ?icae?e?a aeanieo aeine?aeaeaiue aaoi?ii
aeeiiai? naiino?eii.
Ai?iaaoe?y ?acoeueoao?a aeena?oaoe??. Iaoa??aee aeena?oaoe?? aoee
i?aaenoaaeai? oa iaaiai?thaaeenue ia iaoeiai-i?aeoe/i?e eiioa?aioe??
iae?io??o?a?a Oe?a?ie (Neaayiiai?nuee,1997), eiioa?aioe?? iieiaeeo
a/aieo (A?iieoey,1998), ?? c’?cae? iae?io??o?a?a ?in?enueei? Oaaea?aoe??
(Ieaei?e Iiaai?iae, 1998), VI ?in?enueei-ssiiinueeiio i?aeia?iaeiiio
iaaee/iiio n?iiic?oi? (Oaaa?ianuee, 1998).
Aeena?oaoe?y ai?iaiaaia ia ni?eueiiio can?aeaii? A/aii? ?aaee
?inoeoooo iae?io??o?a?? ?i. A.I.?iiiaeaiiaa AII Oe?a?ie, eaoaae?
iae?io??o?a?? Ee?anueei? iaaee/ii? aeaaeai?? i?neyaeeieiiii? ina?oe ?
Iaoe?iiaeueiiai iaaee/iiai oi?aa?neoaoo 02 .10.1998 ?ieo.
Ioae?eaoe??. Ca iaoa??aeaie i?iaaaeaieo aeine?aeaeaiue iioae?eiaaii 5
ae?oeiaaieo i?aoeue, o oiio /ene? 4 aeo?iaeuei? noaoo? ? 1 ?iaioa o
ca??eao oac iaoeiaeo c’?cae?a.
Ianya oa no?oeoo?a aeena?oaoe??. Aeena?oaoe?th aeeeaaeaii ia 140
noi??ieao iaoeiiae?oeo, ?ethno?iaaii 32 oaaeeoeyie ? 14 oioia?ao?yie.
Aeena?oaoe?y neeaaea?oueny ?c anooio, 5 ?icae?e?a (iaeyae e?oa?aoo?e,
iaoiaee ? iaoa??ae aeine?aeaeaiue, iieace ? i?ioeiieace aei i?iaaaeaiiy
ioieoe?eii? eaca?ii? aeeneaeoii??, iniaeeaino? i?aeaioiaee oai?eo,
ioe?iea ?acoeueoao?a e?eoaaiiy) ? aeniiae?a. Iieaae/ee e?oa?aoo?e
aeeeaaeaiee ia 14 noi??ieao ? i?noeoue 142 iaeiaioaaiiy aeei?enoaieo
aeaea?ae. 1 aeiaeaoie i?noeoueny ia 8 noi??ieao.
INIIAIEE CI?NO
Iaoa??aee ? iaoiaee aeine?aeaeaiiy. Aeine?aeaeaiiy aeeiiaii ia
ee?i?/iiio iaoa??ae?. A iniiao ?iaioe iieeaaeaii aiae?c 183
niinoa?aaeaiue oai?eo c aeeneiaaiiei iiia?aeiai-e?eaeiaei ?aaeeeoe?oii,
a?eii a?ae 15 aei 74 ?ie?a, yeei aoea i?iaaaeaia ioieoe?eia eaca?ia
aeeneaeoii?y. Oai?? ia?aaoaaee ia e?eoaaii? o a?aeae?eaii?
aiaeineii?/ii? iae?io??o?a?? iae?io??o?a?? ?inoeoooo iae?io??o?a?? ?i.
aeaae.A.I.?iiiaeaiiaa AII Oe?a?ie a 1995-1997 ?ieao.
An?i 183 oai?ei aoea i?iaaaeaia ioieoe?eia eaca?ia aeeneaeoii?y ia
iaeiiio ??ai?. ?iciiae?e ii ??aith o?aaeaiiy i?aaenoaaeaii a oaae.1.
Oaaeeoey 1.
??aaiue o?aaeaiiyE?euee?noue oai?eo Aan. A %
L5 95 51,9 L4 81
44,2L1,L2,L3. 7 3,9 Onueiai: 183
100 %
Ee?i?ei – ?ino?oiaioaeueia ianoaaeaiiy oai?eo aeeiioaaeinue ca?aeii
noaiaea?oiiai ae?aaiinoe/iiai eiiieaeno (Iiiaeyinueeee ss.TH.,1989),
yeee aeeth/aa ioe?ieo oa a?aooaaiiy iayaieo iaa?ieia?/ieo neiioii?a. A
a?oio aaaeo/eo ie aeae?eeee ianooii? neiioiie: aieth/?noue
ia?aaa?oaa?aeueieo oi/ie, iayai?noue caoeniiai iai?oaeaiiy i’yc?a nieie,
neiioiie iaoyae?iiy (Eanaaa, Aana?iaia), neiioii eaoeueiaiai iiooiaoo,
iayai?noue iciae iiae?aciaiiy ia?aiaiai ei??ioey, oa?aeoa? ?iceaae?a
/ooeeaino?, ?ooia? ?iceaaee, noai ?aoeaen?a.
Oaeiae canoiniaoaaee ia’?eoeai? iaoiaee ianoaaeaiiy – niiiae?eia?ao?th,
aeno?aeio iiceoeaio i??eia?ao?th, aeeneia?ao?th, eiii’thoa?io
oiiia?ao?th, iaai?oii-?aciiainio oiiia?ao?th.
An?i oai?ei i?iaiaeeany caaaeueiee aiae?c e?ia? c iaoith aeeeth/aiiy
iayaiino? aino?eo oa o?ii?/ieo caiaeueieo i?ioean?a, iniaeeaa oaaaa
i?eae?eyeanue iieacieeai eaeeioeeoico ? OIA.
I?e i?iaaaeaii? ioieoe?eii? eaca?ii? aeeneaeoii?? aeei?enoiaoaaeenue
aieee aeiaaeeiith 18 ? 12 ni ae?aiao?ii 1,2 ii. Aeey eiio?ieth
iieiaeaiiy aieee o i?aeo?aaoeaaiio i?inoi?? canoiniaoaaany
aeaeo?iiii-iioe/iee ia?aoai?thaa/ “N??aiia?eue 2000” o??ie “N?iain”,
aeey aeia?thaaiiy aeei?enoaiee i?iaeeiiaee YAG eaca? o??ie “Aei?iue?”,
iniauaiee eaa?oeaaeie na?oeiaiaeaie ae?aiao?ii 600 i?e?ii.
Iaeaeeae/? oa a?aeaeaeai? ?acoeueoaoe e?eoaaiiy ioe?ithaaeenue iaie ca
o?ueiia oeaeaie: iiaeeo?eiaaieie oeaeaie Nurick ? Iacnab, oa
?ic?iaeaiith iaie oeaeith aaeueii? ioe?iee ?acoeueoao?a ao?o/aiiy.
Iiaeeo?eiaaia oeaea Nurick (OI) ( Iie?uoe I.? ? ni?aaao.,1997),
ia?aaeaa/a? 4 ??aiy ioe?iee noaio oai?iai, aea 1 ??aaiue- iiaiee ?aa?an
iaa?ieia?/ii? neiioiiaoeee, 2 – iie?ioaiiy, 3 – noai aac ci?i,
4-iia??oaiiy iaa?ieia?/iiai noaoono.
sse iieacaee ianooii? aeine?aeaeaiiy, ia caaaeaee a i?neyiia?aoe?eiiio
ia??iae? a?aei?/a?oueny ei?aeyoe?y noa’?oeaieo a?ae/ooo?a oai?iai ?
ia’?eoeaieo iieaciee?a (noai ?ooiai? ? ?aoeaeoi?ii? noa?e, aeai? I?O oa
?i.)
C iaoith ia?iaee oa ii??aiyiiy noa’?eoeaieo oa ia’?eoeaieo iieaciee?a
aeei?enoiaoaaeanue iiaeeo?eiaaia oeaea Iacnab (Casper G.D.,1998), yea
caniiaaia ia aeae?eaii? /ioe?ueio a?aaeaoe?e ?acoeueoao?a e?eoaaiiy, aea
1 nooi?iue – i?ae?ani? ?acoeueoaoe – neiioiiaoeea iiai?noth cieeea,
oai?? iiaa?ioeenue aei ?iaioe, 2 nooi?iue – a?aei?/a?oueny iieaaoaiiy
aea ia iiaia cieeiaiiy aieae (oaeiae iiaa?ioeenue aei ?iaioe), 3 no.-
noai aac ci?i, 4 no. – iia??oaiiy. I?e oeueiio ii??aithaaeenue
ia’?eoeai? oa noa’?eoeai? iieacieee noaio oai?eo. Ia’?eoeai? e?eoa???
aeeth/aee ioe?ieo iaa?ieia?/iiai noaoono, noaio /ooeeaino?, ?ooiaeo
?iceaae?a, a oaeiae noaoi-aeeiai?/ieo ii?ooaiue. Noa’?eoeai? e?eoa???
ia?aaeaa/aee ioe?ieo naiai noaio naieie oai?eie.
Aeey ia’?eoea?caoe?? io?eiaieo aeaieo iaie cai?iiiiiaaia oeaea aaeueii?
ioe?iee noaio iaa?ieia?/ieo neiioii?a, aea 0 – a?aenooi?noue neiioii?a,
1 – neaaei i?iyaeaia, iaiino?eia iciaea, 2 – iii??ii i?iyaeaiee, no?eeee
neiioii, 3– ?ioaineaii i?iyaeaiee, iino?eiee neiioii. Oey oeaea
caniiaaia ia o?aaeeoe?eieo e?eoa??yo ioe?iee iaa?ieia?/iiai noaio
oai?iai, ? oaeei /eiii a?eueoa aaeaioiaaia aeey aeei?enoaiiy oao?aoeyie
– iaa?ieiaaie ? iae?io??o?aaie. A caeaaeiino? a?ae cai?iiiiiaaii? oeaee
noai eiaeiiai oai?iai ioe?ithaaany noiith aae?a ii 7 neiioiiai a
ne?aeoth/? no?iee: aei iia?aoe??, aaciina?aaeiuei i?ney iia?aoe??, /a?ac
7 aei?a, 3 i?nyoe?, 6 i?nyoe?a ? 12 i?nyoe?a i?ney ao?o/aiiy. Oaeiae
i?iaaaeaii ni?anoaaeaiiy aeaieo iaai?oii-?aciiainii? oiiia?ao?? aei
iia?aoe?? ? a ??ci? no?iee i?ney i?iaaaeaiiy ioieoe?eii? eaca?ii?
aeeneaeoii??.
?acoeueoaoe aeine?aeaeaiue oa ?o iaaiai?aiiy.
sse na?ae/aoue e?oa?aoo?i? aeai? (Inia A.?.,1975) ? iao? niinoa?aaeaiiy,
aea?? iaoiaeo iia?aoeaiiai ao?o/aiiy aecia/a?oueny aeaoia a?oiaie
oaeoi??a:
1. Ee?i?/ieie iieacieeaie – ee?i?ei-iaa?ieia?/ia ea?oeia caoai?aaiiy,
a?e oai?eo, aeaai?noue caoai?thaaiiy ? inoaiiueiai caaino?aiiy, ee?i?/i?
iciaee noiooi?o ae?noeeoo, ai?aeo?eoo, aa??eico, ?ai?o i?iaaaeaia
o??o?a?/ia e?eoaaiiy ia oeueiio ??ai?, iayai?noue noiooiuei? niiaoe/ii?
iaoieia??.
2. Iieacieeaie ?ino?oiaioaeueieo (niiiae?eia?ao?y, i??eia?ao?y,
aeeneia?ao?y, eiii’thoa?ia aai iaai?oii-?aciiainia oiiia?ao?y) ?
eaai?aoi?ieo iaoiae?a ianoaaeaiiy.
Oaeiae iio??aii a?aoiaoaaoe eieae?caoe?th oa nooi?iue ?ioaineaiino?
aieueiaiai neiae?iio, iayai?noue ei??ioeaaeo oa /ooeeaeo ?iceaae?a, noai
?aoeaen?a, a oaeiae iayai?noue niiaoe/ii? iaoieia??.
Aeae?eai? o?e a?oie oai?eo:
1. Oai??, yeei aaniethoii i?ioeiieacaii i?iaaaeaiiy ioieoe?eii? eaca?ii?
aeeneaeoii??.
2. Oai??, yeei iieacaii iia?aoeaia e?eoaaiiy – ye ioieoe?eia eaca?ia
aeeneaeoii?y, oae ? a?aee?eoa iia?aoeaia ao?o/aiiy.
3. Oai??, yeei aaniethoii iieacaia ioieoe?eia eaca?ia aeeneaeoii?y.
Ioieoe?eia eaca?ia aeeneaeoii?y aaniethoii i?ioeiieacaia oai?ei c yaiith
niiaoe/iith iaoieia??th (iniaeeai i?aee?aneeii aeoeaiee ?aaiaoe/iee
i?ioean), ee?i?ei-eaai?aoi?ieie iciaeaie ae?noeeoo, i?e
?ioaeoe?eii-caiaeueieo i?ioeanao ye? noi?iaiaeaeothoueny noaoaa?eeueiith
oaiia?aoo?ith, i?aeaeuaiiyi OIA, eaeeioeeoicii, i?e ineo?/ieo ?iceaaeao
(i?e aa?aaaoe?? aieueiaiai neiae?iio), aocueeiio nieii-iiceiaiio
eaiae?, iayai?noth noiooiueiai ai?aeo?eoo, aa??eiciiio ?icoe?aii?
ai?aeo?aeueieo aai, aaa?oiino?, caoai?thaaiiyo e?ia? (aaiio?e??), i?e
?ai?oa i?iaaaeaieo iia?aoeaieo ao?o/aiiyo ia oeueiio ??ai? (aeeth/ath/e
iaia?i?caoe?th aeenea), a oaeiae i?e naeaano?aoe?? i?aeo?aaoeaaiai
aeeneo.
A?aeiinieie i?ioeiieacaie aei i?iaaaeaiiy IEAe ? ?ai?oa aaaaoi?aciai
i?iaaaeaia iaioaeueia oa?ai?y c iineeaiiyi aieueiaiai neiae?iio,
ia?aianai? o?aaie o?aaoa.
IEAe aaniethoii iieacaia i?e aeeneiaaiieo iiia?aeiai-e?eaeiaeo
?aaeeeoe?oao a noaae?? ethiaaai oa ?o?aea?? aac a?oaiai ?ooiaiai
aeaoaeoo i?e eee? aeenea iaio i?ae iaeia o?aoeia i?ina?oo
nieii-iiceiaiai eaiaeo, aai aei 6 ii. IEAe iniaeeai aoaeoeaia i?e
e?eoaaii? oai?eo o a?oe? a?ae 20 aei 50 ?ie?a i?e aeaaiino?
caoai?thaaiiy ia a?eueoa o?ueio ?ie?a ca oiiae iayaiino? inoaiiueiai
caaino?aiiy aei 6 i?nyoe?a. A oeo aeiaaeeao aea aoee aeeiiai? oe? oiiae,
iai aaeaeiny aeiaeoeny iaaaeii? no?eei? e?ea?aeaoe?? aieueiaiai
neiae?iio o an?o iia?iaaieo oai?eo. Iaiao?aeii a?aei?oeoe, ui
iayai?noue noiooiuei? niiaoe/ii? iaoieia?? (oeoe?iaee ae?aaao, o?ii?/i?
caoai?thaaiiy ie?ie, ia/?iee, eaaai?a) ia ? aaniethoieie i?ioeiieacaie
aei i?iaaaeaiiy IEAe.
Ao?o/aiiy i?iaiaeeeinue a oiiaao iia?aoe?eii? ca o/anoth iia?oth/iai
o??o?aa, iia?aoe?eii? iaaenano?e, aianoac?ieiaa ? ?aiaaieaai?aioa o an?o
aeiaaeeao a iieiaeaii? oai?iai eaaea/e ia aioe?, i?ae i?noeaaei
ciaaiethaaiiyi, o 19 aeiaaeeao i?ae eiia?iiaaiei ciaaiethaaiiyi c
aioo??oiueiaaiiei aaaaeaiiyi oeaio?aeueieo aianoaoee?a. Aeey
aeinyaiaiiy i?aeo?aaoeaaiai aeenea iaie aeei?enoiaoaaeenue 2 aeinooie –
caaeiueiaieiaee ? o?ainaeo?aeueiee (135 ? 48 aeiaaee?a a?aeiia?aeii).
Ioieoe?y i?iaiaeeeanue aeaoia aeaeaie aieie a caeaaeiino? a?ae aeinooio.
I?e caaeiueiaieiaiio aeinooi? aeei?enoiaoaaeanue aieea aeiaaeeiith 18 ni
c u?eueii i?ae?aiaiei iaiae?aiii, o?eniaaiei aeey caiia?aaiiy ci?uaiiy
eiai a i?ina?o? aieee i?ae /an i?iaaaeaiiy iai?ioeyoe??. Ioieoe?y
i?aeo?aaoeaaiai aeenea i?iaiaeeeanue /a?acoe??ii ia a?aenoai? 10-12 ni
a?ae na?aaeiuei? e?i?? i?ae eooii 45-50. A ?yae? aeiaaee?a i?e ni?ia?
ioieoe?? L5/S1 aeenea aeieeaee ia?aoeiaee, iia’ycai? c aenieei
?icoaooaaiiyi e?eea eeoaiai? e?noee. A oaeeo aeiaaeeao canoiniaoaaany
o?ainaeo?aeueiee aeinooi. Aaaaeaiiy aieee iino?eii eiio?iethaaeinue
na???th ci?ie?a a ?aaeei? niiiae?eia?ao?? o aieia?e oa
ia?aaeiuei-caaei?e i?iaeoe??. I?ney aeeiiaiiy ioieoe?? a aieeo
aaiaeeany eaa?oeaaee na?oeiaiae ? iiaeaaaeinue eaca?ia aei?ii?ithaaiiy c
aeiaaeeiith oaee? 1,06 iei. Eaca?ia aaii?ecaoe?y ioeueiiciiai yae?a
cae?nithaaeany aeeooa?aioe?eiaaii a caeaaeiino? a?ae nooiaith
aeaaaia?aoeaii-aeeno?io?/ieo ci?i aeeneo. sse i?aaeei, noia?ia ae?y
eaca?iiai aei?ii?ithaaiiy noaiiaeea aei 1700-1800 Aeae i?e ?acia?e
iiooaeiino? 15-20 Aeae oa aeniiceoe?? 1 nae. Aaii?ecaoe?y ioeueiiciiai
yae?a cae?enithaaeanue a 2-3o oi/eao i?ae ?aiaaiieia?/iei eiio?ieai
iieiaeaiiy aieee. O?eaae?noue ao?o/aiiy neeaaeaea a?ae 15 aei 45 oa.
I?e aeei?enoaii? o?ainaeo?aeueiiai aeinooio oai?? aini?oae?coaaeenue ia
no?ie aei aeiae c ?aeiiaiaeaoe??th aeio?eioaaoenue noai?iai e?aeeiaiai
?aaeeio aeey aeeeth/aiiy ?icaeoeo e?eai?ii? a?iioaic??.
Iaei??th c iniaeeainoae i?iaaaeaiiy IEAe ? a?aenooi?noue iaiao?aeiino?
i?iaaaeaiiy caaaeueii? aianoac??. I?enooi?noue aianoac?ieiaa o
iia?aoe?ei?e iaiao?aeia aeey ?io?aiia?aoe?eiiai eiio?ieth caaaeueiiai
noaio oai?iai, nai?/aniiai iiia?aaeaeaiiy iiaeeeaeo iaoieia?/ieo noai?a
oa aiioe?eieo ?aaeoe?e.
