Clinical picture Damage to the interspinous and supraspinous ligaments depends on the duration of the injury and concomitant injuries to the spine. At the same time clinical diagnosis These injuries are quite complex: the injury is often not always detected by palpation, since the displacements in the vertebral area are insignificant, and x-rays cannot always help in making a diagnosis. This is especially true for the quite common sprains in the upper segment. cervical spine spine. In the next order of magnitude, the articular joints of the middle and lower parts of the cervical spine are damaged. Depending on the location of the damage, they are defined as post-traumatic suboccipital syndrome, median And lower cervical syndrome . The clinical picture is characterized by the appearance of typical neurological pain in occipital region with scanty objective signs. The cause of occipital neuralgia is compression occipital nerves, which, being formed from the dorsal roots of two cervical segments, “pierce the yellow ligament” between the arch of the atlas and epistrophea, next to the intervertebral joints. Spondylograms do not reveal any changes.

PAIN

For damage to the interspinous and supraspinous ligaments in late dates After an injury, persistent pain in the area of ​​injury is typical, such as cervicalgia, lumbago. Patients note rapid fatigue of the neck and back muscles. In the future, radicular pain may appear, which often depends on secondary degenerative changes intervertebral disc at the level of damage with the formation of posterior and posterolateral disc herniations.

FORCED POSITION

It is known that the lateral joints of the cervical vertebral bodies are located in an oblique plane, passing from back to front and from bottom to top. Deviation from the horizontal plane increases from top to bottom: it is less pronounced in the joints between the C1-C2 vertebrae, more between C7-Th1. Therefore, forward displacement of the vertebra (with hypermobility or instability) is accompanied by its elevation until the lower articular process of the vertebral body slips into the superior vertebral notch of the underlying vertebra, when the displaced vertebra again approaches the underlying one.

At various options displacements the head takes on a characteristic position. which is considered typical. The maximum height of displacement of the lower articular process with hypermobility (instability) is I – III degree. does not exceed 0.7 cm. If there is a forced tilt of the head anteriorly, then upon examination, kyphosis is clearly visible, the apex of which is formed by the spinous process of the affected vertebra. The so-called typical head positions are not always clearly expressed during sprains in old cases, as they are masked by compensatory displacements in adjacent undamaged joints.

For diagnosis in unclear cases of “head tilt”, it is recommended to focus according to the height of the corners lower jaw with a straightened neck (“bent head”). On the convex side of the curvature, the angle of the lower jaw occupies more high position on the side of the injury, especially if the patient first makes several nodding movements.

The best forced position of the head is revealed when examining the patient in the initial position - standing, which is not always possible and acceptable, especially in fresh cases. therefore, many authors emphasize the unreliability of diagnosis based on symptoms of typical head position. However, the identification of a forced position of the head serves as a sufficient basis for an in-depth clinical and radiological examination, without which the assumption of damage to the ligamentous apparatus of the cervical spine cannot be rejected.

HEAD INSTABILITY

Head instability is a consequence of disorders of the alignment of the spine due to a violation of the relationships between the vertebrae, damage to the ligamentous apparatus, displacement of the load axis and the direction of muscle traction. The degree of instability can be different, which depends both on the severity of the damage and the development of compensatory phenomena.

At severe lesions ligamentous apparatus (III degree), instability of the head is detected immediately after the injury and persists for a long time (weeks, months). In milder cases (grade I – II damage) this symptom expressed to a lesser extent, disappears faster due to scarring of damaged tissues and compensatory devices in the ligamentous-muscular apparatus of the neck. In a number of patients, head instability persists constantly in vertical position, or it occurs when changing body position, with more or less prolonged load (for example, when walking, prolonged sitting, especially with the head tilted anteriorly).

