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Лікування хронічної передньомедіальної нестабільності колінного суглоба: Автореф. дис… канд. мед. наук / Ю.О. Гребенюк, Укр. наук.-дослід. ін-т трав

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I?i?noa?noai ioi?iie caei?ia’y Oe?a?ie

Oe?a?inueeee iaoeiai-aeine?aeiee ?inoeooo o?aaiaoieia?? oa i?oiiaae??

A?aaaithe TH?ie Oeaenaiae?iae/

OAeE 616.728.3:616.72-018.38-001-[085+089]

E?eoaaiiy o?ii?/ii? ia?aaeiueiiaaeeaeueii? ianoaa?eueiino? eie?iiiai
noaeiaa

14.01.21 – “O?aaiaoieia?y oa i?oiiaae?y”

AAOI?AOA?AO

Aeena?oaoe?? ia caeiaoooy iaoeiaiai nooiaiy

eaiaeeaeaoa iaaee/ieo iaoe

1999

Aeena?oaoe??th ? ?oeiien.

?iaioa aeeiiaia a Aeiiaoeueeiio iaoeiai-aeine?aeiiio ?inoeooo?
o?aaiaoieia?? oa i?oiiaae?? Aeiiaoeueeiai aea?aeaaiiai iaaee/iiai
oi?aa?neoaoo ?i. I.Ai?ueeiai.

Iaoeiaee ea??aieeaeieoi? iaaee/ieo iaoe, i?ioani? Aaaioa Aaeaioei
Ieaenaiae?iae/, Aeiiaoeueeee aea?aeaaiee iaaee/iee oi?aa?neoao ?i.
I.Ai?ueeiai. caa?aeoaa/ eaoaae?ith o?aaiaoieia??,i?oiiaae?? ?
AIOIo?oe?ei? iiiiaioe:aeieoi? iaaee/ieo iaoe Aa?oeai Aai??o ?aaiiae/,
Ee?anueea iaaee/ia aeaaeai?y i?neyaeeieiiii? ina?oe ?i. I.E.Ooieea IIC
Oe?a?ie, i?ioani? eaoaae?e o?aaiaoieia?? oa i?oiiaae?? ? 1aeieoi?
iaaee/ieo iaoe Aa?aneiaiei Na?a?e ?aaiiae/, canooiiee aee?aeoi?a ii
ee?i?oe? Oe?a?inueeiai iaoeiai-aeine?aeiiai ?inoeoooo o?aaiaoieia?? oa
i?oiiaae??

I?ia?aeia onoaiiaa:

Aei?i?iiao?ianueea aea?aeaaia iaaee/ia aeaaeai?y

Caoeno aeena?oaoe?? a?aeaoaeaoueny “18” n?/iy 2000 ?. i 14 aiaeei? ia
can?aeaii? niaoe?ae?ciaaii? a/aii? ?aaee Ae 26.606.01 i?e Oe?a?inueeiio
iaoeiai-aeine?aeiiio ?inoeooo? o?aaiaoieia?? oa i?oiiaae?? ca aae?anith:
01054, i.Ee?a, aoe. Ai?ianueeiai, 27.

C aeena?oaoe??th iiaeia iciaeiieoeny o a?ae?ioaoe? Oe?a?inueeiai
iaoeiai-aeine?aeiiai ?inoeoooo o?aaiaoieia?? oa i?oiiaae?? ca aae?anith:
01054, i.Ee?a, aoe. Ai?ianueeiai, 27.

Aaoi?aoa?ao ?ic?neaiee “17” a?oaeiy 1999 ?.

A/aiee nae?aoa? niaoe?ae?ciaaii?

a/aii? ?aaee, aeieoi? iaaee/ieo iaoe
Oeauaiei A.A.

Caaaeueia oa?aeoa?enoeea ?iaioe

Aeooaeuei?noue ?iaioe. Iino?aaeaeae? c o?ii?/iith iinoo?aaiaoe/iith
ia?aaeiueiiaaeiaeueiith ianoaa?euei?noth(OIII) eie?iiiai noaeiaa
iiaeathoue iaeei ?c iaea?eueoa neeaaeieo eiioeiaaio?a oai?eo ye o
a?aeiioaii? ianoaaeaiiy ? iinoaiiaee ae?aaiico, oae ? a e?eoaaii?.
Eie?iiee noaeia caeia? ia?oa i?noea ii /anoio? ooeiaeaeaiue cayceiaiai
aia?aoa (A.I.Eaaaiaoeue, I.I.Iineioii,1998;A.A. Eocueiaiei, A.Ae.
Eacioaeei, 1997), yei ceeaaeathoue aei 33% onio o?aai eie?iiiai noaeiaa.

E?eoaaiiy oai?eo ?c ia?aaeiueiiaaeiaeueiith ianoaa?euei?noth
eie?iiiai noaeiaa caeeoa?oueny i?iaeaiith i?oiiaae??. A Oe?a?i?
i?aaenoaaieee Oa?e?anueei? i?oiiaaee/ii? oeiee I.I.Ei?ae ? A.I.Neiaia/
cai?iiiioaaee ?icaeyaeaoe iioeiaeaeaiiy eainoey?ii-cayceiaiai aia?aoo
eie?iiiai noaeiaa c iiceoe?e nenoaiiiai i?aeoiaeo. I?aaenoaaiee
Ee?anueei? i?oiiaaee/ii? oeiee A.I.Eaaaiaoeue aeoeaii ai?iaaaeaeo? a
ee?i?/io i?aeoeeo ? i?iiaao? a iaoeia?e oa inaioi?e ae?yeueiino? ciiio
eiioeaioe?th aoaeiae noaa?e?coth/iai aia?aoo eie?iiiai noaeiaa oa
eiia?iaoe?eiee i?eioeei iia?aoeaiiai e?eoaaiiy iinoo?aaiaoe/ii?
ianoaa?eueiino? eie?iiiai noaeiaa oeyoii canoinoaaiiy eiia?iiaaieo
?aeiino?oeoeaii-a?aeiiaethaaeueieo iia?aoe?e ia eiai
eainoey?ii-cayceiaiio aia?ao?. I?neyiia?aoe?ei? ?aoeeaeeae
ianoaa?eueiino? neeaaeathoue 4% – 11% (Ae.Oieeaa, 1996). Ca iaoeie
niinoa?aaeaiiyie, iiaai? ?acoeueoaoe e?eoaaiiy neeaaeathoue, o
caeaaeiino? a?ae e?eoaaeueii? oaeoeee, a?ae 11,76% aei 47,62% aeiaaee?a.

O ia?oo /a?ao, oea iia’ycaii c iaae??oai?noth ieoaiiy i?i
ia?aaaao oaeoeee e?eoaaiiy(A.I.Eaaaiaoeue, 1995), aeai?? oiai aai ?ioiai
aeaeo o?ainieaioao?a (Benoit J.,1972). ??ciiiai?oi? oaeoe/i? onoaiiaee
i?e niieo/aii? ooeiaeaeaiue ia?aaeiuei? o?anoiiiae?aii? ?
aaeeeiaiiieeiai? caycie (A.I.Eaaaiaoeue, ss.A.Eeiueei,1989; W. Nottage,
P. Matsuura, 1994).

?nioaaiiy a?eueo 250 niinia?a o??o?a?/ii? ei?aeoe?? ooeiaeaeaiue
caycie eie?iiiai noaeiaa i?aeoaa?aeaeo? iaae??oai?noue oe??? i?iaeaie.

Iaoa ? caaea/? aeine?aeaeaiiy . Iaoith ae?enii? ?iaioe ? iie?ioaiiy
aeoiae?a e?eoaaiiy iino?aaeaeaeeo ?c o?ii?/iith iinoo?aaiaoe/iith
ia?aaeiueiiaaeiaeueiith ianoaa?euei?noth eie?iiiai noaeiaa oeyoii
canoinoaaiiy ?ic?iaeaii? a aenia?eiaio? iaoiaeeee ieanoeee caycie eiai
nooiaeeeeyi iaiianooiaeeeueiiai i’yca ooeiaeaeaii? eiioeiaee.

Aeey aeinyaiaiiy iaoe aoee aecia/ai? oae? caaea/?:

1. Aea/eoe iniaeeaino? ee?i?/iiai ieeio ? ?acoeueoaoe e?eoaaiiy
??ciiiai?oieo ooeiaeaeaiue eainoeueii-cayceiaeo no?oeoo? o
iino?aaeaeaeeo ?c yaeuaie o?ii?/ii? ia?aaeiueiiaaeiaeueii?
ianoaa?eueiino? eie?iiiai noaeiaa, aeaoe ?i oa?aeoa?enoeeo;

2. Oaeineiiaeeoe noaio (aeai?eoi) ae?aaiinoeee iinoo?aaiaoe/ii?
ia?aaeiueiiaaeiaeueii? ianoaa?eueiino? eie?iiiai noaeiaa,
aeei?enoiaoth/e ee?i?/i?, aeaeo?ioiciieiai/ii ? a?iiaoai?/i? e?eoa???;