Aiae?c ?acoeueoao?a ioieoe?eii? eaca?ii? aeeneaeoii?? i?e aeei?enoaii?
oeaee Nurick (oaae.2) iieacaa, ui aaciina?aaeiuei i?ney iia?aoe??,
iiaiee ?aa?an iaa?ieia?/ii? neiioiiaoeee aeyaeaiee o 27 oai?eo (14,8%
aeiaaee?a). A?eueo?noue oai?eo (118 – 64,2%) a?aei?/aee cia/ia
iie?ioaiiy aaciina?aaeiuei ia iia?aoe?eiiio noie?. O 21 % oai?eo
iie?ioaiiy ia aoei. Iia??oaiiy noaio i?ney i?iaaaeaiiy ioieoe?eii?
eaca?ii? aeeneaeoii?? ia a?aei?/aii. I?ney i?iaaaeaiiy iai?ioeyoe?? o
an?o oai?eo a?aei?/aeenue ia?ioaineai? ooi? aie? a i?noe? aeeiiaiiy
ioieoe?? ia i?ioyc? a?ae o?ueio aiaeei aei aeiae.
*a?ac 7 ae?a ie a?aei?/aee ??ciiiai?aaeai? ci?ie iaa?ieia?/iiai noaio –
o a?eueoino? oai?eo noai a?aeiia?aeaa 2 ??aith OI (127 niino. – 69,3%).
C 21% aei 18% ciaioeeanue e?euee?noue oai?eo c a?aenooi?noth ci?i
iaa?ieia?/iiai noaoono a i?neyiia?aoe?eiiio ia??iae?. O 5 oai?eo
niinoa??aaeinue oei/aniaa iia??oaiiy iiaeeeai iia’ycaia c ?icaeoeii
iaa?yeo ioeueiiciiai yae?a ? iineeaiiyi eiii?an?? ia?aiaiai ei??ioey.
E?euee?noue oai?eo, ye? a?aei?oeee iiaiee ?aa?an iaa?ieia?/ii?
neiioiiaoeee aaciina?aaeiuei i?ney iia?aoeaiiai ao?o/aiiy ciaioeeinue c
14,8% aei 12%.
I?e aiae?c? /a?ac o?e i?nyoe? i?ney i?iaaaeaiiy ioieoe?eii? eaca?ii?
aeeneaeoii?? a?aei?/aii cia/ia iie?ioaiiy noaio i?iiia?iaaieo oai?eo.
62% iaoe??io?a a?aei?oeee iiaiee ?aa?an iaa?ieia?/ii? neiioiiaoeee,
cia/ia iie?ioaiiy noaio a?aei?/aii o 22 % aeiaaee?a. Iaiao?aeii
a?aei?oeoe, ui e?euee?noue oai?eo, o yeeo aaciina?aaeiuei i?ney IEAe
iie?ioaiiy ia a?aei?/aeinue, ciaioeeanue c 18 aei 16 a?aenioe?a.
Aeai? oaae. 2 na?ae/aoue i?i iiaeaeueoa no?eea iie?ioaiiy noaio oai?eo,
naiiii/oooy yeeo /a?ac 3-6 i?nyoe?a i?ney i?iaaaeaiiy IEAe
a?aeiia?aeaei 1-io oa
Oaaeeoey 2.
Ioe?iea ?acoeueoao?a ioieoe?eii? eaca?ii? aeeneaeoii?? ca oeaeith
Nurick.
??aaiue OIE?euee?noue niinoa?aaeaiueAaciina?aaeiuei i?ney iia?aoe??*a?ac
7 aei?a *a?ac 3 i?nyoe?*a?ac 6 i?nyoe?a*a?ac ??e i?ney
iia?aoe??127221121131092118127414145338343029294—–
2-io ??aiyi OI. Iio??aii a?aei?oeoe, ui e?euee?noue oai?eo, noai yeeo
ia iie?ioeany, neeaea 16 %. Iiae?ai? ?acoeueoaoe io?eiai? ? /a?ac ??e
i?ney iia?aoe??. ?acoeueoaoe e?eoaaiiy a?aeiia?aeath/? 1 ? 2 ??aiyi OI
aecia/ai? o 154 c 183 oai?eo, oiaoi o 84,1 %.
Aea/aiiy ee?ie/ii? aoaeoeaiino? i?iaaaeaiiy IEAe a caeaaeiino? a?ae
?ici???a eee i?aeo?aaoeaaeo aeene?a (ii aeaiei I?O) ia iniia? e?eoa???a
OI, iieacaei, ui ?acoeueoao o??o?a?/iiai ao?o/aiiy a cia/i?e i???
aecia/a?oueny nooiaiai aei’y/oaaiiy i?aeo?aaoeaaiai aeenea a
nieiiiiceiaee eaiae (oaae.3).
Oaeei /eiii, o an?o aeiaaeeao i?e eeeao aeeneo iaaaeeeeo ?ici???a
a?aei?/aiee iiaiee ?aa?an iaa?ieia?/ii? neiioiiaoeee a aeeiai?oe?
i?neyiia?aoe?eiiai ia??iaeo. I?e ?ici??ao eeee aei 6 ii cia/ia
iie?ioaiiy noaio niinoa??aaeinue o 90 % aeiaaee?a, noai aac ci?i 10 %.
I?e ?ici??ao eee aeenea a?ae 6 aei 10 ii noai a?eueoino? oai?eo (16 c
20) caeeoaany aac ci?i. Iaie aea/aii o?eueee 3 niinoa?aaeaiiy
canoinoaaiiy ioieoe?eii? eaca?ii? aeeneaeoii?? i?e eeeao aeeneo a?eueoa
10 ii. O?eueee a iaeiiio niinoa?aaeaii? noai oai?iai a?aeiia?aeaa 2
??aith OI, o aeaoo aeiaaeeao iie?ioaiiy ia ianooieei. Iaiao?aeii
a?aei?oeoe, ui a aeiaeiiio c iienaieo aeiaaee?a ia a?aei?/aii iia??oaiiy
noaio oai?eo. I?ioeaio iiaiiai cieeiaiiy oa cia/iiai ciaioaiiy
iaa?ieia?/ii? neiioiiaoeee noaiiaeoue 84,1%.
Aea/aiiy ?acoeueoao?a ioieoe?eii? eaca?ii? aeeneaeoii?? c aeei?enoaiiyi
oeaee Iacnab i?iaeaiiino?oaaei aeai?, iiae?ai? io?eiaiei i?e
aeei?enoaii? OI. Iio??aii a?aei?oeoe ?ica?aei?noue noa’?eoeaieo ?
ia’?eoeaieo e?eoa???a ioe?iee noaio oa iaa?ieia?/iiai noaoono oai?eo a
?aiiueiio i?neyiia?aoe?eiiio
Oaaeeoey 3.