CLASSIFICATION OF DEGREES OF HEAD INSTABILITY
(Epifanov V.A., Epifanov A.V., 2002)

mild (I) degree of instability (damage to 1 vertebral motion segment)

clinical picture : tension in the neck muscles that hold the head in a forced position; when moving the torso and limbs, the position of the head remains unchanged (due to tension in the neck muscles); the patient makes movements carefully, slowly; if compensation is observed, it is not stable and is easily disrupted during work, especially when the head is tilted forward

medium (II) degree of instability (damage to 1 - 2 vertebral motor segments)

clinical picture: tension in the neck muscles that support the head; the patient supports his head with his hands when the body is in an upright position, when trying to stand up or lie down, when bending the torso forward (Thomsen's symptom); the patient can get up and lie down without supporting his head with his hands, but only with his side to the horizontal plane (preservation of lateral stability)

severe (III) degree of instability (damage to 2 or more vertebral motor segments)

clinical picture: tension in the muscles of the neck, shoulder girdle and paravertebral muscles; the patient constantly supports his head with his hands; the patient’s head cannot be supported and falls when lifting a “lying” patient (symptom of “guillotining”)

Head instability is common and important symptom damage to the ligamentous apparatus of the cervical spine, but it can also be observed with fractures of the vertebral bodies, damage to the intervertebral discs, osteochondrosis of the spine, paresis and atrophy of the neck muscles, and some developmental anomalies. Therefore this syndrome cannot serve self-test in differential diagnosis traumatic injuries spinal ligaments.

MOVEMENT DISORDERS IN THE CERVICAL SPINE

Displacement in the lateral joints of the cervical spine in any location is accompanied by impaired movement. These disorders are expressed more clearly the less time has passed since the injury. Later, with the development of compensatory processes, the instability of the head decreases and the range of movements increases.

There are three possible variants of movement disorders in the cervical spine (Epifanov V.A., Epifanov A.V., 2002): 1. complete immobility; 2. restriction of movements in all directions; 3. restriction of movement in the direction of damage.

When studying movements, it should be kept in mind that:
movement disorder in the same patient is more pronounced in a vertical position than in a horizontal position;
in the initial lying position, restrictions on tilting and turning the head are more accurately determined in cases where the patient’s head is located along the axis of the body, since when the cervical spine is extended, these movements can be limited without damage;
simultaneously with movement disorders due to damage to the ligamentous apparatus, tension in the neck muscles and crepitus during movements are observed; muscle tension in this case may be a consequence of their reflex tension or tension as the distance of attachment points increases;
crunching, clicking or crepitus during movements in the cervical spine, experienced by the patient or determined by palpation of the affected area - perhaps this is a manifestation of degenerative-dystrophic changes in the lateral joints, intervertebral discs and spinal ligaments, not accompanied by other clinical symptoms.

Movement disorders in the cervical spine are common symptom damage or impairment of compensation, in some diseases of the spine and cannot serve as a reliable basis for differential diagnosis between damage to the ligamentous apparatus and other injuries and diseases. However, the study of movements in the cervical spine can confirm the assumption of spinal damage, and the restoration of movements after treatment by means of exercise therapy is the most valuable clinical sign the onset of recovery.

Symptoms of ligament damage revealed by palpation:
deviation of the spinous processes in one direction or another, as a result of which the location in one sagittal plane is disrupted; however, detection of such a displacement is possible only in individual cases (this depends on the unequal length of the spinous processes, on the unequal form of bifurcation of their ends, on the masking effect of the supraspinous ligament in the event of its separation from the spinous processes, on the large thickness of the muscles and their tension); curvatures of the line of the spinous processes are more easily detected only in the area of ​​C6-7 and C2-3;
upon palpation of the area of ​​damage to the vertebral motor segment of the spine, pain is determined, and in the first hours or even days it can be detected only outside the affected area; this depends on the greater extent of the ligament damage, on the displacement of damaged tissues that occurs during palpation of mobile formations (supraspinal ligament, muscles) and away from the site of damage;
with anterior displacement of the vertebral bodies (hypermobility, instability), accompanied by their anterior tilt, the posterior ligaments rupture and the distance between the spinous processes of the affected and underlying vertebrae increases.

The most common injuries to the cervical spine are sprains of the ligaments and muscles of the neck. The condition is accompanied by severe pain, limited head movements, weakness and drowsiness. Damage requires immediate medical consultation and proper treatment, since it can provoke complications in the form of osteochondrosis, curvature of posture, improper supply nerve cells upper limbs.

Why does stretching occur?

A child is injured due to carelessness during play. Parents can also damage their neck muscles by lifting their baby without supporting his head. Damage to the neck ligaments is caused by the following factors:

• a sharp turn of the head during aerobics or gymnastics;
• an incorrectly selected pillow, as a result of which the muscles and ligaments of the cervical spine are overstrained and stretched;
• playing sports that involve grabbing the head;
• a fall in which the head is in an unnatural position;
• diseases of the cervical spine;
• regular lifting of weights.

Symptoms: How does the injury manifest itself?

Movements are accompanied by acute pain.

A sprained cervical ligament is characterized by the following symptoms:

• severe shooting pain when trying to move the neck, radiating to the back of the head;
• edema;
• unnatural head position (temporary torticollis);
• feeling of numbness and muscle spasms in the upper limbs.

Due to edema, blood vessels can be pinched, which is why cerebral circulation. The main symptoms include:

• lethargy;
• increased drowsiness;
• psycho-emotional instability;
• fainting.

What are the complications?

If therapy is not carried out on time, limitation of passive movements may develop, in which a person will not be able to fully tilt or turn his head to the sides. In addition, cervical sprain leads to such pathological conditions, How:

• curvature of posture;
• torticollis;
• osteochondrosis;
• impairment of motor functions, sensitivity of the upper extremities and the collar area;
• chronic pain in the elbow or shoulder.

How to provide first aid?

The neck must be immobilized as much as possible.

Due to the risk of developing edema and poor circulation first aid should be provided immediately. Algorithm of actions:

1. Place the victim on a hard surface.
2. Place a tight cushion under your neck.
3. Limit any head movements.
4. Apply cold by first wrapping the ice in a clean rag.
5. Give painkillers (children's medicine for babies).
6. Transport to emergency room.

What is strictly prohibited?

• warm up sore spot immediately after injury;
• roughly massage the neck;
• make sudden movements of the head, overcoming the pain.

Diagnostic measures

The victim is examined by a traumatologist. The doctor finds out the circumstances of the sprain, palpates the sore spot, assesses the degree of limited mobility of the neck and refers to diagnostic procedures- radiography, ultrasound, CT or MRI. The methods allow us to determine the degree of damage to muscle and ligament fibers and the condition of the surrounding soft tissues. Based on the indications of the measures taken, therapy is prescribed.

Treatment: how to act correctly?

Drug therapy

Analgesics will reduce pain.

All medications should be taken as recommended by a doctor and not self-medicated. To remove pain analgesics “Analgin”, “Ketanov” (can be taken for no longer than 2 days), “Ibuprofen” are prescribed. For children, Nurofen or Paracetamol is recommended. Anti-inflammatory liniments “Teraflex” and “Fastum Gel” are also effective. IN difficult cases You should use special neck orthoses or bandages that reduce the load on the neck muscles.

Physiotherapy

To restore motor functions, neck strains are recommended to be treated with physiotherapeutic methods such as:

• magnetic therapy;
• electrophoresis;
• inductothermy;
• UHF therapy;
• laser treatment.

The effectiveness of the procedures is as follows:

• eliminate pain and muscle spasms;
• normalize blood circulation;
• restore neck mobility;
• improve metabolic processes in damaged tissues.

Acupuncture helps relieve pain and relieve spasms. The procedure should only be carried out in specialized clinic licensed. The method has contraindications and side effects, since here the needle impacts active points. Therefore, you should consult your doctor before the session.

Long periods of time will help speed up the recovery process. hiking in the fresh air.

Traditional medicine methods

Facilities traditional medicine will relieve sprain symptoms for a while.

Strained neck muscles can be treated at home with applications of blue clay, which should be diluted with water to a paste and applied to the sore spot. Healers recommend a compress of grated raw potatoes And sauerkraut. An effective decoction for lotions prepared according to the following recipe:

1. Take 2 tbsp. l. dry lingonberry leaves and chop.
2. Pour in 200 ml of hot water.
3. Let it brew and filter.
4. Soak gauze in the product and apply to the sprained area.

1. Dry birch leaves in a well-ventilated place, away from sunlight.
2. Fill a belt or roller with the raw material and put it around your neck.
3. Hold the device until sweat begins to flow.
4. Remove the compress and wipe your neck dry.

Preventing neck sprains

To avoid sprains, you should gently stretch your neck after sleep. Sports should also begin with a warm-up of the cervical spine. If you feel discomfort the next morning, it is recommended to purchase an orthopedic pillow with a bolster. Or use a flat, hard pillow, placing the bottom edge between your shoulder and head. You should do strengthening exercises daily: turning and tilting your head up and down and from side to side.

A neck sprain is a common and painful injury, often accompanied by long-term discomfort. This area of ​​the body is one of the most mobile structures in the human body. Possessing many ligaments, muscles and seven vertebrae, the neck is capable of circular, horizontal and vertical plane. This injury can be caused by a variety of factors, such as:

• Sudden movements to the side;
• Road traffic accidents;
• Prolonged adoption of an uncomfortable position during sleep;
• Unfortunate falls or blows.

The stretch itself appears as microscopic ruptures of the fibrous structures of the ligamentous apparatus. Most often, injuries plague athletes and people involved in physical activity. However, neck ligament sprains also affect other people whose lifestyle is not related to strength-training activities.

Symptoms

Signs accompanying neck sprains:

1. Pain. This sensation appears immediately at the moment of injury, but there have been cases when pain appeared one or several days after the injury. It can be both long-lasting and sharp. Any attempt to move the neck leads to increased pain at the site of the damaged ligament. In addition, pain can spread to neighboring areas - the shoulder or back;
2. Loss or decreased sensation in the arms or legs. This phenomenon is explained possible damage passing next to the ligaments of nerves. Also in these areas of the body, victims may feel crawling or any other unknown to the person feelings;
3. Local swelling in the affected area of ​​the ligament. Outwardly, this may appear to increase the size of this area of ​​the neck;
4. Aching headaches in posterior areas heads;
5. Sore throat;
6. Limitation of neck movements. The victim cannot make a full turn of his head. For a comfortable state, a person, as a rule, takes a specific position of the head in such a way as not to feel pain;
7. Due to prolonged experience of pain, the victim becomes irritable, lethargic, his concentration decreases and the quality of sleep deteriorates.

In a child, the clinical picture of a sprained cervical ligament does not differ from that in an adult.

First aid: what to do

It is important to remember that the neck is a delicate structure, and any inaccurate movement can provoke a deterioration of not only the local manifestations of the sprain, but also the general condition of the victim. It is worth knowing that by following certain points of assistance, you can prevent the consequences and alleviate hospital treatment sick. First aid involves performing a number of points:

• To begin the manipulations, the person needs to be ensured peace, remove the load from his neck and place him on a flat surface. You need to place a soft cushion under your neck. Such a device can be made from soft fabrics. This action ensures an even load on cervical vertebrae, muscles and ligaments;
• Using a cold compress. Ice is good example. When using cold, you need to know that when applying cold to the neck, the victim will feel severe discomfort, so the ice needs to be wrapped in cloth. In addition, it is necessary to monitor general condition patient, because ice cooling affects the temperature of the main vessels, which can lead to its deterioration. Ice also relieves the development of edema;
• It is appropriate to take anti-inflammatory drugs. In addition to, in fact, relieving the development of inflammation, this group of drugs can quench severe pain. Well-known representatives of such drugs are ibuprofen, ketanov or baralgin.

Treatment at home

For effective and successful treatment neck sprains, general approaches should be followed:

1. Use of painkillers. Such drugs are easy to buy at the pharmacy: aspirin, ibuprofen or naproxen. In addition to relieving pain, they prevent the development of swelling and inflammation;
2. In the future, warm compresses should be applied to the site of injury: they warm the skin, increase local blood flow and accelerate the rate of healing of the ligaments;
3. Providing complete rest to the ligaments and muscles of the neck. It is necessary to create all the conditions in order to remove any load from the neck.

Rehabilitation and recovery

Full recovery depends on the severity of the sprains. So, a severe injury can take 3 months to recover, while a simple sprain of a small ligament can take two weeks. The rehabilitation course involves the use of massage and self-massage, physical therapy, reflexology and further medication.

Due to the fact that the cervical region spinal column is the most mobile, neck dislocation is quite common. IN medical reference books This injury is called “prolapse of the cervical spine capsule.”

This damage is very dangerous because it is characterized not only by displacement articular surfaces, vertebrae, but also internal processes, stretching muscle tissue and ligamentous apparatus.

As a result, damage to the substance and shell almost always occurs. spinal cord. Considering these points, we can confidently say that a dislocated neck is a direct threat to human life.

In what situations can you get injured?

The cause of neck dislocation and damage to its ligaments can be:

• Road traffic accident.
• Ice skating and skiing.
• Headstand exercises.
• Diving in untested bodies of water.
• Somersaults in physical education lessons.
• Injuries received from sports equipment.
• Involuntary arching of the neck with sudden raising of the head during sleep.

Unfortunately, neck dislocation and ligament sprain are often accompanied by a fracture of the cervical vertebrae.

Different types of dislocation are classified according to the mechanism of injury, location of injury, and degree of displacement.

1. Anterior and posterior dislocations.
2. Single-sided and double-sided.
3. Incomplete and complete.
4. Linked.
5. Sliding.
6. Tipping.

It is quite difficult to get a dislocation and sprain in another part of the spinal column, which is due to its structure. The spine is the foundation of the human body, therefore all vertebral joints are firmly connected to each other using ligaments and intervertebral discs.

Due to the fact that the joints of the cervical region are actively working, and the ligaments are flexible, the human neck is capable of turning, bending and tilting, that is, it is very mobile. Neck dislocation most often occurs in the first vertebra.

Symptoms of a dislocated cervical vertebra

Since cervical spine dislocations come in a variety of forms, the symptoms of each have their own individual characteristics.

• With a unilateral neck dislocation, the head tilts in the direction opposite to the displacement.
• With bilateral cervical dislocation, the head tilts forward.
• The patient experiences severe pain, which intensifies every day.
• The pain becomes more intense when the head is in a horizontal position.
• It becomes impossible to turn and tilt your head. This can only be achieved by holding the head with your hands.
• Patients diagnosed with a dislocation of the cervical spine are forced to turn their entire body if necessary to turn their head.
• These symptoms are accompanied by crepitus, headache, dizziness, darkening of the eyes.
• The pain may radiate to the arm or shoulder joint.

However, when making a diagnosis, doctors do not rush to a final conclusion, since the symptoms of a neck dislocation are quite similar to the signs of myositis and osteochondrosis.

Usually, to clarify the diagnosis, already at the first appointment, the doctor sends the patient for an x-ray. Although on x-rays the dislocation is not always determined, but the displacement of the head in relation to the cervical spine is quite clearly recorded.

Based on these signs, the doctor can determine a dislocation of the neck.

If a patient has the above symptoms, there is every reason to suspect this particular injury, so the person should immediately see a traumatologist. Neglect of the problem can result in sprains and contracture of tendons and muscles, and these are already irreversible phenomena:

1. the neck becomes crooked;
2. The patient's head is always tilted to one side or forward.

Diagnosis and treatment of neck dislocation

Today, for a more accurate diagnosis, the spondylography method is used (x-ray of the spinal column without prior contrast).

If it is not possible to immediately make a diagnosis, and all symptoms indicate the presence of a dislocated neck, the examination is performed through the oral cavity.

The doctor is absolutely convinced that a neck dislocation is present if the following pathological changes are observed on the photographs:

• displacement of articular surfaces;
• unilateral reduction in the size of the intervertebral disc;
• asymmetrical position of the first vertebra.

Sprains and neck dislocations can be treated with both conservative measures and surgical intervention. TO conservative methods are included:

1. skeletal traction by the parietal tuberosities;
2. one-stage closed reduction using a Glisson loop;
3. reduction using the Richet-Hüther method.

Conservative therapy is indicated in acute phase damage.

Treatment of children

If a cervical spine injury is diagnosed in a child, experienced doctor performs a one-step reduction of the vertebra, for which the doctor uses a special Glisson loop. First, the traumatologist makes careful rotational movements, tilting the patient's head to the right and left, back and forth.

During such manipulations, a crunching sound is clearly audible; this is characteristic of repositioning the vertebra to its anatomical place. The procedure is performed only by a doctor who has sufficient experience in operating traction equipment. The doctor stays next to the patient all the time and gradually increases the load on the device.

If a sudden sharp crunch appears, the doctor immediately eases the load and sends the child for a repeat x-ray. Treatment of old neck injuries is carried out using a Crutchfield brace. This procedure is much more serious and requires drilling blind holes in the skull.

After repositioning, the tissue around the affected vertebra will certainly swell. After swelling subsides, it is recommended to apply plaster or plastic thoracocranial orthoses.

The child must wear such a device for two months. In about three months, the cervical spine will fully recover.

How to treat a sprained or dislocated cervical spine in adults

TO emergency measures assistance includes ensuring the victim complete rest and immediately transporting him to medical institution. With such injuries there is always a risk of damage to the spinal cord.

At the clinic, the patient will have an X-ray, the vertebra will be realigned and an immobilizing bandage will be applied for 4-6 months. Some doctors prefer to perform vertebral adjustment without anesthesia. They explain this approach by the fact that the doctor can control the patient’s sensations during the procedure.

Reduction occurs as follows:

• the doctor tells the patient about possible pain syndromes and their manipulations;
• the patient is seated on a chair;
• the doctor takes the patient’s head and begins to lift it, thus the patient’s body turns out to be a natural counterweight;
• The doctor does not stop his actions until the vertebrae are in place.

After this procedure, the patient is prescribed a course of physiotherapeutic measures.

In their practice, doctors sometimes resort to realignment of the cervical spine using the Richet-Hüter method. The essence of this technique is as follows:

1. the patient lies with his back on the couch in such a way that his head and neck hang down;
2. a solution of novocaine is injected into the diseased area;
3. the doctor applies a Glisson loop and fixes it on his lower back, while the doctor holds the patient’s head with his hands;
4. The medical assistant stands opposite and holds the patient’s neck with his hands (the edges of the assistant’s palms should be on the border of the injury);
5. the neck gradually stretches along the axis, and the doctor begins to tilt it in the healthy direction;
6. With utmost care, the doctor turns the patient’s head in the direction of the dislocation, as a result of which the vertebra should return to its place.

If these techniques are ineffective, surgery is indicated for the patient.

Backache. How to determine the cause and eliminate the attack Angela Valerievna Evdokimova

Ligamentous apparatus and muscles

Ligamentous apparatus and muscles

Ligaments (dense connective tissue structures) firmly connect the vertebrae, directing and limiting their movements in different directions. The ligaments can withstand heavy loads and are so strong in tension that they do not rupture in the event of an injury (usually a section of bone at the site of attachment of the ligaments is torn off). Numerous back muscles - superficial, deep, long and short - along with ligaments, ensure reliable connection of the vertebrae and mobility of the spine.

The bodies of adjacent vertebrae are connected by intervertebral discs, and the arches and processes - with the help of ligaments.

Human muscles are divided into smooth, cardiac and striated.

Smooth muscles are located in the walls internal organs, blood vessels and in the skin. They are part of arteries and veins, almost all organs digestive tract, gall and urinary bladders, fallopian tubes, uterus, etc. Contractions of smooth muscles are subordinate to the autonomic nervous system, which means they are involuntary, that is, not controlled by consciousness.

The heart muscle, unlike other muscles, contracts automatically, involuntarily and does not stop working throughout a person’s life.

Striated (skeletal) muscles are attached to bones and set them in motion, participate in the formation of the walls of some internal organs (pharynx, upper esophagus, larynx), as well as body cavities, for example oral, thoracic, abdominal, pelvic, and are among the auxiliary organs eyes ( oculomotor muscles), affect the auditory ossicles in tympanic cavity. With the help of skeletal muscles, breathing and swallowing movements are carried out, facial expressions are formed, and the human body is maintained in balance and moves in space. Up to 80% of the total muscle weight falls on the muscles of the limbs (Fig. 2.3).

Rice. 2.3. Muscular system human: a - front: 1 - sternocleidomastoid muscle; 2 - serratus anterior muscle; 3 - external oblique abdominal muscle; 4 - biceps muscle; b - behind: 1 - trapezius muscle; 2 - latissimus dorsi muscle; 3 - gluteus maximus muscle; 4 - biceps femoris muscle; 5 - calf muscle

All skeletal muscles are divided into muscles of the trunk, head and limbs. The muscles of the trunk, in turn, are divided into posterior (muscles of the back and neck) and anterior (muscles of the neck, chest and abdomen).

Muscles are made up of muscle fibers, the main properties of which are excitability and contractility. Thanks to this, they can be considered a special sensory organ that transmits signals to the central nervous system. On the way back, the nerve impulse, passing through the neuromuscular ending, promotes the formation of acetylcholine. This substance causes and transmits nervous excitement from one cell to another, therefore its enhanced formation during massage increases the overall performance of the muscles.

From the book Dictionary of Psychoanalysis by J. Laplanche

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From the book Atlas: human anatomy and physiology. Complete practical guide author Elena Yurievna Zigalova

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