3. O aenia?eiaio? aea/eoe iioei?noue ia ?ic??aaiiy nooiaeeeey
iaiianooiaeeeueiiai i’yca, ?? aeinoaoi?noue aeey cai?uaiiy ooeiaeaeaieo
ia?aaeiuei? o?anoiiiae?aii? ? aaeeeiaiiieeiai? caycie eie?iiiai noaeiaa;

4. ?ic?iaeoe iiaee can?a o??o?a?/iiai e?eoaaiiy niieo/aiiiai
ooeiaeaeaiiy ia?aaeiuei? o?anoiiiae?aii? ? aaeeeiaiiieeiai? caycie o
iino?aaeaeaeeo ?c ia?aaeiueiiaaeiaeueiith ianoaa?euei?noth eie?iiiai
noaeiaa;

5. Oaeineiiaeeoe oaoiieia?th nooiaeeeueii? aooiieanoeee ia?aaeiuei?
o?anoiiiae?aii? caycee;

6. Aea/eoe aeoiaee o??o?a?/iiai e?eoaaiiy ia?aaeiueiiaaeiaeueii?
ianoaa?eueiino? eie?iiiai noaeiaa a iaeaeeae/iio ? a?aeaeaeaiiio
ia??iaeao, aeei?enoiaoth/e oaeineiiaeaio noaio ae?aaiinoeee.

Iaoa??ae ? ianya aeine?aeaeaiiy. ?iaioa caniiaaia ia aiae?c? e?eoaaiiy
164 iino?aaeaeaeeo ?c ia?aaeiueiiaaeiaeueiith ianoaa?euei?noth
eie?iiiai noaeiaa, ui ciaoiaeeeeny ia e?eoaaii? a Aeiiaoeuee?e iaeani?e
o?aaiaoieia?/i?e e?ea?i? o a?aeae?eaii? o?aaiaoieia?? e i?oiiaae?? aeey
aei?ineeo ?c 1985 ?. ii 1999 ?. O ?iaio? aeei?enoai?
ee?i?ei-?aioaaiieia?/iee, eaai?aoi?iee, aeaeo?ioiciieiai/iee ?
noaoenoe/iee iaoiaee aeine?aeaeaiiy.

Iaoeiaa iiaecia. I?aeo?eioth/e eiioeaioe?th Ei?aea I.I., Neiaia/a A.I.,
Eaaaioey A.I. a?aenoith?oueny iiceoe?y nenoaiiiai i?aeoiaeo aei ioe?iee
noaa?e?caoe?? eie?iiiai noaeiaa. I?e oeueiio ie aaaaea?ii, ui ?icaeoie
OIII i?e ooeiaeaeaii? iaei??? yeee aai no?oeoo?e eie?iiiai noaeiaa
iiaeeeai eeoa a ??aee?nieo aeiaaeeao, /ano?oa i?e o?eaaeeo oa?i?iao
?nioaaiiy ooeiaeaeaiiy.

Oaeineiiaeaii noaio ae?aaiinoeee ia?aaeiueiiaaeiaeueii?
ianoaa?eueiino? eie?iiiai noaeiaa oeyoii aianaiiy a ??
aeaeo?ioiciieiai/ieo ? a?iiaoai?/ieo e?eoa???a ioe?iee, ui aeicaieeei
i?aeaeueoe ?acoeueoaoeai?noue ae?aaiinoeee.

O aenia?eiaio? i?aeoaa?aeaeaia iiaeeea?noue aeei?enoaiiy nooiaeeeey
iaiianooiaeeeueiiai i’yca ooeiaeaeaii? eiioeiaee aeey ieanoeee
ia?aaeiuei? o?anoiiiae?aii? ? aaeeeiaiiieeiai? caycie, oaeineiiaeai?
iaoiaeeee i?aeaeuaiiy eiai o?eaeino? ? aeeoo?no?eeino?.

Oaeineiiaeaii oaoiieia?th aooiieanoeee ia?aaeiuei? o?anoiiiae?aii?
caycee eie?iiiai noaeiaa ca aeiiiiiaith nooiaeeeey iaiianooiaeeeueiiai
i’yca.

?ic?iaeaii iiaee niin?a o??o?a?/iiai e?eoaaiiy niieo/aiiiai
ooeiaeaeaiiy ia?aaeiuei? o?anoiiiae?aii? ? aaeeeiaiiieeiai? caycie
eie?iiiai noaeiaa ( iaoaio Oe?a?ie ? 25124A a?ae 25.12.98.).