Iieacieee noaio iia?iaaieo oai?eo a caeaaeiino? a?ae ?ici???a eeee
aeeneo ii oeae? Nurick.
OI?ici??e eeee Aei 3 ii
(n=38)3-6 ii
(n=122)6-10 ii
(n=20)A?eueoa 10 ii
(n=3)1 ??aaiue387222 ??aaiue38213 ??aaiue121624 ??aaiue—-
Oaaeeoey 4.
Ioe?iea ?acoeueoao?a eaca?ii? aeeneaeoii?? ii oeae? Iacnab.
Iciaee?acoeueoaoe e?eoaaiiyI?ney iia?aoe??*a?ac 7 aei?a*a?ac 3
i?nyoe?*a?ac 6 i?nyoe?a*a?ac 1
??eNoa’?eoeai?Ia’?eoeai?Noa’?eoeai?Ia’?eoeai?Noa’?eoeai?Ia’?eoeai?Noa’?e
oeai?Ia’?eoeai?Noa’?eoeai?Ia’?eoeai? Iie?ioaiiy
161
142
112
141
148
150
152
154
154
154
Aac ci?i
22
41
59
42
35
33
31
29
29
29Iia??oaiiy
–
–
12
–
–
–
–
–
–
–
ia??iae?.(oaae.4). Oae, aeaye? oai?? noa’?eoeaii a?aei?oeee iia??oaiiy
naiai noaio. Aiie a?aei?/aee iiyao aai i?aeneeaiiy oyaio/eo ooieo aieae
a iiia?aeo, ia??iaee/ii aeieeath/? a?ae/oooy “iiacaiiy io?aoie”, ?ieiee
aieae a iic?. O oie aea /an ia’?eoeai? iieacieee ia iaee oaiaeaioe?? aei
iia??oaiiy.
A oe?eiio iieacieee ioe?iee noaio oai?eo ii oeae? Iacnab /a?ac ??e i?ney
iia?aoe?? ni?aiaaeathoue c e?eoa??yie OI. Aoaeoeai?noue iia?aoe??
a?aei?/aia o 84,1% aeiaaee?a.
Cai?iiiiiaaia iaie oeaea aaeueii? ioe?iee, i?e aeei?enoaii? a?eueoi?
e?eueeino? ae?aaiinoe/ieo e?eoa???a, aea? iiaeeea?noue eiiieaenii?
ia’?eoea?caoe?? noaio oai?iai aei iia?aoe??, ioe?iee aeeiai?ee
iaa?ieia?/ieo i?iya?a aeeneiai? iaoieia?? a aei- oa i?neyiia?aoe?eiiio
ia??iae?, aeicaiey? a?aeia?aceoe io?eiai? aeai? a a?ao?/iiio
cia?aaeaii?. Canoiniaaia oeaea caniiaaia ia o?aaeeoe?eieo e?eoa??yo
ioe?iee iaa?ieia?/iiai noaio oai?iai ?, oaeei /eiii a?eueo i?ae
caei?aeiii? noaie aaeaioiaaia aeey aeei?enoaiiy oao?aoeyie-iaa?ieiaaie ?
iae?io??o?aaie.
C iaoith ii??aiyiiy io?eiaieo aeaieo, eiaeiee iaa?ieia?/iee neiioii
ioe?ithaaany ii o?ueioaaeuei?e oeae?, aea 0 – a?aenooi?noue neiioiio; 1
– neaaei ae?aaeaiee, iaiino?eiee neiioii, 2 – iii??ii ae?aaeaiee,
no?eeee neiioii, 3 – ?ioaineaii ae?aaeaiee, no?eeee neiioii (oaae.5). O
a?aeiia?aeiino? c cai?iiiiiaaiith aaeueiith a?aaeaoe??th, noai eiaeiiai
oai?iai ioe?ithaaany noiith aae?a ii an?i aeacaiei neiioiiai a
ianooii? no?iee: aei iia?aoe??, aaciina?aaeiuei i?ney iia?aoe??, /a?ac 7
aei?a,3,6 ? 12 i?nyoe?a i?ney ao?o/aiiy.
Aea/aiiy ?acoeueoao?a e?eoaaiiy oai?eo ia aeeneiaaiiee
iiia?aeiai-e?eaeiaee ?aaeeeoe?o c aeei?enoaiiyi cai?iiiiiaaii? aaeueii?
a?aaeaoe?? ? aeae?eaiiyi /ioe?ueio a?oi iieacaei ianooiia:
Aeae?eaii 4 a?oie oai?eo: 1- a?ae 0 aei 7 aae?a; 2-a?ae 8 aei 12 aae?a;
3- a?ae 13 aei 18 aae?a; 4- a?ae 18 aei 21 aae?a. Ioe?iea iaa?ieia?/iiai
noaio oai?eo aei ao?o/aiiy aeicaieeea a?aeianoe 7% oai?eo aei ia?oi?
a?oie, 56% aei ae?oai?, 25% aei o?aouei? ? 12% aei /aoaa?oi? a?oie.
?acoeueoaoe e?eoaaiiy i?aaenoaaeai? o aeaeyae? a?ao?e?a (iae.1-4) aea
?yae 1 – oai?? aei iia?aoe??, ?yae –2 oai?? i?ney i?iaaaeaiiy IEAe. Ia
iae. 1 a?aeia?aaeaiee noai oai?eo aei- ? aaciina?aaeiuei i?ney
ao?o/aiiy. I?e aea/aii? oeeo aeaieo a?aei?/aii, ui aei ao?o/aiiy
a?eueo?noue oai?eo a?aeianaia aei ae?oai? a?oie, a i?ney iia?aoe?? aei
ia?oi?, ui na?ae/eoue i?i ?? ?acoeueoaoeai?noue. Ianooiiee a?ao?e
(iae.2) ii??aith? noai oai?eo aei o??o?a?/iiai ao?o/aiiy ? /a?ac
oeaeaeaiue i?ney i?iaaaeaiiy IEAe. Aeyaeaii, ui /a?ac 7 aei?a i?ney
i?iaaaeaiiy ioieoe?eii? eaca?ii? aeeneaeoii?? oai?? a?aei?/aee aeayea
iia??oaiiy o ii??aiyii? c aeiai iia?aoe??, ia iao iiaeyae, ca ?aooiie
ia?inoaiiy iaa?yeo ioeueiiciiai yae?a, yeee i?eaiaeeoue aei i?aeneeaiiy
aai a?aeiiaeaiiy aieueiaiai neiae?iio. Iiaeaeueoee aiae?c ?acoeueoao?a
iia?aoeaiiai ao?o/aiiy (iae. 3) iieaco? cia/ia iie?ioaiiy ?
noaa?e?caoe?th noaio i?ney i?iaaaeaiiy IEAe. I?e ii??aiyii? iae.1 ? 3
a?aei?/aii cia/ia iie?ioaiiy noaio cai?eo a ii??aiyii? c 7-i aeiai i?ney
iia?aoe??.
