ɄȻ. ȻɈɅɈȻɈɒɄɈ, Ⱥɇ. ɌɈɅɋɌɂɄ ÑÎÂÐÅÌÅÍÍÛÅ ÒÅÍÄÅÍÖÈÈ Â ÄÈÀÃÍÎÑÒÈÊÅ È ËÅ×ÅÍÈÈ ÄÅÔÅÊÒÎÂ
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ɄȻ. ȻɈɅɈȻɈɒɄɈ, Ⱥɇ. ɌɈɅɋɌɂɄ ÑÎÂÐÅÌÅÍÍÛÅ ÒÅÍÄÅÍÖÈÈ Â ÄÈÀÃÍÎÑÒÈÊÅ È ËÅ×ÅÍÈÈ ÄÅÔÅÊÒΠÑÓÑÒÀÂÍÎÃÎ ÕÐßÙÀ ɑɚɫɬɶ 1) ɍɈ «ȼɢɬɟɛɫɤɢɣ ɝɨɫɭɞɚɪɫɬɜɟɧɧɵɣ ɦɟɞɢɰɢɧɫɤɢɣ ɭɧɢɜɟɪɫɢɬɟɬ», Ɋɟɫɩɭɛɥɢɤɚ Ȼɟɥɚɪɭɫɶ ȼ ɫɬɚɬɶɟ, ɩɪɟɞɫɬɚɜɥɟɧɧɨɣ ɜ ɜɢɞɟ ɨɛɡɨɪɧɨɣ ɥɟɤɰɢɢ, ɨɛɨɛɳɟɧɵ ɫɨɜɪɟɦɟɧɧɵɟ ɬɟɧɞɟɧɰɢɢ ɜ ɞɢɚɝɧɨɫɬɢɤɟ ɢ ɥɟɱɟɧɢɢ ɞɟɮɟɤɬɨɜ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ. ɉɪɢɜɟɞɟɧɵ ɞɚɧɧɵɟ ɨ ɫɬɪɭɤɬɭɪɟ ɢ ɮɭɧɤɰɢɢ ɯɪɹɳɟɜɨɣ ɬɤɚɧɢ, ɫɬɪɨɟɧɢɢ ɪɚɡɥɢɱɧɵɯ ɟɺ ɡɨɧ, ɦɧɨɝɨɝɪɚɧɧɨɣ ɪɨɥɢ ɯɨɧɞɪɨɰɢɬɨɜ ɢ ɜɧɟɤɥɟɬɨɱɧɨɝɨ ɦɚɬɪɢɤɫɚ. Ⱦɚɧ ɚɧɚɥɢɡ ɪɚɡɥɢɱɧɵɯ ɩɪɢɱɢɧ, ɜɟɞɭɳɢɯ ɤ ɩɨɜɪɟɠɞɟɧɢɸ ɢ ɜɨɡɧɢɤɧɨɜɟɧɢɸ ɞɟɮɟɤɬɨɜ ɯɪɹɳɟɜɨɝɨ ɩɨɤɪɨɜɚ ɫɢɧɨɜɢɚɥɶɧɵɯ ɫɭɫɬɚɜɨɜ. Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ: ɯɪɹɳ, ɫɭɫɬɚɜ, ɞɟɮɟɤɬ, ɩɚɬɨɥɨɝɢɹ The up-to-date tendencies in diagnostics and treatment of the articular cartilage defects in the form of the review lecture are summarized in the article. The data concerning the structure and functions of the cartilage tissue, its various zones construction, many-sided role of chondrocytes and extracellular matrix are presented. The analysis of different causes resulting in damage and occurrence of cartilage covering defects of the synovial joints is given. Keywords: cartilage, joint, defect, pathology ɋɬɪɭɤɬɭɪɚ ɢ ɮɭɧɤɰɢɹ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɋɭɫɬɚɜɧɨɣ ɯɪɹɳ ɩɪɟɞɫɬɚɜɥɹɟɬ ɫɨɛɨɣ ɭɩɪɭɝɨɷɥɚɫɬɢɱɧɵɣ ɦɚɬɟɪɢɚɥ ɫ ɜɵɫɨɤɢɦ ɭɪɨɜɧɟɦ ɨɪɝɚɧɢɡɚɰɢɢ, ɫɨɫɬɨɹɳɢɣ ɢɡ ɯɨɧɞɪɨɰɢɬɨɜ, ɜɨɞɵ ɢ ɜɧɟɤɥɟɬɨɱɧɨɝɨ ɦɚɬɪɢɤɫɚ. Ʉɚɤ ɢɡɜɟɫɬɧɨ, ɨɧ ɧɟ ɢɦɟɟɬ ɤɪɨɜɨɫɧɚɛɠɟɧɢɹ, ɥɢɦɮɨɨɬɬɨɤɚ ɢ ɢɧɧɟɪɜɚɰɢɢ. Ɍɤɚɧɟɜɨɣ ɛɚɥɚɧɫ ɩɨɞɞɟɪɠɢɜɚɟɬɫɹ ɤɨɦɩɥɟɤɫɧɵɦ ɜɡɚɢɦɨɞɟɣɫɬɜɢɟɦ ɦɟɠɞɭ ɯɨɧɞɪɨɰɢɬɚɦɢ ɢ ɦɟɠɤɥɟɬɨɱɧɵɦ ɦɚɬɪɢɤɫɨɦ. Ɏɨɪɦɚ, ɪɚɡɦɟɪ ɢ ɦɟɬɚɛɨɥɢɱɟɫɤɚɹ ɚɤɬɢɜɧɨɫɬɶ ɯɨɧɞɪɨɰɢɬɨɜ ɪɚɡɥɢɱɚɸɬɫɹ ɜ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɥɨɤɚɥɢɡɚɰɢɢ ɜ ɩɪɟɞɟɥɚɯ ɯɪɹɳɟɜɵɯ ɡɨɧ. ɂɫɬɨɱɧɢɤ ɩɢɬɚɧɢɹ ɯɨɧɞɪɨɰɢɬɨɜ – ɫɢɧɨɜɢɚɥɶɧɚɹ ɠɢɞɤɨɫɬɶ. ɂɡɦɟɧɹɸɳɭɸɫɹ ɦɟɯɚɧɢɱɟɫɤɭɸ ɧɚɝɪɭɡɤɭ, ɩɟɪɟɞɚɸɳɭɸɫɹ ɱɟɪɟɡ ɨɤɪɭɠɚɸɳɢɣ ɦɚɬɪɢɤɫ, ɯɨɧɞɪɨɰɢɬɵ ɜɨɫɩɪɢɧɢɦɚɸɬ ɱɟɪɟɡ ɜɧɭɬɪɢɰɢɬɨɩɥɚɡɦɚɬɢɱɟɫɤɢɟ ɜɨɥɨɤɧɚ ɢ ɤɨɪɨɬɤɢɟ ɪɟɫɧɢɱɤɢ, ɪɚɫɩɨɥɚɝɚɸɳɢɟɫɹ ɧɚ ɩɨɜɟɪɯɧɨɫɬɢ ɯɨɧɞɪɨɰɢɬɨɜ [1]. ȼɧɟɤɥɟɬɨɱɧɵɣ ɦɚɬɪɢɤɫ ɫɨɫɬɨɢɬ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɢɡ ɜɨɞɵ (ɨɬ 65% ɞɨ 80% ɨɛ130 ɳɟɝɨ ɜɟɫɚ), ɩɪɨɬɟɨɝɥɢɤɚɧɨɜ ɢ ɤɨɥɥɚɝɟɧɚ. Ⱦɨɦɢɧɢɪɭɟɬ ɤɨɥɥɚɝɟɧ II ɬɢɩɚ (95%), ɚ ɤɨɥɥɚɝɟɧɵ ɞɪɭɝɢɯ ɬɢɩɨɜ (IV, VI, IX, X, XI) ɨɩɪɟɞɟɥɹɸɬɫɹ ɜ ɫɨɫɬɚɜɟ ɜɧɟɤɥɟɬɨɱɧɨɝɨ ɦɚɬɪɢɤɫɚ ɜ ɧɟɛɨɥɶɲɢɯ ɤɨɥɢɱɟɫɬɜɚɯ. ɉɪɟɞɩɨɥɚɝɚɸɬ, ɱɬɨ ɢɯ ɪɨɥɶ ɡɚɤɥɸɱɚɟɬɫɹ ɜ ɫɬɚɛɢɥɢɡɚɰɢɢ ɢ ɡɚɤɪɟɩɥɟɧɢɢ ɜ ɦɚɬɪɢɤɫɟ ɜɨɥɨɤɨɧ ɤɨɥɥɚɝɟɧɚ II. Ʉɨɥɥɚɝɟɧ ɮɨɪɦɢɪɭɟɬ ɬɪɟɯɦɟɪɧɭɸ ɫɟɬɶ, ɭɞɟɪɠɢɜɚɸɳɭɸ ɦɨɥɟɤɭɥɵ ɩɪɨɬɟɨɝɥɢɤɚɧɚ, ɯɨɧɞɪɨɢɬɢɧɚ ɢ ɤɟɪɚɬɚɧɚ ɫɭɥɶɮɚɬɚ. Ɍɚɤɨɣ ɪɟɲɺɬɱɚɬɵɣ ɤɚɪɤɚɫ ɨɩɪɟɞɟɥɹɟɬ ɫɬɪɭɤɬɭɪɧɵɟ ɫɜɨɣɫɬɜɚ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ, ɜɤɥɸɱɚɹ ɭɩɪɭɝɨɫɬɶ, ɭɫɬɨɣɱɢɜɨɫɬɶ ɤ ɧɚɝɪɭɡɤɚɦ ɢ ɪɚɫɬɹɠɟɧɢɸ. ɂɦɟɸɳɢɟ ɨɬɪɢɰɚɬɟɥɶɧɵɣ ɡɚɪɹɞ ɩɪɨɬɟɨɝɥɢɤɚɧɵ «ɩɪɢɬɹɝɢɜɚɸɬ» ɢ ɫɜɹɡɵɜɚɸɬ ɨɫɧɨɜɧɭɸ ɱɚɫɬɶ ɜɨɞɵ ɢ ɤɚɬɢɨɧɵ. ɋɬɟɩɟɧɶ ɞɟɮɨɪɦɢɪɭɟɦɨɫɬɢ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɜ ɨɬɜɟɬ ɧɚ ɜɨɡɧɢɤɚɸɳɢɟ ɧɚɝɪɭɡɤɢ ɧɚɯɨɞɢɬɫɹ ɜ ɩɪɹɦɨɣ ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɫɤɨɪɨɫɬɢ ɜɵɫɜɨɛɨɠɞɟɧɢɹ ɜɨɞɵ ɢ ɫɬɪɭɤɬɭɪɧɨɣ ɰɟɥɨɫɬɧɨɫɬɢ ɤɨɥɥɚɝɟɧɚ. ɇɨɪɦɚɥɶɧɚɹ ɬɨɥɳɢɧɚ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹ- ʋ2x 2009 i ɬɨɦ 17 ɳɚ ɨɩɪɟɞɟɥɹɟɬɫɹ ɤɨɧɬɚɤɬɧɵɦ ɞɚɜɥɟɧɢɟɦ ɧɚ ɫɭɫɬɚɜɧɵɯ ɩɨɜɟɪɯɧɨɫɬɹɯ. ȼɵɲɟ ɩɢɤɨɜɨɟ ɞɚɜɥɟɧɢɟ – ɬɨɥɳɟ ɫɭɫɬɚɜɧɨɣ ɯɪɹɳ. Ⱦɚɧɧɨɟ ɩɨɥɨɠɟɧɢɟ ɢɡɜɟɫɬɧɨ ɤɚɤ ɹɜɥɟɧɢɟ ɮɢɡɢɨɥɨɝɢɱɟɫɤɨɣ ɚɞɚɩɬɚɰɢɢ ɢ ɞɨɫɬɚɬɨɱɧɨ ɯɨɪɨɲɨ ɢɡɭɱɟɧɨ, ɛɥɚɝɨɞɚɪɹ ɜɨɡɦɨɠɧɨɫɬɹɦ ɦɚɝɧɢɬɧɨɪɟɡɨɧɚɧɫɧɨɣ ɬɨɦɨɝɪɚɮɢɢ [2]. ɋɚɦɵɦ ɬɨɥɫɬɵɦ ɯɪɹɳɨɦ ɜ ɨɪɝɚɧɢɡɦɟ ɱɟɥɨɜɟɤɚ ɹɜɥɹɟɬɫɹ ɯɪɹɳ ɧɚɞɤɨɥɟɧɧɢɤɚ. ȼ ɫɬɪɨɟɧɢɢ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɜɵɞɟɥɹɸɬ ɱɟɬɵɪɟ ɫɥɨɹ: ɩɨɜɟɪɯɧɨɫɬɧɵɣ, ɫɪɟɞɧɢɣ, ɝɥɭɛɨɤɢɣ ɢ ɤɚɥɶɰɢɮɢɰɢɪɨɜɚɧɧɵɣ, ɤɨɬɨɪɵɟ ɪɚɡɥɢɱɚɸɬɫɹ ɩɨ ɤɥɟɬɨɱɧɨɣ ɦɨɪɮɨɥɨɝɢɢ, ɛɢɨɦɟɯɚɧɢɱɟɫɤɨɦɭ ɫɬɪɨɟɧɢɸ, ɫɬɪɭɤɬɭɪɧɵɦ ɫɜɨɣɫɬɜɚɦ. ȼ ɩɨɜɟɪɯɧɨɫɬɧɨɦ ɫɥɨɟ ɤɨɥɥɚɝɟɧ ɨɪɢɟɧɬɢɪɨɜɚɧ ɩɚɪɚɥɥɟɥɶɧɨ ɩɨɜɟɪɯɧɨɫɬɢ, ɚ ɜ ɝɥɭɛɨɤɨɦ ɢ ɤɚɥɶɰɢɮɢɰɢɪɨɜɚɧɧɨɦ – ɩɟɪɩɟɧɞɢɤɭɥɹɪɧɨ ɟɣ ɢ ɫɭɛɯɨɧɞɪɚɥɶɧɨɣ ɤɨɫɬɢ. Ƚɥɭɛɨɤɚɹ ɡɨɧɚ ɫɨɞɟɪɠɢɬ ɫɚɦɵɟ ɤɪɭɩɧɵɟ ɤɨɥɥɚɝɟɧɨɜɵɟ ɜɨɥɨɤɧɚ, ɢɦɟɟɬ ɧɚɢɛɨɥɶɲɭɸ ɤɨɧɰɟɧɬɪɚɰɢɸ ɩɪɨɬɟɨɝɥɢɤɚɧɨɜ ɢ ɧɚɢɦɟɧɶɲɟɟ ɫɨɞɟɪɠɚɧɢɟ ɜɨɞɵ. Ɇɨɪɮɨɥɨɝɢɹ ɢ ɪɚɫɩɨɥɨɠɟɧɢɟ ɯɨɧɞɪɨɰɢɬɨɜ ɪɚɡɥɢɱɚɸɬɫɹ ɜ ɤɚɠɞɨɣ ɡɨɧɟ. Ɍɚɤ, ɜ ɩɪɟɞɟɥɚɯ ɤɚɥɶɰɢɮɢɰɢɪɨɜɚɧɧɨɣ ɡɨɧɵ ɧɟɛɨɥɶɲɢɯ ɪɚɡɦɟɪɨɜ ɯɨɧɞɪɨɰɢɬɵ ɪɚɫɩɨɥɨɠɟɧɵ ɜ ɫɥɭɱɚɣɧɨɦ ɩɨɪɹɞɤɟ ɛɟɡ ɫɬɪɨɝɨɣ ɫɢɫɬɟɦɵ. Ʉɚɥɶɰɢɮɢɰɢɪɨɜɚɧɧɚɹ ɢ ɧɟɤɚɥɶɰɢɮɢɰɢɪɨɜɚɧɧɚɹ ɡɨɧɵ ɪɚɡɝɪɚɧɢɱɟɧɵ ɬɨɧɤɨɣ ɛɚɡɨɮɢɥɶɧɨɣ ɥɢɧɢɟɣ, ɤɨɬɨɪɭɸ ɦɨɠɧɨ ɭɜɢɞɟɬɶ ɜ ɫɜɟɬɨɜɨɦ ɦɢɤɪɨɫɤɨɩɟ ɧɚ ɩɪɟɩɚɪɚɬɚɯ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ. ɉɨɫɥɟ 30 ɥɟɬ ɜ ɫɭɫɬɚɜɧɨɦ ɯɪɹɳɟ, ɧɟ ɬɪɨɧɭɬɨɦ ɪɚɧɟɟ ɩɚɬɨɥɨɝɢɱɟɫɤɢɦɢ ɩɪɨɰɟɫɫɚɦɢ, ɧɚɱɢɧɚɸɬɫɹ ɩɪɨɹɜɥɟɧɢɹ ɜɨɡɪɚɫɬɧɨɣ ɞɟɝɟɧɟɪɚɰɢɢ (ɞɟɝɪɚɞɚɰɢɢ). Ɋɚɧɧɟɦɭ ɧɚɱɚɥɭ ɞɟɝɟɧɟɪɚɬɢɜɧɵɯ ɩɪɨɰɟɫɫɨɜ ɫɩɨɫɨɛɫɬɜɭɸɬ ɢɡɦɟɧɟɧɢɹ ɤɚɱɟɫɬɜɟɧɧɨɝɨ ɥɢɛɨ ɤɨɥɢɱɟɫɬɜɟɧɧɨɝɨ ɫɨɫɬɚɜɚ ɫɢɧɨɜɢɚɥɶɧɨɣ ɠɢɞɤɨɫɬɢ. ɋɨɞɟɪɠɚɧɢɟ ɩɪɨɬɟɢɧɚ ɢ ɜɹɡɤɨɫɬɶ ɫɢɧɨɜɢɚɥɶɧɨɣ ɠɢɞɤɨɫɬɢ ɫɧɢɠɚɸɬɫɹ ɫ ɜɨɡɪɚɫɬɨɦ [3]. Ɇɚɤɪɨɫɤɨɩɢɱɟɫɤɢ ɦɨɠɧɨ ɧɚɛɥɸɞɚɬɶ ɢ ɨɰɟɧɢɜɚɬɶ ɢɡɦɟɧɟɧɢɟ ɫ ɜɨɡɪɚɫɬɨɦ ɰɜɟɬɚ ɢ ɷɥɚɫɬɢɱɧɨɫɬɢ (ɬɭɪɝɨɪɚ) ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ. ɍ ɩɨɞɪɨɫɬɤɨɜ ɛɟɥɨɝɨɥɭɛɨɣ ɯɪɹɳ ɢɦɟɟɬ ɨɫɨɛɵɣ ɬɭɪɝɨɪ. ɋ ɜɨɡɪɚɫɬɨɦ ɨɤɪɚɫɤɚ ɝɢɚɥɢɧɨɜɨɝɨ ɯɪɹɳɚ ɩɪɢɨɛɪɟɬɚɟɬ ɠɟɥɬɢɡɧɭ, ɷɥɚɫɬɢɱɧɨɫɬɶ ɢ ɭɩɪɭɝɨɫɬɶ ɟɝɨ ɫɧɢɠɚɸɬɫɹ, ɩɨɜɵɲɚɟɬɫɹ ɱɭɜɫɬɜɢɬɟɥɶɧɨɫɬɶ ɤ ɦɟɯɚɧɢɱɟɫɤɢɦ ɧɚɝɪɭɡɤɚɦ. ɋɭɛɯɨɧɞɪɚɥɶɧɭɸ ɤɨɫɬɶ ɨɬ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɨɬɞɟɥɹɟɬ ɫɭɛɯɨɧɞɪɚɥɶɧɚɹ ɤɨɫɬɧɚɹ ɩɥɚɫɬɢɧɤɚ. ȼ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɢɡɜɟɫɬɧɨ, ɱɬɨ ɪɨɥɶ ɫɭɛɯɨɧɞɪɚɥɶɧɨɣ ɤɨɫɬɢ ɜ ɩɢɬɚɧɢɢ ɯɪɹɳɚ ɫɭɳɟɫɬɜɟɧɧɚ ɬɨɥɶɤɨ ɭ ɞɟɬɟɣ. ɋɩɟɰɢɮɢɱɟɫɤɢɟ ɫɜɨɣɫɬɜɚ ɫɭɛɯɨɧɞɪɚɥɶɧɨɣ ɤɨɫɬɧɨɣ ɩɥɚɫɬɢɧɤɢ ɢɝɪɚɸɬ ɜɚɠɧɭɸ ɪɨɥɶ ɜ ɛɢɨɦɟɯɚɧɢɤɟ ɫɭɫɬɚɜɚ. ɋ ɜɨɡɪɚɫɬɨɦ ɩɪɨɝɪɟɫɫɢɪɭɸɳɢɣ ɫɤɥɟɪɨɡ ɫɭɛɯɨɧɞɪɚɥɶɧɨɣ ɡɨɧɵ ɫɨɱɟɬɚɟɬɫɹ ɫ ɞɟɝɟɧɟɪɚɰɢɟɣ ɯɪɹɳɚ. ɗɬɢɨɥɨɝɢɹ ɩɨɜɪɟɠɞɟɧɢɣ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ Ɍɪɚɜɦɚ Ɍɪɚɜɦɚ ɪɟɞɤɨ ɹɜɥɹɟɬɫɹ ɩɪɢɱɢɧɨɣ ɢɡɨɥɢɪɨɜɚɧɧɵɯ ɥɨɤɚɥɶɧɵɯ ɞɟɮɟɤɬɨɜ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ. ȼ ɛɨɥɶɲɢɧɫɬɜɟ ɫɥɭɱɚɟɜ ɜɧɭɬɪɢɫɭɫɬɚɜɧɵɟ ɩɟɪɟɥɨɦɵ, ɬɪɚɜɦɚɬɢɱɟɫɤɢɟ ɜɵɜɢɯɢ ɜɟɞɭɬ ɤ ɟɝɨ ɨɛɲɢɪɧɵɦ ɩɨɜɪɟɠɞɟɧɢɹɦ. ɇɨ ɧɟ ɬɨɥɶɤɨ «ɫɟɪɶɺɡɧɵɟ» ɬɪɚɜɦɵ ɦɨɝɭɬ ɫɬɚɬɶ ɩɪɢɱɢɧɨɣ ɩɪɨɛɥɟɦ. Ʉɪɚɬɤɨɜɪɟɦɟɧɧɚɹ ɩɨɬɟɪɹ ɫɬɚɛɢɥɶɧɨɫɬɢ ɜ ɫɭɫɬɚɜɟ ɫ ɨɬɫɭɬɫɬɜɢɟɦ ɦɵɲɟɱɧɨɝɨ ɤɨɧɬɪɨɥɹ, ɫɥɭɱɚɢ ɫɩɨɧɬɚɧɧɨɣ ɪɟɩɨɡɢɰɢɢ ɧɚɞɤɨɥɟɧɧɢɤɚ ɫ ɹɜɥɟɧɢɹɦɢ ɭɦɟɪɟɧɧɨɝɨ ɫɢɧɨɜɢɬɚ – ɬɚɤɢɟ ɚɧɚɦɧɟɫɬɢɱɟɫɤɢɟ ɫɜɟɞɟɧɢɹ ɞɨɥɠɧɵ ɛɵɬɶ ɭɱɬɟɧɵ ɜ ɞɢɚɝɧɨɫɬɢɤɟ, ɬɚɤ ɤɚɤ ɥɸɛɚɹ, ɞɚɠɟ ɫɚɦɚɹ ɦɢɧɢɦɚɥɶɧɚɹ ɬɪɚɜɦɚ, ɦɨɠɟɬ ɫɬɚɬɶ ɩɪɢɱɢɧɨɣ ɩɨɜɪɟɠɞɟɧɢɹ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ [1, 4]. ɉɨɜɪɟɠɞɟɧɢɹ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɦɨɠɧɨ ɪɚɡɞɟɥɢɬɶ ɧɚ ɬɪɢ ɪɚɡɥɢɱɧɵɯ ɬɢɩɚ: 1 ɬɢɩ – ɢɡɦɟɧɟɧɢɹ ɯɨɧɞɪɨɰɢɬɨɜ ɢ ɦɟɠɤɥɟɬɨɱɧɨɝɨ ɦɚɬɪɢɤɫɚ ɜɵɹɜɥɹɟɦɵɟ ɥɢɲɶ ɦɢɤɪɨɫɤɨɩɢɱɟɫɤɢ (ɤɥɟɬɨɱɧɚɹ ɬɪɚɜɦɚ); 2 ɬɢɩ – ɦɚɤɪɨɫɤɨɩɢɱɟɫɤɢ ɪɚɡɥɢɱɢɦɵɟ ɪɚɡɪɭɲɟɧɢɹ ɫɭɫɬɚɜɧɨɣ ɩɨɜɟɪɯɧɨɫɬɢ (ɯɪɹɳɟɜɵɟ ɩɟɪɟɥɨɦɵ ɢ ɬɪɟɳɢɧɵ). ɗɬɢ ɞɜɚ ɬɢɩɚ ɩɨɜɪɟɠɞɟɧɢɣ ɢɦɟɸɬ ɧɚɢɦɟɧɶɲɢɣ ɩɨɬɟɧɰɢɚɥ ɞɥɹ ɪɟɝɟɧɟɪɚɰɢɢ, ɬɚɤ ɤɚɤ ɩɪɢ ɧɢɯ ɧɟ ɩɪɨɢɫɯɨɞɢɬ ɩɟ131 ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ ɧɟɬɪɚɰɢɢ ɫɭɛɯɨɧɞɪɚɥɶɧɨɣ ɤɨɫɬɢ ɢ ɧɟ ɨɛɟɫɩɟɱɢɜɚɟɬɫɹ ɪɚɡɜɢɬɢɟ ɚɞɟɤɜɚɬɧɨɝɨ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɨɬɜɟɬɚ. ɉɨɜɪɟɠɞɟɧɢɹ 3 ɬɢɩɚ ɯɚɪɚɤɬɟɪɢɡɭɸɬɫɹ ɞɟɮɟɤɬɨɦ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɧɚ ɜɫɸ ɟɝɨ ɬɨɥɳɢɧɭ ɫ ɩɟɧɟɬɪɚɰɢɟɣ ɫɭɛɯɨɧɞɪɚɥɶɧɨɣ ɤɨɫɬɢ, ɱɬɨ ɫɩɨɫɨɛɫɬɜɭɟɬ ɪɚɡɜɢɬɢɸ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ. Ɏɨɪɦɢɪɭɟɬɫɹ ɮɢɛɪɢɧɨɜɵɣ ɫɝɭɫɬɨɤ ɢ ɦɟɡɟɧɯɢɦɚɥɶɧɵɟ ɧɟɞɢɮɮɟɪɟɧɰɢɪɨɜɚɧɧɵɟ ɤɥɟɬɤɢ ɩɪɨɞɭɰɢɪɭɸɬ ɪɟɝɟɧɟɪɚɬ (ɮɢɛɪɨɡɧɵɣ ɯɪɹɳ), ɤɨɬɨɪɵɣ ɧɟ ɹɜɥɹɟɬɫɹ ɧɨɪɦɚɥɶɧɵɦ ɫɭɫɬɚɜɧɵɦ ɯɪɹɳɨɦ, ɧɨ ɫɨɞɟɪɠɢɬ ɤɨɥɥɚɝɟɧ I ɬɢɩɚ ɢ ɢɦɟɟɬ ɬɟɧɞɟɧɰɢɸ ɩɨɞɜɟɪɝɚɬɶɫɹ ɪɚɧɧɢɦ ɞɟɝɟɧɟɪɚɬɢɜɧɵɦ ɢɡɦɟɧɟɧɢɹɦ [5]. ȼɨ ɦɧɨɝɢɯ ɫɥɭɱɚɹɯ ɩɨɜɪɟɠɞɟɧɢɹ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɫɨɩɪɨɜɨɠɞɚɸɬɫɹ ɪɚɡɪɵɜɨɦ ɩɟɪɟɞɧɟɣ ɤɪɟɫɬɨɨɛɪɚɡɧɨɣ ɫɜɹɡɤɢ. ɋɤɪɵɬɵɣ ɨɫɬɟɨɯɨɧɞɪɚɥɶɧɵɣ ɥɢɡɢɫ ɢ ɭɲɢɛ ɫɭɛɯɨɧɞɪɚɥɶɧɨɣ ɤɨɫɬɢ ɦɨɠɟɬ ɛɵɬɶ ɨɩɪɟɞɟɥɟɧ ɩɪɢ ɆɊɌ ɢɫɫɥɟɞɨɜɚɧɢɢ ɭ 80% ɩɚɰɢɟɧɬɨɜ. ɇɚɢɛɨɥɟɟ ɱɚɫɬɨ ɩɨɞɜɟɪɠɟɧɵ ɩɨɜɪɟɠɞɟɧɢɹɦ ɥɚɬɟɪɚɥɶɧɵɟ ɨɬɞɟɥɵ ɤɨɥɟɧɧɨɝɨ ɫɭɫɬɚɜɚ [6]. ɍɱɚɫɬɤɢ ɩɨɜɪɟɠɞɟɧɢɹ ɦɨɝɭɬ ɜɵɝɥɹɞɟɬɶ ɧɟɢɡɦɟɧɟɧɧɵɦɢ ɞɚɠɟ ɩɪɢ ɚɪɬɪɨɫɤɨɩɢɱɟɫɤɨɦ ɨɛɫɥɟɞɨɜɚɧɢɢ, ɚ ɝɢɫɬɨɥɨɝɢɱɟɫɤɢɟ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɨɤɚɡɵɜɚɸɬ ɜɵɪɚɠɟɧɧɵɟ ɧɚɪɭɲɟɧɢɹ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ. ɋɨɜɪɟɦɟɧɧɵɟ ɞɚɧɧɵɟ ɫɜɢɞɟɬɟɥɶɫɬɜɭɸɬ, ɱɬɨ ɧɟɨɛɪɚɬɢɦɵɟ ɢɡɦɟɧɟɧɢɹ ɜ ɯɨɧɞɪɨɰɢɬɚɯ ɦɨɠɟɬ ɜɵɡɜɚɬɶ ɞɚɠɟ ɨɞɧɨɤɪɚɬɧɨɟ, ɤɪɚɬɤɨɜɪɟɦɟɧɧɨɟ ɩɪɢɥɨɠɟɧɢɟ ɬɪɚɜɦɢɪɭɸɳɟɣ ɫɢɥɵ [1, 7]. ɇɚɪɭɲɟɧɢɹ ɛɢɨɦɟɯɚɧɢɤɢ Ɉɫɧɨɜɧɚɹ ɩɪɢɱɢɧɚ ɛɢɨɦɟɯɚɧɢɱɟɫɤɨɝɨ ɞɢɫɛɚɥɚɧɫɚ ɜ ɫɭɫɬɚɜɚɯ ɧɢɠɧɢɯ ɤɨɧɟɱɧɨɫɬɟɣ – ɢɡɦɟɧɟɧɢɟ ɦɟɯɚɧɢɱɟɫɤɨɣ ɨɫɢ. ɇɚɪɭɲɟɧɢɟ ɧɚɝɪɭɠɟɧɢɹ ɫɭɫɬɚɜɧɵɯ ɩɨɜɟɪɯɧɨɫɬɟɣ ɜɟɞɺɬ ɤ ɞɟɝɟɧɟɪɚɰɢɢ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ, ɨɛɪɚɡɨɜɚɧɢɸ ɥɨɤɚɥɶɧɵɯ ɞɟɮɟɤɬɨɜ ɢ ɪɚɡɜɢɬɢɸ ɨɫɬɟɨɚɪɬɪɨɡɚ [2]. ɇɚɪɭɲɟɧɢɹ ɦɟɯɚɧɢɱɟɫɤɨɣ ɨɫɢ ɧɢɠɧɟɣ ɤɨɧɟɱɧɨɫɬɢ ɨɩɪɟɞɟɥɹɸɬ ɩɨ «ɞɥɢɧɧɨɣ» ɪɟɧɬɝɟɧɨɝɪɚɦɦɟ, ɜɵɩɨɥɧɟɧɧɨɣ ɜ ɩɨɥɨɠɟɧɢɢ ɫɬɨɹ. Ⱦɚɧɧɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟ ɩɨɦɨɝɚɟɬ ɜ ɩɥɚɧɢɪɨɜɚɧɢɢ ɨɩɟɪɚɬɢɜɧɨɝɨ ɥɟɱɟɧɢɹ, ɧɚɩɪɚɜɥɟɧɧɨɝɨ ɧɚ ɤɨɪɪɟɤɰɢɸ ɛɢɨɦɟɯɚɧɢɱɟɫɤɢɯ 132 ɢɡɦɟɧɟɧɢɣ. Ɇɟɧɢɫɤɢ Ɂɧɚɱɟɧɢɟ ɦɟɧɢɫɤɨɜ ɞɥɹ ɮɭɧɤɰɢɢ ɫɭɫɬɚɜɚ ɢ ɨɩɬɢɦɚɥɶɧɨɝɨ ɫɨɫɬɨɹɧɢɹ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɜ ɫɨɜɪɟɦɟɧɧɨɣ ɥɢɬɟɪɚɬɭɪɟ ɨɛɳɟɩɪɢɡɧɚɧɨ ɢ ɧɟ ɞɢɫɤɭɬɢɪɭɟɬɫɹ. Ⱦɨɤɚɡɚɧɨ, ɱɬɨ ɭ 90% ɩɚɰɢɟɧɬɨɜ, ɩɟɪɟɧɟɫɲɢɯ ɬɨɬɚɥɶɧɭɸ ɦɟɧɢɫɤɷɤɬɨɦɢɸ, ɪɚɡɜɢɜɚɟɬɫɹ ɚɪɬɪɨɡ ɡɚɢɧɬɟɪɟɫɨɜɚɧɧɨɝɨ ɫɨɱɥɟɧɟɧɢɹ ɱɟɪɟɡ 5–10 ɥɟɬ. ɇɚɢɦɟɧɶɲɢɟ ɩɨɫɥɟɞɫɬɜɢɹ ɞɥɹ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɧɟɫɺɬ ɚɤɤɭɪɚɬɧɚɹ «ɦɢɧɢɦɚɥɶɧɨɞɨɫɬɚɬɨɱɧɚɹ» ɦɟɧɢɫɤɷɤɬɨɦɢɹ. Ɉɧɚ ɬɚɤɠɟ ɹɜɥɹɟɬɫɹ ɜɚɠɧɵɦ ɩɪɨɮɢɥɚɤɬɢɱɟɫɤɢɦ, ɫɛɟɪɟɝɚɸɳɢɦ ɫɭɫɬɚɜɧɨɣ ɯɪɹɳ ɨɬ ɚɛɪɚɡɢɜɧɨɝɨ ɜɨɡɞɟɣɫɬɜɢɹ ɩɨɜɪɟɠɞɺɧɧɨɝɨ ɦɟɧɢɫɤɚ, ɦɟɬɨɞɨɦ ɫɩɟɰɢɮɢɱɟɫɤɨɣ ɬɟɪɚɩɢɢ. ɍ ɦɨɥɨɞɵɯ ɩɚɰɢɟɧɬɨɜ ɩɪɟɞɩɨɱɬɢɬɟɥɶɧɚ ɪɟɤɨɧɫɬɪɭɤɰɢɹ ɩɨɜɪɟɠɞɺɧɧɨɝɨ ɦɟɧɢɫɤɚ – ɪɟɮɢɤɫɚɰɢɹ, ɥɢɛɨ ɢɦɩɥɚɧɬɚɰɢɹ. ȼ ɤɚɱɟɫɬɜɟ ɩɪɨɬɟɡɚ ɦɟɧɢɫɤɚ ɢɫɩɨɥɶɡɭɸɬ ɤɨɥɥɚɝɟɧɨɜɵɟ ɢɦɩɥɚɧɬɵ, ɤɨɬɨɪɵɟ ɩɨɞɲɢɜɚɸɬ ɩɨɞ ɚɪɬɪɨɫɤɨɩɢɱɟɫɤɢɦ ɤɨɧɬɪɨɥɟɦ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɫɩɟɰɢɚɥɶɧɨɝɨ ɨɛɨɪɭɞɨɜɚɧɢɹ. ɐɟɥɶ ɢɦɩɥɚɧɬɚɰɢɢ ɛɢɨɥɨɝɢɱɟɫɤɨɝɨ ɪɚɫɫɚɫɵɜɚɟɦɨɝɨ ɩɪɨɬɟɡɚ – ɫɨɡɞɚɧɢɟ ɭɫɥɨɜɢɣ ɞɥɹ ɮɨɪɦɢɪɨɜɚɧɢɹ ɩɨɯɨɠɟɣ ɩɨ ɮɭɧɤɰɢɢ ɧɚ ɦɟɧɢɫɤ ɬɤɚɧɢ, ɤɨɬɨɪɚɹ ɨɛɪɚɡɭɟɬɫɹ ɜ ɬɟɱɟɧɢɟ ɨɞɧɨɝɨ ɝɨɞɚ. Ⱦɨɥɝɨɫɪɨɱɧɵɯ ɪɟɡɭɥɶɬɚɬɨɜ ɞɚɧɧɨɣ ɚɪɬɪɨɫɤɨɩɢɱɟɫɤɨɣ ɩɪɨɰɟɞɭɪɵ ɩɨɤɚ ɟɳɟ ɧɟ ɨɩɢɫɚɧɨ, ɧɨ ɨɧɚ ɢɦɟɟɬ ɩɪɚɜɨ ɧɚ ɠɢɡɧɶ, ɬɚɤ ɤɚɤ ɧɟɫɟɬ ɦɢɧɢɦɚɥɶɧɵɣ ɪɢɫɤ ɞɥɹ ɩɚɰɢɟɧɬɚ [8, 9]. ɉɪɟɞɥɚɝɚɥɢɫɶ ɪɚɡɥɢɱɧɵɟ ɦɟɬɨɞɢɤɢ ɞɥɹ ɪɟɤɨɧɫɬɪɭɤɰɢɢ ɩɨɜɪɟɠɞɟɧɧɨɝɨ (ɥɢɛɨ ɪɟɡɟɰɢɪɨɜɚɧɧɨɝɨ) ɥɚɬɟɪɚɥɶɧɨɝɨ ɦɟɧɢɫɤɚ. Ɉɞɧɚɤɨ ɯɨɪɨɲɢɟ ɤɥɢɧɢɱɟɫɤɢɟ ɪɟɡɭɥɶɬɚɬɵ ɞɚɺɬ ɬɨɥɶɤɨ ɚɥɥɨɬɪɚɧɫɩɥɚɧɬɚɰɢɹ. ȼɨɡɦɨɠɧɚ ɢɦɩɥɚɧɬɚɰɢɹ ɤɚɤ ɫ ɤɨɫɬɧɨɣ ɮɢɤɫɚɰɢɟɣ, ɬɚɤ ɢ ɛɟɡ ɧɟɺ. Ⱥɥɥɨɬɪɚɧɫɩɥɚɧɬɚɰɢɹ ɩɪɢ ɩɨɥɧɨɦ ɨɬɫɭɬɫɬɜɢɢ ɥɚɬɟɪɚɥɶɧɨɝɨ ɦɟɧɢɫɤɚ ɪɚɫɫɦɚɬɪɢɜɚɟɬɫɹ ɤɚɤ ɟɞɢɧɫɬɜɟɧɧɚɹ ɜɨɡɦɨɠɧɨɫɬɶ ɫɨɯɪɚɧɟɧɢɹ ɮɭɧɤɰɢɢ ɫɭɫɬɚɜɚ ɧɚ ɞɥɢɬɟɥɶɧɵɣ ɩɟɪɢɨɞ ɜɪɟɦɟɧɢ. ɇɟɫɬɚɛɢɥɶɧɨɫɬɶ ɦɨɠɟɬ ɛɵɬɶ ɩɪɢɱɢɧɨɣ ɞɟɝɟɧɟɪɚɰɢɢ ɯɪɹɳɚ ɚɧɚɥɨɝɢɱɧɨ ɛɢɨɦɟɯɚ- ʋ2x 2009 i ɬɨɦ 17 ɧɢɱɟɫɤɨɦɭ ɞɢɫɛɚɥɚɧɫɭ ɩɪɢ ɧɚɪɭɲɟɧɢɹɯ ɨɫɢ ɤɨɧɟɱɧɨɫɬɢ, ɥɢɛɨ ɩɪɢ ɩɨɜɪɟɠɞɟɧɢɢ ɦɟɧɢɫɤɚ. Ɋɚɡɪɵɜɵ ɩɟɪɟɞɧɟɣ ɤɪɟɫɬɨɨɛɪɚɡɧɨɣ ɫɜɹɡɤɢ (ɉɄɋ) ɧɚɢɛɨɥɟɟ ɱɚɫɬɵ ɢ ɢɦɟɸɬ ɧɚɢɛɨɥɶɲɟɟ ɤɥɢɧɢɱɟɫɤɨɟ ɡɧɚɱɟɧɢɟ. Ɋɟɤɨɧɫɬɪɭɤɰɢɹ ɉɄɋ ɞɨɥɠɧɚ ɩɪɟɞɲɟɫɬɜɨɜɚɬɶ ɦɟɪɨɩɪɢɹɬɢɹɦ, ɧɚɩɪɚɜɥɟɧɧɵɦ ɧɚ ɜɨɫɫɬɚɧɨɜɥɟɧɢɟ ɞɟɮɟɤɬɚ ɯɪɹɳɚ [6, 9]. Ɇɟɧɟɟ ɱɚɫɬɵɟ ɪɚɡɪɵɜɵ ɡɚɞɧɟɣ ɤɪɟɫɬɨɨɛɪɚɡɧɨɣ ɫɜɹɡɤɢ ɢ ɞɨɪɫɨɥɚɬɟɪɚɥɶɧɨɝɨ ɭɝɥɚ ɤɚɩɫɭɥɵ ɤɨɥɟɧɧɨɝɨ ɫɭɫɬɚɜɚ ɢɦɟɸɬ ɛɨɥɶɲɨɟ ɡɧɚɱɟɧɢɟ ɜ ɮɭɧɤɰɢɢ ɢ ɫɬɚɛɢɥɶɧɨɫɬɢ [9, 10]. ȼɵɡɜɚɧɧɚɹ ɩɨɜɪɟɠɞɟɧɢɟɦ ɫɜɹɡɨɱɧɨɝɨ ɚɩɩɚɪɚɬɚ ɧɟɫɬɚɛɢɥɶɧɨɫɬɶ ɝɨɥɟɧɨɫɬɨɩɧɨɝɨ ɫɭɫɬɚɜɚ ɦɨɠɟɬ ɫɬɚɬɶ ɩɪɢɱɢɧɨɣ ɞɟɝɟɧɟɪɚɬɢɜɧɵɯ ɢɡɦɟɧɟɧɢɣ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɢ ɞɨɥɠɧɚ ɛɵɬɶ ɭɫɬɪɚɧɟɧɚ ɜ ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ ɩɪɢɧɹɬɵɦɢ ɯɢɪɭɪɝɢɱɟɫɤɢɦɢ ɩɪɨɬɨɤɨɥɚɦɢ. Ɋɚɫɫɟɤɚɸɳɢɣ ɨɫɬɟɨɯɨɧɞɪɢɬ (ɊɈ) ɦɨɠɟɬ ɩɪɨɬɟɤɚɬɶ ɛɟɫɫɢɦɩɬɨɦɧɨ ɦɧɨɝɢɟ ɝɨɞɵ ɢ ɱɚɫɬɨ ɞɢɚɝɧɨɫɬɢɪɭɟɬɫɹ ɫɥɭɱɚɣɧɨ ɩɪɢ ɪɟɧɬɝɟɧɨɝɪɚɮɢɢ. Ⱦɥɹ ɊɈ ɯɚɪɚɤɬɟɪɧɨ ɦɟɞɥɟɧɧɨɟ ɨɬɞɟɥɟɧɢɟ ɤɨɫɬɧɨɯɪɹɳɟɜɨɝɨ ɮɪɚɝɦɟɧɬɚ ɨɬ ɫɭɛɯɨɧɞɪɚɥɶɧɨɣ ɤɨɫɬɢ. ɉɪɢɱɢɧɵ ɊɈ ɞɨ ɤɨɧɰɚ ɧɟ ɜɵɹɫɧɟɧɵ. ɇɚɢɛɨɥɟɟ «ɩɨɩɭɥɹɪɧɵɟ» ɬɟɨɪɢɢ: ɫɟɝɦɟɧɬɚɪɧɨɝɨ ɧɚɪɭɲɟɧɢɹ ɤɪɨɜɨɨɛɪɚɳɟɧɢɹ, ɝɟɧɟɬɢɱɟɫɤɚɹ ɩɪɟɞɪɚɫɩɨɥɨɠɟɧɧɨɫɬɶ, ɦɢɤɪɨɬɪɚɜɦɚ. Ʌɨɤɚɥɢɡɚɰɢɹ ɦɨɠɟɬ ɛɵɬɶ ɪɚɡɥɢɱɧɨɣ, ɧɨ ɧɚɢɛɨɥɟɟ ɱɚɫɬɨ ɊɈ ɜɫɬɪɟɱɚɟɬɫɹ ɜ ɤɨɥɟɧɧɵɯ, ɥɨɤɬɟɜɵɯ ɢ ɝɨɥɟɧɨɫɬɨɩɧɵɯ ɫɭɫɬɚɜɚɯ. Ɉɰɟɧɤɚ ɫɬɚɛɢɥɶɧɨɫɬɢ ɮɪɚɝɦɟɧɬɚ ɦɨɠɟɬ ɛɵɬɶ ɩɪɨɜɟɞɟɧɚ ɚɪɬɪɨɫɤɨɩɢɱɟɫɤɢ. ɍ ɦɨɥɨɞɵɯ ɩɚɰɢɟɧɬɨɜ ɜɚɠɧɨ ɪɚɡɝɪɭɡɢɬɶ ɢ ɢɦɦɨɛɢɥɢɡɢɪɨɜɚɬɶ ɫɭɫɬɚɜ. ȿɫɬɶ ɫɨɨɛɳɟɧɢɹ ɨɛ ɷɤɫɬɪɚɤɨɪɩɨɪɚɥɶɧɨɣ ɲɨɤɨɜɨɣ ɜɨɥɧɨɜɨɣ) ɬɟɪɚɩɢɢ, ɤɨɬɨɪɚɹ ɦɨɠɟɬ ɛɵɬɶ ɭɫɩɟɲɧɨɣ ɜ ɥɟɱɟɧɢɢ ɊɈ. Ɉɞɧɚɤɨ ɞɨɫɬɨɜɟɪɧɵɯ ɞɚɧɧɵɯ ɨɛ ɷɬɨɦ ɦɟɬɨɞɟ ɥɟɱɟɧɢɹ ɧɟɬ. ɉɪɢɜɨɞɹɬɫɹ ɩɨɥɨɠɢɬɟɥɶɧɵɟ ɪɟɡɭɥɶɬɚɬɵ ɪɟɬɪɨɝɪɚɞɧɨɣ ɨɫɬɟɨɩɟɪɮɨɪɚɰɢɢ. Ɍɟɦ ɧɟ ɦɟɧɟɟ ɚɧɬɟɝɪɚɞɧɚɹ ɩɟɪɮɨɪɚɰɢɹ ɪɚɫɰɟɧɢɜɚɟɬɫɹ ɦɧɨɝɢɦɢ ɚɜɬɨɪɚɦɢ ɤɚɤ ɬɪɚɜɦɚɬɢɱɧɚɹ, ɜɟɞɭɳɚɹ ɤ ɩɨɜɪɟɠɞɟɧɢɸ ɫɭɫɬɚɜɧɨɣ ɩɨɜɟɪɯɧɨɫɬɢ ɩɪɨɰɟɞɭɪɚ. Ⱦɥɹ ɜɵɩɨɥɧɟɧɢɹ ɨɫɬɟɨɩɟɪɮɨɪɚɰɢɣ ɫ ɦɢɧɢɦɚɥɶɧɨɣ ɬɪɚɜɦɚ- ɬɢɱɧɨɫɬɶɸ ɢ ɦɚɤɫɢɦɚɥɶɧɨɣ ɬɨɱɧɨɫɬɶɸ ɢɫɩɨɥɶɡɭɸɬ ɫɩɟɰɢɚɥɶɧɵɟ ɢɧɫɬɪɭɦɟɧɬɵ – ɧɚɩɪɚɜɢɬɟɥɢ ɞɥɹ ɪɚɡɥɢɱɧɵɯ ɫɭɫɬɚɜɨɜ. Ʉɚɤ ɚɥɶɬɟɪɧɚɬɢɜɧɵɣ ɫɩɨɫɨɛ ɜɨɫɫɬɚɧɨɜɥɟɧɢɹ ɥɨɤɚɥɶɧɨɝɨ ɞɟɮɟɤɬɚ ɩɪɢ ɊɈ ɢɫɩɨɥɶɡɭɟɬɫɹ ɦɟɬɨɞ ɨɫɬɟɨɯɨɧɞɪɚɥɶɧɨɣ ɚɭɬɨɬɪɚɧɫɩɥɚɧɬɚɰɢɢ, ɤɨɬɨɪɵɣ ɧɚɪɹɞɭ ɫ ɩɨɥɨɠɢɬɟɥɶɧɵɦɢ ɫɬɨɪɨɧɚɦɢ ɧɟ ɥɢɲɺɧ ɨɬɪɢɰɚɬɟɥɶɧɵɯ ɦɨɦɟɧɬɨɜ, ɫɜɹɡɚɧɧɵɯ ɜ ɩɟɪɜɭɸ ɨɱɟɪɟɞɶ ɫ ɩɪɨɛɥɟɦɨɣ ɞɨɧɨɪɫɤɢɯ ɭɱɚɫɬɤɨɜ. ȼ ɛɨɥɶɲɢɧɫɬɜɟ ɫɥɭɱɚɟɜ ɨɬɞɟɥɟɧɧɵɣ ɩɨɥɧɨɫɬɶɸ ɥɢɛɨ ɱɚɫɬɢɱɧɨ ɮɪɚɝɦɟɧɬ ɭɞɚɥɹɸɬ, ɜɵɩɨɥɧɹɸɬ ɞɟɛɪɢɞɠɟɦɟɧɬ ɩɨɜɟɪɯɧɨɫɬɢ, ɤɨɫɬɧɨɯɪɹɳɟɜɭɸ ɩɥɚɫɬɢɤɭ. Ʉɨɫɬɧɨɯɪɹɳɟɜɵɟ ɮɪɚɝɦɟɧɬɵ ɛɨɥɶɲɢɯ ɪɚɡɦɟɪɨɜ (ɛɨɥɟɟ 1 ɫɦ ɜ ɞɢɚɦɟɬɪɟ) ɦɨɝɭɬ ɛɵɬɶ ɪɟɮɢɤɫɢɪɨɜɚɧɵ. ȼɚɠɧɵɦ ɹɜɥɹɟɬɫɹ ɡɚɱɢɫɬɤɚ (ɞɟɛɪɢɞɠɟɦɟɧɬ) ɥɨɠɚ ɩɟɪɟɞ ɪɟɮɢɤɫɚɰɢɟɣ ɮɪɚɝɦɟɧɬɚ, ɬɚɤ ɤɚɤ ɨɧɚ ɦɨɠɟɬ ɫɬɢɦɭɥɢɪɨɜɚɬɶ ɩɪɨɰɟɫɫɵ ɪɟɝɟɧɟɪɚɰɢɢ [8, 11]. Ɉɫɬɟɨɚɪɬɪɨɡ ɋ ɫɨɜɪɟɦɟɧɧɵɯ ɩɨɡɢɰɢɣ ɨɫɬɟɨɚɪɬɪɨɡ ɪɚɫɫɦɚɬɪɢɜɚɟɬɫɹ ɤɚɤ ɩɚɬɨɥɨɝɢɹ ɫɭɫɬɚɜɚ ɜ ɰɟɥɨɦ, ɚ ɧɟ ɬɨɥɶɤɨ ɤɚɤ ɩɪɨɰɟɫɫ ɞɟɝɟɧɟɪɚɰɢɢ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ. ȼɟɞɭɳɢɦ ɮɚɤɬɨɪɨɦ ɩɪɨɝɪɟɫɫɢɜɧɨɣ ɞɟɫɬɪɭɤɰɢɢ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɪɚɫɫɦɚɬɪɢɜɚɸɬɫɹ ɯɨɧɞɪɨɬɨɤɫɢɱɟɫɤɢɟ ɩɪɨɬɟɢɧɵ, ɜɵɫɜɨɛɨɠɞɚɟɦɵɟ (ɩɪɨɞɭɰɢɪɭɟɦɵɟ) ɫɢɧɨɜɢɚɥɶɧɨɣ ɦɟɦɛɪɚɧɨɣ ɩɪɢ ɟɟ ɜɨɫɩɚɥɟɧɢɢ. ɉɪɨɰɟɫɫ ɭɫɭɝɭɛɥɹɟɬɫɹ ɮɭɧɤɰɢɨɧɚɥɶɧɵɦɢ ɧɚɪɭɲɟɧɢɹɦɢ ɧɚ ɮɨɧɟ ɛɨɥɟɜɨɝɨ ɫɢɧɞɪɨɦɚ ɢ ɨɝɪɚɧɢɱɟɧɢɟɦ ɩɟɪɮɭɡɢɢ. ȼ ɫɥɭɱɚɹɯ ɩɟɪɜɢɱɧɨɝɨ ɪɚɫɩɪɨɫɬɪɚɧɟɧɧɨɝɨ ɨɫɬɟɨɚɪɬɪɨɡɚ (ɩɨɥɢɨɫɬɟɨɚɪɬɪɨɡɚ) ɢɡɨɥɢɪɨɜɚɧɧɨɟ ɥɟɱɟɧɢɟ ɞɟɮɟɤɬɨɜ ɯɪɹɳɚ ɛɭɞɟɬ ɢɦɟɬɶ ɦɢɧɢɦɚɥɶɧɵɣ ɭɫɩɟɯ. Ɉɛɨɫɬɪɟɧɢɸ ɫɢɦɩɬɨɦɨɜ ɡɚɛɨɥɟɜɚɧɢɹ ɫɩɨɫɨɛɫɬɜɭɟɬ ɩɟɪɟɨɯɥɚɠɞɟɧɢɟ ɢɥɢ ɮɭɧɤɰɢɨɧɚɥɶɧɚɹ ɩɟɪɟɝɪɭɡɤɚ ɫɭɫɬɚɜɚ. ȼɬɨɪɢɱɧɵɣ ɨɫɬɟɨɚɪɬɪɨɡ ɪɚɡɜɢɜɚɟɬɫɹ ɧɚ ɮɨɧɟ ɧɟɫɬɚɛɢɥɶɧɨɫɬɢ, ɩɨɜɪɟɠɞɟɧɢɣ ɦɟɧɢɫɤɨɜ ɢɥɢ ɧɚɪɭɲɟɧɢɹ ɛɢɨɦɟɯɚɧɢɱɟɫɤɨɣ ɨɫɢ ɤɨɧɟɱɧɨɫɬɢ. Ɍɚɤɚɹ ɜɡɚɢɦɨɫɜɹɡɶ ɭɤɚɡɚɧɧɵɯ ɩɚɬɨɥɨɝɢɱɟɫɤɢɯ ɩɪɨɰɟɫɫɨɜ ɦɨɠɟɬ ɪɚɫɫɦɚɬɪɢɜɚɬɶɫɹ ɤɚɤ «ɮɭɧɤɰɢɨɧɚɥɶɧɚɹ ɟɞɢɧɫɬɜɨ» ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ. Ʌɸɛɵɟ ɧɚɪɭɲɟɧɢɹ 133 ɇɨɜɨɫɬɢ ɯɢɪɭɪɝɢɢ ɛɢɨɦɟɯɚɧɢɱɟɫɤɨɣ ɨɫɢ, ɩɚɬɨɥɨɝɢɹ ɦɟɧɢɫɤɨɜ, ɫɜɹɡɨɱɧɨɝɨ ɚɩɩɚɪɚɬɚ ɜɟɞɭɬ ɤ ɢɡɦɟɧɟɧɢɹɦ ɜ ɭɫɥɨɜɢɹɯ ɮɭɧɤɰɢɨɧɢɪɨɜɚɧɢɹ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ. ɋɨɨɬɜɟɬɫɬɜɟɧɧɨ, ɫɜɨɟɜɪɟɦɟɧɧɨɟ ɭɫɩɟɲɧɨɟ ɥɟɱɟɧɢɟ ɬɚɤɢɯ ɧɚɪɭɲɟɧɢɣ ɦɨɠɟɬ ɨɫɬɚɧɨɜɢɬɶ ɢɥɢ ɫɭɳɟɫɬɜɟɧɧɨ ɫɧɢɡɢɬɶ ɫɤɨɪɨɫɬɶ ɞɟɝɟɧɟɪɚɬɢɜɧɵɯ ɢɡɦɟɧɟɧɢɣ ɯɪɹɳɚ. ȼɨɫɫɬɚɧɨɜɥɟɧɢɟ ɥɨɤɚɥɶɧɵɯ ɯɪɹɳɟɜɵɯ ɞɟɮɟɤɬɨɜ ɦɨɠɟɬ ɛɵɬɶ ɫɥɟɞɭɸɳɢɦ ɲɚɝɨɦ. Ɋɟɜɦɚɬɨɢɞɧɵɣ ɚɪɬɪɢɬ Ⱦɥɹ ɷɬɨɝɨ ɫɢɫɬɟɦɧɨɝɨ ɡɚɛɨɥɟɜɚɧɢɹ ɯɚɪɚɤɬɟɪɧɨ ɩɨɥɢɫɭɫɬɚɜɧɨɟ ɩɨɪɚɠɟɧɢɟ ɫ ɩɪɨɝɪɟɫɫɢɪɭɸɳɟɣ ɷɪɨɡɢɜɧɨɣ ɞɟɫɬɪɭɤɰɢɟɣ ɯɪɹɳɚ, ɷɬɢɨɥɨɝɢɹ ɤɨɬɨɪɨɣ ɨɫɬɚɺɬɫɹ ɨɤɨɧɱɚɬɟɥɶɧɨ ɧɟ ɜɵɹɫɧɟɧɧɨɣ. ɂɦɦɭɧɨɥɨɝɢɱɟɫɤɢɦ ɩɪɨɰɟɫɫɚɦ ɨɬɜɨɞɢɬɫɹ ɥɢɲɶ ɨɩɪɟɞɟɥɺɧɧɚɹ ɱɚɫɬɶ ɜ ɩɚɬɨɝɟɧɟɡɟ ɞɚɧɧɨɝɨ ɫɬɪɚɞɚɧɢɹ. ɉɪɢɱɢɧɚɦɢ ɪɚɡɜɢɬɢɹ ɫɢɦɩɬɨɦɨɤɨɦɩɥɟɤɫɚ ɫ ɹɜɥɟɧɢɹɦɢ ɦɨɧɨɚɪɬɪɢɬɚ ɥɢɛɨ ɩɨɥɢɚɪɬɪɢɬɚ ɦɨɝɭɬ ɛɵɬɶ ɬɚɤɢɟ ɡɚɛɨɥɟɜɚɧɢɹ, ɤɚɤ: ɩɫɨɪɢɚɡ, ɫɢɧɞɪɨɦ Ɋɟɣɬɟɪɚ, ɜɨɥɱɚɧɤɚ ɢ ɦɧɨɝɢɟ ɞɪɭɝɢɟ. ɇɟɨɛɯɨɞɢɦɨ ɨɩɪɟɞɟɥɹɬɶ ɩɪɢɱɢɧɭ ɯɪɨɧɢɱɟɫɤɨɝɨ ɫɩɟɰɢɮɢɱɟɫɤɨɝɨ ɜɨɫɩɚɥɢɬɟɥɶɧɨɝɨ ɩɪɨɰɟɫɫɚ, ɨɬɜɟɬɫɬɜɟɧɧɨɝɨ ɡɚ ɛɨɥɟɜɨɣ ɫɢɧɞɪɨɦ. ɗɬɨ ɬɚɤ ɠɟ ɫɩɪɚɜɟɞɥɢɜɨ ɞɥɹ ɫɥɭɱɚɟɜ ɪɟɚɤɬɢɜɧɨɝɨ ɢɥɢ ɩɨɫɬɢɧɮɟɤɰɢɨɧɧɨɝɨ ɚɪɬɪɢɬɚ. Ⱦɢɚɝɧɨɫɬɢɤɚ ɨɫɧɨɜɵɜɚɟɬɫɹ ɧɚ ɦɟɬɨɞɚɯ ɩɪɹɦɨɝɨ ɢɥɢ ɧɟɩɪɹɦɨɝɨ ɨɩɪɟɞɟɥɟɧɢɹ ɛɚɤɬɟɪɢɣ: ɢɟɪɫɢɧɢɣ, ɯɥɚɦɢɞɢɣ, ɛɨɪɪɟɥɢɣ, ɫɬɪɟɩɬɨɤɨɤɤɨɜ ɢɥɢ ɢɯ ɫɩɟɰɢɮɢɱɟɫɤɢɯ ɬɨɤɫɢɧɨɜ. Ƚɟɧɟɬɢɱɟɫɤɢɟ ɮɚɤɬɨɪɵ Ɇɧɨɝɢɟ ɝɟɧɟɬɢɱɟɫɤɢɟ ɡɚɛɨɥɟɜɚɧɢɹ ɩɪɨɹɜɥɹɸɬɫɹ ɩɚɬɨɥɨɝɢɟɣ ɪɚɡɥɢɱɧɵɯ ɨɪɝɚɧɨɜ ɢ ɫɢɫɬɟɦ. ɋɟɦɟɣɧɚɹ ɩɪɟɞɪɚɫɩɨɥɨɠɟɧɧɨɫɬɶ ɤ ɯɨɧɞɪɨɦɚɥɹɰɢɢ ɜ ɫɨɱɟɬɚɧɢɢ ɫɨ ɫɥɚɛɨɫɬɶɸ ɫɜɹɡɨɱɧɨɝɨ ɚɩɩɚɪɚɬɚ ɦɨɠɟɬ ɢɦɟɬɶ ɜ ɨɫɧɨɜɟ ɨɛɭɫɥɨɜɥɟɧɧɨɟ ɝɟɧɟɬɢɱɟɫɤɢ ɧɚɪɭɲɟɧɢɟ ɫɢɧɬɟɡɚ ɤɨɥɥɚɝɟɧɚ. Ɉɛɵɱɧɵɟ ɥɟɱɟɛɧɵɟ ɦɟɪɨɩɪɢɹɬɢɹ ɦɨɝɭɬ ɢɦɟɬɶ ɧɢɡɤɭɸ ɷɮɮɟɤɬɢɜɧɨɫɬɶ ɧɚ ɮɨɧɟ ɨɬɫɭɬɫɬɜɢɹ ɥɟɱɟɧɢɹ ɨɫɧɨɜɧɨɝɨ ɡɚɛɨɥɟɜɚɧɢɹ. Ɉɠɢɪɟɧɢɟ ɉɨɜɵɲɟɧɧɵɣ ɜɟɫ ɢ ɨɠɢɪɟɧɢɟ – ɞɨɤɚɡɚɧɧɵɟ ɮɚɤɬɨɪɵ ɩɨɜɵɲɟɧɧɨɝɨ ɪɢɫɤɚ ɪɚɡ134 ɜɢɬɢɹ ɨɫɬɟɨɚɪɬɪɢɬɢɱɟɫɤɢɯ ɷɪɨɡɢɣ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ. ȼ ɫɨɱɟɬɚɧɢɢ ɫ ɩɟɪɟɧɟɫɟɧɧɨɣ ɬɪɚɜɦɨɣ ɜɟɪɨɹɬɧɨɫɬɶ ɪɚɡɜɢɬɢɹ ɨɫɬɟɨɚɪɬɪɨɡɚ ɜɨɡɪɚɫɬɚɟɬ ɞɨ 80%. ȼɚɠɧɨɫɬɶ ɤɨɧɬɪɨɥɹ ɜɟɫɚ ɤɚɤ ɞɥɹ ɩɪɨɮɢɥɚɤɬɢɤɢ, ɬɚɤ ɢ ɞɥɹ ɥɟɱɟɧɢɹ ɩɨɜɪɟɠɞɟɧɢɣ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɧɟ ɜɵɡɵɜɚɟɬ ɫɨɦɧɟɧɢɣ. ɋɧɢɠɟɧɢɟ ɜɟɫɚ ɩɪɟɞɭɩɪɟɠɞɚɟɬ ɨɝɪɚɧɢɱɟɧɢɟ ɮɭɧɤɰɢɢ ɫɭɫɬɚɜɚ, ɩɨɡɜɨɥɹɟɬ ɭɦɟɧɶɲɢɬɶ ɞɨɡɭ ɥɟɤɚɪɫɬɜɟɧɧɵɯ ɩɪɟɩɚɪɚɬɨɜ ɢ ɪɢɫɤ ɯɢɪɭɪɝɢɱɟɫɤɨɝɨ ɜɦɟɲɚɬɟɥɶɫɬɜɚ. ɋ ɷɬɨɣ ɰɟɥɶɸ ɫɥɟɞɭɟɬ ɤɨɧɫɨɥɢɞɢɪɨɜɚɬɶ ɭɫɢɥɢɹ ɞɢɟɬɨɥɨɝɨɜ, ɮɢɡɢɨɬɟɪɚɩɟɜɬɨɜ, ɫɩɟɰɢɚɥɢɫɬɨɜ ɩɨ ɥɟɱɟɛɧɨɣ ɮɢɡɤɭɥɶɬɭɪɟ. Ʉɚɤ ɚɥɶɬɟɪɧɚɬɢɜɚ ɜ ɫɥɭɱɚɹɯ ɜɵɪɚɠɟɧɧɨɝɨ ɨɠɢɪɟɧɢɹ ɦɨɠɟɬ ɪɚɫɫɦɚɬɪɢɜɚɬɶɫɹ ɯɢɪɭɪɝɢɱɟɫɤɨɟ ɜɦɟɲɚɬɟɥɶɫɬɜɨ. Ɍɟɦ ɧɟ ɦɟɧɟɟ, ɧɟ ɩɨɞɜɟɪɝɚɟɬɫɹ ɨɛɫɭɠɞɟɧɢɸ ɭɬɜɟɪɠɞɟɧɢɟ, ɱɬɨ ɯɨɪɨɲɨ ɫɛɚɥɚɧɫɢɪɨɜɚɧɧɚɹ ɞɢɟɬɚ ɨɤɚɡɵɜɚɟɬ ɛɥɚɝɨɬɜɨɪɧɨɟ ɜɥɢɹɧɢɟ ɧɚ ɜɫɟ ɬɤɚɧɢ ɢ ɨɪɝɚɧɵ ɱɟɥɨɜɟɱɟɫɤɨɝɨ ɬɟɥɚ. ɏɪɹɳɟɜɵɟ ɨɩɭɯɨɥɢ Ȼɨɥɶɲɢɧɫɬɜɨ ɞɨɛɪɨɤɚɱɟɫɬɜɟɧɧɵɯ ɢ ɡɥɨɤɚɱɟɫɬɜɟɧɧɵɯ ɨɩɭɯɨɥɟɣ ɯɪɹɳɟɜɨɝɨ ɩɪɨɢɫɯɨɠɞɟɧɢɹ, ɪɚɫɩɨɥɚɝɚɸɳɢɯɫɹ ɜɛɥɢɡɢ ɫɭɫɬɚɜɨɜ, ɢɦɟɸɬ ɯɚɪɚɤɬɟɪɧɭɸ ɪɟɧɬɝɟɧɨɥɨɝɢɱɟɫɤɭɸ ɤɚɪɬɢɧɭ ɢ ɫɬɪɭɤɬɭɪɭ ɤɨɫɬɢ ɢ ɯɪɹɳɚ. ɋɪɟɞɢ ɧɢɯ – ɝɢɝɚɧɬɨɤɥɟɬɨɱɧɚɹ ɨɩɭɯɨɥɶ, ɯɨɧɞɪɨɦɢɤɫɨɢɞɧɚɹ ɮɢɛɪɨɦɚ, ɨɫɬɟɨɯɨɧɞɪɨɦɚ, ɩɟɪɢɨɫɬɚɥɶɧɚɹ ɯɨɧɞɪɨɦɚ, ɷɧɯɨɧɞɪɨɦɚ. ɇɚɢɛɨɥɶɲɢɟ ɬɪɭɞɧɨɫɬɢ ɜɵɡɵɜɚɟɬ ɞɢɚɝɧɨɫɬɢɤɚ ɪɟɞɤɨɣ ɨɩɭɯɨɥɢ – ɯɨɧɞɪɨɛɥɚɫɬɨɦɵ. Ɍɢɩɢɱɧɚɹ ɟɺ ɥɨɤɚɥɢɡɚɰɢɹ – ɩɟɪɢɮɟɪɢɹ ɤɨɥɟɧɧɨɝɨ ɫɭɫɬɚɜɚ, ɚ ɪɨɫɬ ɯɨɧɞɪɨɛɥɚɫɬɨɦɵ ɫɨɩɪɨɜɨɠɞɚɟɬɫɹ ɞɟɫɬɪɭɤɰɢɟɣ ɯɪɹɳɚ. ɋɬɪɚɞɚɸɬ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɨ ɞɟɬɢ ɢ ɩɨɞɪɨɫɬɤɢ. Ɉɫɬɟɨɥɢɬɢɱɟɫɤɚɹ ɤɢɫɬɚ ɨɤɪɭɝɥɨɣ ɮɨɪɦɵ ɪɚɫɩɨɥɚɝɚɟɬɫɹ ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨ ɜ ɫɭɛɯɨɧɞɪɚɥɶɧɨɣ ɨɛɥɚɫɬɢ ɢ ɦɨɠɟɬ ɩɟɧɟɬɪɢɪɨɜɚɬɶ ɜ ɩɨɥɨɫɬɶ ɫɭɫɬɚɜɚ. ɇɚ ɪɟɧɬɝɟɧɨɝɪɚɦɦɟ ɦɨɠɧɨ ɪɚɡɥɢɱɢɬɶ ɨɬɞɟɥɶɧɵɟ ɭɱɚɫɬɤɢ ɦɢɧɟɪɚɥɢɡɚɰɢɢ, ɪɚɫɩɨɥɨɠɟɧɧɵɟ ɜɧɭɬɪɢ ɤɢɫɬɵ. Ɇɢɤɪɨɬɪɚɜɦɚ Ⱦɟɝɟɧɟɪɚɬɢɜɧɵɟ ɢɡɦɟɧɟɧɢɹ ɯɪɹɳɚ ɜɨɡɦɨɠɧɵ ɞɚɠɟ ɩɪɢ ɦɢɧɢɦɚɥɶɧɨɣ ɩɨɜɬɨɪɹɸɳɟɣɫɹ ɦɢɤɪɨɬɪɚɜɦɟ. ɇɚɛɥɸɞɚɟɬɫɹ ɩɨɬɟɪɹ ʋ2x 2009 i ɬɨɦ 17 ɩɪɨɬɟɨɝɥɢɤɚɧɨɜ ɢ ɩɨɹɜɥɟɧɢɟ ɚɬɢɩɢɱɧɵɯ ɤɨɥɥɚɝɟɧɨɜ I, III ɢ X ɬɢɩɨɜ. ɏɨɧɞɪɨɰɢɬɵ ɦɨɝɭɬ ɩɨɞɜɟɪɝɚɬɶɫɹ ɞɟɝɟɧɟɪɚɰɢɢ ɢɥɢ ɩɪɨɥɢɮɟɪɚɰɢɢ, ɨɝɪɚɧɢɱɟɧɧɨɣ ɡɨɧɨɣ ɩɨɜɬɨɪɹɸɳɟɣɫɹ ɦɢɤɪɨɬɪɚɜɦɵ. Ɍɚɤɢɟ ɢɡɦɟɧɟɧɢɹ ɧɟ ɦɨɝɭɬ ɛɵɬɶ ɢɞɟɧɬɢɮɢɰɢɪɨɜɚɧɵ ɢ ɜɢɡɭɚɥɢɡɢɪɨɜɚɧɵ. Ɉɧɢ ɫɥɭɠɚɬ ɩɪɟɞɩɨɫɵɥɤɨɣ ɪɚɡɜɢɬɢɹ ɞɟɝɟɧɟɪɚɬɢɜɧɵɯ ɢɡɦɟɧɟɧɢɣ ɯɪɹɳɚ ɫ ɩɨɬɟɪɟɣ ɟɝɨ ɛɢɨɥɨɝɢɱɟɫɤɨɣ ɫɬɚɛɢɥɶɧɨɫɬɢ. ɋɨɜɪɟɦɟɧɧɵɟ ɦɟɬɨɞɢɤɢ ɜɢɡɭɚɥɢɡɚɰɢɢ ɢɧɮɨɪɦɚɬɢɜɧɵ ɬɨɥɶɤɨ ɩɪɢ ɩɪɨɝɪɟɫɫɢɪɨɜɚɧɢɢ ɡɚɛɨɥɟɜɚɧɢɹ [9]. ɉɨɜɟɪɯɧɨɫɬɧɵɟ ɷɪɨɡɢɢ ɫɭɫɬɚɜɧɨɝɨ ɯɪɹɳɚ ɫɬɢɦɭɥɢɪɭɸɬ ɨɤɪɭɠɚɸɳɢɟ ɯɨɧɞɪɨɰɢɬɵ ɤ ɜɪɟɦɟɧɧɨɦɭ ɩɨɜɵɲɟɧɢɸ ɦɟɬɚɛɨɥɢɱɟɫɤɨɣ ɢ ɦɢɬɨɬɢɱɟɫɤɨɣ ɚɤɬɢɜɧɨɫɬɢ. ȼɨ ɜɧɟɤɥɟɬɨɱɧɨɦ ɦɚɬɪɢɤɫɟ ɨɩɪɟɞɟɥɹɟɬɫɹ ɩɨɜɵɲɟɧɧɵɣ ɭɪɨɜɟɧɶ ɩɪɨɬɟɨɝɥɢɤɚɧɚ ɢ ɤɨɥɥɚɝɟɧɚ II ɬɢɩɚ. Ɉɞɧɚɤɨ ɷɬɨɬ ɩɪɨɰɟɫɫ ɧɟ ɩɪɢɜɨɞɢɬ ɤ ɜɨɫɫɬɚɧɨɜɥɟɧɢɸ ɡɨɧɵ ɩɨɜɪɟɠɞɟɧɢɹ [9]. ɉɨɜɪɟɠɞɟɧɢɹ, ɪɚɫɩɪɨɫɬɪɚɧɹɸɳɢɟɫɹ ɞɨ ɫɭɛɯɨɧɞɪɚɥɶɧɨɣ ɤɨɫɬɢ, ɨɛɵɱɧɨ ɡɚɠɢɜɚɸɬ, ɤɚɤ ɜɨɫɩɚɥɢɬɟɥɶɧɵɟ ɩɪɨɰɟɫɫɵ. Ɉɞɧɚɤɨ ɞɥɹ ɜɵɯɨɞɚ ɜ ɞɟɮɟɤɬ ɦɟɡɟɧɯɢɦɚɥɶɧɵɯ ɫɬɜɨɥɨɜɵɯ ɤɥɟɬɨɤ ɧɟɨɛɯɨɞɢɦɨ ɨɛɧɚɠɟɧɢɟ ɫɭɛɯɨɧɞɪɚɥɶɧɨɣ ɤɨɫɬɢ. ɗɬɢ ɤɥɟɬɤɢ ɨɛɥɚɞɚɸɬ ɫɩɨɫɨɛɧɨɫɬɶɸ ɤ ɞɢɮɮɟɪɟɧɰɢɪɨɜɤɟ ɜ ɯɪɹɳ- ɢ ɤɨɫɬɶɩɪɨɞɭɰɢɪɭɸɳɢɟ ɤɥɟɬɤɢ ɬɚɤɢɟ, ɤɚɤ ɯɨɧɞɪɨɰɢɬɵ ɢ ɨɫɬɟɨɛɥɚɫɬɵ. Ⱥɧɚɥɨɝɢɱɧɨ ɨɛɪɚɡɨɜɚɧɢɸ ɤɨɠɧɨɝɨ ɪɭɛɰɚ ɨɫɬɟɨɯɨɧɞɪɚɥɶɧɵɣ ɞɟɮɟɤɬ ɡɚɩɨɥɧɹɟɬɫɹ ɮɢɛɪɨɡɧɨɣ ɬɤɚɧɶɸ, ɤɨɬɨɪɚɹ ɨɛɥɚɞɚɟɬ ɯɭɞɲɢɦɢ ɦɟɬɚɛɨɥɢɱɟɫɤɢɦɢ ɢ ɛɢɨɦɟɯɚɧɢɱɟɫɤɢɦɢ ɫɜɨɣɫɬɜɚɦɢ ɜ ɫɪɚɜɧɟɧɢɢ ɫ ɝɢɚɥɢɧɨɜɵɦ ɯɪɹɳɨɦ. Ɏɢɛɪɨɡɧɵɣ ɯɪɹɳ ɧɟ ɫɩɨɫɨɛɟɧ ɩɪɨɬɢɜɨɫɬɨɹɬɶ ɦɟɯɚɧɢɱɟɫɤɢɦ ɧɚɝɪɭɡɤɚɦ, ɜɨɡɧɢɤɚɸɳɢɦ ɜ ɡɨɧɚɯ ɤɨɧɬɚɤɬɚ ɫɭɫɬɚɜɧɵɯ ɩɨɜɟɪɯɧɨɫɬɟɣ, ɢ ɫɨ ɜɪɟɦɟɧɟɦ ɩɨɞɜɟɪɝɚɟɬɫɹ ɞɟɝɟɧɟɪɚɬɢɜɧɵɦ ɢɡɦɟɧɟɧɢɹɦ. ɅɂɌȿɊȺɌɍɊȺ 1. Articular cartilage biology / M. Ulrich-Vinther [et al.] // J. Am. Acad. Orthop Surg. – 2003. – Vol. 11. – P. 421-430. 2. Eckstein, F. The effects of exercise on human articular cartilage / F. Eckstein, M. Hudelmaier, R. Putz // Journal of Anatomy. – 2006. – Vol. 208, N 4. – P. 491-512. 3. Accumulation of advanced glycation end products as a molecular mechanism for aging as a risk factor in osteoarthritis / J. Degroot [et al.] // Arthritis Rheum. – 2004. – Vol. 50. – P. 1207-1215. 4. Fithian, D. Patellar instability: the Lyon experience / D. Fithian, Ph. Neyret, E. Servien // Current Orthopaedic Practice. – 2008. – Vol. 19, N 3 – P. 328338. 5. Outcomes of microfracture for traumatic chondral defects of the knee: Average 11-year follow-up / J. R. Steadman [et al.] // Arthroscopy. – 2003. – Vol. 19. – P. 477-484. 6. DeFranco, M. J. A Comprehensive Review of Partial Anterior Cruciate Ligament Tears / M. J. DeFranco, B. R. Bach // The Journal of Bone & Joint Surgery. – 2009. – Vol. 91-A, N 1. – P. 198-208. 7. Induction of chondrocyte apoptosis following impact load / J. Borrelli [et al.] // J. Orthop Trauma. – 2003. – Vol. 17. – P. 635-641. 8. Erggelet, C. Principles of Cartilage Repair / C. Erggelet, B. R. Mandelbaum. – Springer, 2008. – 121 p. 9. Gerdeman, A. C. What’s New in Sports Medicine / A. C. Gerdeman, M. V. Hogan, M. D. Miller // The Journal of Bone & Joint Surgery. – 2009. – Vol. 91-A, N 1. – P. 241-256. 10. Analysis of Tibiofemoral Cartilage Deformation in the Posterior Cruciate Ligament-Deficient Knee / S. K. Van de Velde [et al.] // The Journal of Bone & Joint Surgery. – 2009. – Vol. 91-A, N 1. – P. 167-175. 11. Autologous chondrocyte implanation compared with microfracture in the knee: A randomized trial / G. Knutsen [et al.] // The Journal of Bone & Joint Surgery. – 2004. – Vol. 86-A. – P. 455-464. `д!е“ дл *%!!е“C%…де…ц,, 210023, pе“C3Kл,*= aел=!3“ь, г. b,2еK“*, C!. t!3…ƒе, 27, b,2еK“*,L г%“3д=!“2"е……/L мед,ц,…“*,L 3…,"е!“,2е2, *=-ед!= 2!="м=2%л%г,,, %!2%Cед,, , bou, 2ел. !=K.: +375 212 22-40-84, е-mail: [email protected] a%л%K%ш*% j.a. ɉɨɫɬɭɩɢɥɚ 29.12.2008 ɝ. 135