Oaaeeoey 5.
Oeaea ioe?iee ee?i?/ieo iciae i?e aeeneiaaiiiio iiia?aeiai-e?eaeiaiio
?aaeeeoe?o?
NEIIOII AE?AAEAI?NOUe NEIIOII?A
0 1 2
3
Aieth/?noue ia?aaa?oaa?aeueieo oi/ie
A?aenooi?noue
Eaaea
Iii??ia
Ae?aaeaia
Caoenia iai?oaeaiiy i’yc?a nieie
A?aenooi?noueEaaea iaeii-noi?iii?, aac neie?ico
Iii??ia aeai noi?iii?, aai iaeiinoi?iii? ?c neie?icii.Ae?aaeaia
aeainoi?iii?, ae?aaeaiee neie?ic
Neiioii Eanaaa
A?aenooi?noueI?e caeiaii?
45-31 I?e caeiaii?
30-16I?e caeiaii?
15-5Iciaee iiae?aciaiiy ei??ioey A?aenooi?noueE?aae?aoe?y aie? a
noaaiiE?aae?aoe?y aie? a aii?eeoE?aae?aoe?y aie? a noiioOa?aeoa?
?iceaae?a /ooeeaino? A?aenooi?noue
Ia?anoac??
A?ianoac?y
Aianoac?y
?ooia? ?iceaaee
A?aenooi?noue
Aoiiethaai?noue i?e ia?anoaaii?
Iii??iee ia?ac noiie
(0-2 aaee)
Ae?aaeaiee ia?ac noiie
(3-4 aaee)Noai ao?eiaeo ?aoeaen?a A?aenooi?noue ?iceaae?aAi?ci?aoeaen?y
Cieaeaiiy ?aoeaeno
A?aenooi?noue ?aoeaeno
Iae.1. Ee?i?/iee noai oai?eo aei ? i?ney i?iaaaeaiiy ioieoe?eii?
eaca?ii? aeeneaeoii??. A?ao?e.
Iae.2. Ee?i?/iee noai oai?eo aei ? ia 7-e aeaiue i?ney i?iaaaeaiiy
ioieoe?eii? eaca?ii? aeeneaeoii??. A?ao?e.
Iae.3. Ee?i?/iee noai oai?eo aei ? /a?ac 3 i?nyoe? i?ney i?iaaaeaiiy
ioieoe?eii? eaca?ii? aeeneaeoii??. A?ao?e.
Iae.4. Ee?i?/iee noai oai?eo aei iia?aoe??, /a?ac 6 ? 12 i?nyoe?a i?ney
ioieoe?eii? eaca?ii? aeeneaeoii??. A?ao?e.
Ioe?iea ?acoeueoao?a e?eoaaiiy oai?eo ia aeeneiaaiiee
iiia?aeiai-e?eaeiaee ?aaeeeoe?o i?ney i?iaaaeaiiy ioieoe?eii? eaca?ii?
aeeneaeoii?? /a?ac 6 oa 12 i?nyoe?a i?ney iia?aoeaiiai ao?o/aiiy
iieacaea no?eeo noaa?e?caoe?th ee?i?/iiai noaio oai?eo (iae.4).
Cacaia/ai? aeua aeai?, oa?aeoa?ecoth/e aeeiai?eo ee?i?/iiai noaio oai?eo
i?ney ioieoe?eii? eaca?ii? aeeneaeoii??, aeiiiaithaaeenue ii??aiyeueiei
aiae?cii I?O aeaieo aei ao?o/aiiy ? a ??ci? no?iee i?ney iueiai.
Iaai?oii-?aciiainia oiiia?ao?y i?iaiaeeeanue a no?iee a?ae 5 i?nyoe?a
aei 2 ?ie?a i?ney i?iaaaeaiiy IEAe.
A cia/i?e a?eueoino? aeiaaee?a ee?i?/ia iie?ioaiiy noi?iaiaeaeoaaeinue
iiceoeaiith aeeiai?eith I?O iciae (iae 5,6).
Aiae?c iacaaeia?eueieo ?acoeueoao?a e?eoaaiiy. sse iieacaee iao?
aeine?aeaeaiiy, i? o iaeiiai oai?iai i?e aeei?enoaii? ioieoe?eii?
eaca?ii? aeeneaeoii?? iia??oaiiy iaa?ieia?/iiai noaio a ii??aiyii? c
aeiiia?aoe?eiei ia??iaeii a?aei?/aii ia aoei.A ca’yceo c oeei,
iacaaeia?eueiei ?acoeueoaoii e?eoaaiiy aaaaeaee a?aenooi?noue iiceoeaii?
aeeiai?ee a ii??aiyii? c aeiiia?aoe?eiei ia??iaeii. Ca?aeii io?eiaieo
aeaieo oaeeo oai?eo aoei 29 /ie. (15,9%). O 27 iaoe??io?a ?ici??e eeee
i?aeo?aaoeaaiai aeenea neeaaeaee aei 10 ii, o 2 – a?eueoa 10 ii. Ia
ianooii?e a?aee?eo?e aeeneaeoii?? o 18 oai?eo aoa ae?aaiinoiaaiee
niaeeiaee ai?aeo?eo i?e a?aenooiueino? eeee aeeneo, a 11 niinoa?aaeaiiyo
– o eiia?iaoe?? c aeeneiaaiiith eiii?ann??th.
Iiaoi?ia ao?o/aiiy i?eaaei aei cia/iiai iie?ioaiiy noaio ? a?aeiiaeaiiy
i?aoeacaeaoiino? o 26 c 29 ?aiia?iaaieo oai?eo.
I?e i?iaaaeaii? ioieoe?eii? eaca?ii? aeeneaeoii?? iaea?eueo /anoi ie
aeei?enoiaoaaee caaeiueiaieiaee (135 aeiaaee?a) aeinooi. Iaeiae, a ?yae?
aeiaaee?a aeeiiaoe caaeiueiaieiaee aeinooi iaiiaeeeai caaaeath/e ia
?iaeea?aeoaeuei? iniaeeaino?. A oaeeo aeiaaeeao iaie canoiniaaiee
o?ainaeo?aeueiee aeinooi (48 aeiaaee?a) i?e yeiio i?aeo?aaoeaaee aeene
aeinyaa?oueny c ioieoe?eiei iioeiaeaeaiiyi aeo?aeueiiai i?oea.Ca oaeeo
oiia iiaeeeaee ?icaeoie e?eai?iiai a?iioaiceaiiai neiae?iio a
i?neyiia?aoe?eiiio ia??iae?. Aiae?c io?eiaieo aeaieo na?aeeo?, ui
neiae?ii e?eai?ii? a?iioaic?? aeiee o 25 % aeiaaee?a i?e aeei?enoaii?
o?ainaeo?aeueiiai aeinooio, ui o a?aeiioaii? aei caaaeueii? e?eueeino?
oai?eo neeaaea? 6 %. Iaiao?aeii cacia/eoe, ui aeeiiaiiy oai?eie
?aeiiaiaeaoe?e a i?neyiia?aoe?eiiio ia??iae? iiia?aaeaeo? ?icaeoie
neiae?iio e?eai?ii? a?iioaic?? (oaae.6)
Oaaeeoey 6.
*anoioa ?icaeoeo e?eai?iiai a?iioaiceaiiai neiae?iio a caeaaeiino? a?ae
aeaeo aeinooio.
Aeae aeinooioE?euee?noue niinoa?aaeaiuecaaeiueiaieiaeeIa
niinoa??aaeinueo?ainaeo?aeueiee12
Iae.5. Iaai?oii-?aciiainia oiiia?ao?y aei iia?aoe??
Iae. 6. Iaai?oii-?aciiainia oiiia?ao?y /a?ac 6 i?nyoe?a i?ney iia?aoe??
AENIIAEE
1. Ioieoe?eia eaca?ia aeeneaeoii?y ? aoaeoeaiei iaei?iaaceaiei iaoiaeii
o??o?a?/iiai ao?o/aiiy i?e aeeneiaaiieo iiia?aeiai-e?eaeiaeo
?aaeeeoe?oao.
2. Aaniethoieie iieacaie aei i?iaaaeaiiy ioieoe?eii? eaca?ii?
aeeneaeoii?? ? no?eeee aieueiaee neiae?ii a noaae?? ethiaaai aai
?o?aea?? aac cia/iiai ?ooiaiai aeaoaeoo, i?e eeeao i?aeo?aaoeaaiai
aeeneo ia a?eueo 6 ii, i?e iaaoaeoeaiino? eiina?aaoeaii? oa?ai??.
3. I?ioeiieacaie aei i?iaaaeaiiy ioieoe?eii? eaca?ii? aeeneaeoii?? ?:
cia/ia niiaoe/ia iaoieia?y (iniaeeai i?aee?aneeii aeoeaiee ?aaiaoe/iee
i?ioean), ?ioaeoe?eii-caiaeuei? i?ioeane, ineo?/i? ?iceaaee (iniaeeai
aa?aaaoe?y aieueiaiai neiae?iio), aaa?oi?noue, caoai?thaaiiy e?ia?
(aaiio?e?y), ?ai?o i?iaaaeai? iia?aoeai? ao?o/aiiy ia oeueiio ??ai?
(aeeth/ath/e iaia?i?caoe?th aeenea), aocueeee nieii-iiceiaee eaiae,
ee?i?ei-eaai?aoi?i? iciaee ae?noeeoo.
4. Iacaaeia?euei? ?acoeueoaoe ioieoe?eii? eaca?ii? aeeneaeoii??, ui
i?eaaei aei i?iaaaeaiiy iiaoi?ieo ao?o/aiue, iaoiiaeai? ?icoe?aiiyi
iieac?a oa iaaeia?aooaaiiyi i?ioeiieac?a.
5. Oneeaaeiaiiyie i?e ioieoe?ei?e eaca?i?e aeeneaeoii?? ?: ?icaeoie
neiae?iio e?eai?ii? a?iioaic?? (6% niinoa?aaeaiue), a oaeiae
niiiae?eiae?noeeoo ( 1,1% niinoa?aaeaiue).
6. Caaeia?euei? ?acoeueoaoe e?eoaaiiy i?e ioieoe?ei?e eaca?i?e
aeeneaeoii?? aeinyaioo? o 84,1 % aeiaaee?a, i?e eeeao aeeneo iaio i?ae 6
ii – o 92,6% iia?iaaieo oai?eo.
7. Ioieoe?eia eaca?ia aeeneaeoii?y iiaea aooe ?aeiiaiaeiaaia aeey
ai?iaaaeaeaiiy a iae?io??o?a?/io i?aeoeeo – ye iaoiae o??o?a?/iiai
e?eoaaiiy i?e aeeneiaaiieo iiia?aeiai-e?eaeiaeo ?aaeeeoe?oao.
NIENIE IIOAE?EIAAIEO I?AOeUe CA OAIITH AeENA?OAOe??
1. Iaaea/aiei A.A. Eineiia A.A., Oeaeiye I.A.,Oaianae/oe A.O.
Oe?o?ae/aneia ea/aiea i?e aeeneiaaiiuo iiynie/ii-e?anooeiauo
?aaeeeoeeoao – auai? iaoiaea, ?acoeueoaou e ia?niaeoeau // Oe?a?inueeee
aeo?iae iaei?iaaceaii? oa aiaeineii?/ii? o??o?a?? ,V1.-1997.-N.86-88.
2. Iaaea/aiei A.A.,Oeaeiye I.A.,Oaianae/oe A.O. Oienoeoei I.A.
Ioieoeeiiiay eaca?iay aeeneaeoiiey i?e aeeneiaaiiii
iiynie/ii-e?anooeiaii ?aaeeeoeeoa // A?a/aaiia aeaei ?1.-1998.-
N.143-145.
3. Iaaea/aiei A.A.,Oeaeiye I.A.,Oaianae/oe A.O. Oienoeoei I.A.
I?eiaiaiea ioieoeeiiiie eaca?iie aeeneaeoiiee ii iiaiaeo aeeneiaaiiiai
iiynie/ii-e?anooeiaiai ?aaeeeoeeoa // Eeeie/aneay oe?o?aey.- ? 6. N.6-8.
4. Iaaea/aiei A.A.,Oeaeiye I.A.,Iaeaaaa O.E.,Oaianae/oe A.O., Oienoeoei
I.A. Ioieoeeiiiay eaca?iay aeeneaeoiiey: iieacaiey, ?acoeueoaou ea/aiey
// Atheaoaiue Oe?a?inueei? Anioe?aoe?? iae?io??o?a?a.-?
4.-1988.-N.31-34.
5. Iaaea/aiei A.A.,Oeaeiye I.A.,Oaianae/oe A.O. Ioieoeeiiiay eaca?iay
aeeneaeoiiey (IEAe) i?e aeeneiaaiiuo iiynie/ii-e?anooeiauo ?aaeeeoeeoao
(AeIE?). // II nuacae iae?ioe?o?aia ?inneeneie oaaea?aoeee:
Na.oac.aeiee.-Ieaeiee Iiaai?iae, 1998.- N.274-275.
AIIOAOe?ss
Oaian?e/oe A.O. Ioieoe?eia eaca?ia aeeneaeoii?y i?e aeeneiaaiieo
iiia?aeiai-e?eaeiaeo ?aaeeeoe?oao (ooi/iaiiy iieac?a, oaoiieia??,
aeeaei? oa a?aeaeaeai? ?acoeueoaoe e?eoaaiiy).- ?oeiien.
Aeena?oaoe?y ia caeiaoooy a/aiiai nooiaiy eaiaeeaeaoa iaaee/ieo iaoe
ca niaoe?aeuei?noth “14.01.05”.-iae?io??o?a?y.- ?inoeooo iae?io??o?a??
?i. aeaae. A.I.?iiiaeaiiaa AII Oe?a?ie, Ee?a,1998.
Aeena?oaoe?th i?enay/aii aeooaeueiei ieoaiiyi e?eoaaiiy inoaioiiae?ico
o?aaoa, cie?aia aeei?enoaiiy ioieoe?eii? eaca?ii? aeeneaeoii?? a
e?eoaaii? iiia?aeiai-e?eaeiaeo aeeneiaaiieo ?aaeeeoe?o?a. Ooi/iaiee
eiiieaen ianoaaeaiue iaiao?aeiee aeey aecia/aiiy iieac?a oa i?ioeiieac?a
aei ioieoe?eii? eaca?ii? aeeneaeoii??, iaa?oioiaai? iieace ? i?ioeiieace
aei i?iaaaeaiiy IEAe, aecia/ai? iniaeeaino? i?iaaaeaiiy IEAe a
caeaaeiino? a?ae ??aiy o?aaeaiiy oa nooiaith aeieiaiiy i?aeo?aaoeaaiai
aeenea, aea/ai? iaeaeeae/? oa a?aeaeaeai? ?acoeueoaoe e?eoaaiiy oai?eo
c aeeneiaaiieie iiia?aeiai-e?eaeiaeie ?aaeeeoe?oaie, i?iaaaeaiee aiae?c
oneeaaeiaiue oa iacaaeia?eueieo ?acoeueoao?a e?eoaaiiy i?e canoinoaaii?
ioieoe?eii? eaca?ii? aeeneaeoii??. Aeiaaaeaia aoaeoeai?noue iaoiaeo
IEAe a e?eoaaii? aeeneiaai- ieo iiia?aeiai-e?eaeiaeo ?aaeeeoe?o?a.
Eeth/ia? neiaa: inoaioiiae?ic o?aaoa, aeeneiaaiiee iiia?aeiai-e?eaeiaee
?aaeeeoe?o, ioieoe?ei? ao?o/aiiy, o??o?a?/iee eaca?.
AIIIOAOeEss
Oaianae/oe A.O. Ioieoeeiiiay eaca?iay aeeneaeoiiey i?e aeeneiaaiiuo
iiynie/ii-e?anooeiauo ?aaeeeoeeoao (ooi/iaiea iieacaiee, oaoiieiaee,
aeeaeaeoea e ioaeaeaiiua ?acoeueoaou ea/aiey).- ?oeiienue.
Aeenna?oaoeey ia nieneaiea o/aiie noaiaie eaiaeeaeaoa iaaeeoeeineeo iaoe
ii niaoeeaeueiinoe 14.01.05. – iae?ioe?o?aey.- Einoeooo iae?ioe?o?aee
ei.aeaae.A.I.?iiiaeaiiaa AII Oe?aeiu, Eeaa1998.
Aeenna?oaoeey iinayuaia aeooaeueiui aii?inai ea/aiey inoaioiiae?ica
iicaiii/ieea, a /anoiinoe eniieueciaaiey ioieoeeiiiie eaca?iie
aeeneaeoiiee a ea/aiee iiynie/ii-e?anooeiauo ?aaeeeoeeoia. Ooi/iai
eiiieaen ianeaaeiaaiee iaiaoiaeeiue aeey ii?aaeaeaiey iieacaiee e
i?ioeaiiieacaiee e ioieoeeiiiie eaca?iie aeeneaeoiiee, iainiiaaiu
iieacaiey e i?ioeaiiieacaiey e i?iaaaeaieth IEAe , ii?aaeaeaiu
iniaaiiinoe i?iaaaeaiey IEAe a caaeneiinoe io o?iaiy ii?aaeaiey e
noaiaie i?ieaae?iaaiey iaiicaiieiaiai aeenea, eco/aiu aeeaeaeoea e
ioaeaeaiiua ?acoeueoaou ea/aiey aieueiuo n aeeneiaaiiuie
iiynie/ii-e?anooeiauie ?aaeeeoeeoaie, i?iaaaeai aiaeec ineiaeiaiee e
iaoaeiaeaoai?eoaeueiuo ?acoeueoaoia ea/aiey i?e eniieueciaaiee
ioieoeeiiiie eaca?iie aeeneaeoiiee. Aeieacaia yooaeoeaiinoue iaoiaea
IEAe a ea/aiee aeeneiaaiiuo iiynie/ii-e?anooeiauo – ?aaeeeoeeoia.
Eeth/aaua neiaa: inoaioiiae?ic iicaiii/ieea, aeeneiaaiiue
iiynie/ii-e?anooeiaue ?aaeeeoeeo, ioieoeeiiiua aiaoaoaeuenoaa,
oe?o?ae/aneee eaca?.
SUMMARY
Tanaseychuk A.F. Puncture laser diskectomy at diskogenic lumbosacral
radiculitis (specification of the indications, technologies, nearest
and remote results of treatment).- Manuscript.
This is dissertation for present on scientifical degree of the candidate
of medical sciences at the profession 14.01.05. – neurosurgely. –
Institute ofNeurosurgery named after acad. A.P.Romodanov MAS of Ukrame,
Kyiv, 1998.
The dissertation is devoted to current question of treatment
osteochondrosis of a spine, in particular uses puncture laser diskectomy
in treatment lumbosacral radiculitis. The complex of inspections
necessary for definition of the indications and contra-indications to
puncture laser diskectomy is specified, the indications and
contra-indications to realization PLD are proved, the features of
realization PLD are determined depending on a level of a defeat and
degree herniated of a disk, the nearest and remote results of treatment
of the patients with diskogenic lumbosacral radiculitis are
investigated, the analysis of complications and unsatisfactory results
of treatment is carried out at use puncture laser diskectomy. The
efficiency of a method PLD in treatment at diskogenic lumbosacral
radiculitis is proved.
Key words: osteochondrosis, lumbosacral radiculitis, puncture
diskectomy, surgical laser.
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