Iniiai? iieiaeaiiy aeena?oaoe??, ui aenoaathoueny ia caoeno:

n cia/aiiy oaeineiiaeaii? noaie ae?aaiinoeee o?ii?/ii?
ia?aaeiueiiaaeiaeueii? ianoaa?eueiino? eie?iiiai noaeiaa;

n aeioe?euei?noue canoinoaaiiy ?ic?iaeaiiai niiniao o??o?a?/iiai
e?eoaaiiy niieo/aiiai ooeiaeaeaiiy ia?aaeiuei? o?anoiiiae?aii? ?
aaeeeiaiiieeiai? caycie eie?iiiai noaeiaa;

n cia/aiiy ?acoeueoao?a i?iaaaeaiiai aenia?eiaioo, ui aeieaco?
iiaeeea?noue aeei?enoaiiy nooiaeeeey iaiianooiaeeeueiiai i’yca
ooeiaeaeaii? eiioeiaee a yeino? ieanoe/iiai iaoa??aeo.

I?aeoe/ia oe?ii?noue ?iaioe. Cai?iiiiiaai? ee?i?/i?, aeaeo?ioiciieiai/ii
? a?iiaoai?/i? e?eoa??? aeicaieythoue i?aaeeueii ioe?ieoe nooi?iue
ii?ooaiiy noaa?eueiino? eie?iiiai noaeiaa ? nooi?iue a?aeiiaeaiiy
ooieoe?? noaeiaa a ?acoeueoao? i?iaaaeaiiai e?eoaaiiy. ?ic?iaeaiee ?
oaeineiiaeaiee niiniae o??o?a?/iiai oo?o/aiiy a?ae??ciythoueny
i?inoioith aeeiiaiiy, iaeio?aaiaoe/ie, aeathoue aenieee a?aenioie
aa?ieo aeoiae?a e?eoaaiiy.

?aae?caoe?y ?acoeueoao?a ?iaioe. ?acoeueoaoe aeine?aeaeaiiy
ai?iaaaeaeai? a o?aaiaoieia?/ieo a?aeae?eaiiyo i?nueeeo e?ea?aiue ??
9, 14 ?. Aeiiaoeueea; Iaeani?e ee?i?/i?e e?ea?i? i. Caii??aeaey;
Eoeaeoaanueeie oeaio?aeuei?e ?aeiii?e e?ea?i? Caii??cueei? iaeano?.

Ai?iaaoe?y ?iaioe. Iaoa??aee ?iaioe iia?aeiieai? e iaaiai?ai? ia :
?anioae?eainueei? iaoeiai-i?aeoe/ii? eiioa?aioe??
o?aaiaoieia?a-i?oiiaae?a “E?einuee? aa/i?a”

( E?ei, 1997); can?aeaii? Aeiiaoeueeiai iaeaniiai oiaa?enoaa
i?oiiaae?a-o?aaiaoieia?a (Aeiiaoeuee, 1997); ae?ciiio ?icoe?aiiio
can?aeaii? oiaa?enoaa i?oiiaae?a-o?aaiaoieia?a Caii??cueei? iaeano? (
Eoeaeoaai, 1997); Anaoe?a?inueei? iaoeiai? eiioa?aioe??(Caii??aeaey,
1999). A?aeaoeany aioo??oiy ai?iaaoe?y ?iaioe a Aeiiaoeueeii
iaoeiai-aeine?aeiiio ?inoeooo? o?aaiaoieia?? e i?oiiaae?? (Aeiiaoeuee,
1999).

Ioae?eaoe??. Ii oai? aeena?oaoe?? iioae?eiaaii 5 iaoeiaeo i?aoeue.
?acoeueoaoe ?iaioe caoeuai? 1 Iaoaioii Oe?a?ie ia aeiaoiae ? 3
?aoe?iiae?caoi?nueeeie i?iiiceoe?yie.

Ianya ? no?oeoo?a aeena?oaoe??. ?iaioa aeeeaaeaia ia 144 noi??ieao
iaoeiiieniiai oaenoo, iaienaia ?in?enueeith iiaith, neeaaea?oueny c
anooio, 6 ?icaeieia, iiaenoieo, aeniiae?a, nieneo e?oa?aoo?e oa
aeiaeaoea. Nienie eioa?aoo?e iinoeoue 243 aeaea?aea iioi?iaoei?, cie?aia
95 – aio/eciyieo i aaoi?ia aea?aeaa NIAe oa 148 – iiicaiieo aaoi?ia.
Aeena?oaoe?y i?noeoue 31 iaethiie ? 30 oaaeeoeue.

Ciino ?iaioe

Iaoa??ae ? iaoiaee aeine?aeaeaiiy Aeine?aeaeaiiy caniiaaia ia aea/aii?
iaoa??ae?a 164 iino?aaeaeaeeo c ooeiaeaeaiiyie noieiai-cayceiaeo
no?oeoo? eie?iiiai noaeiaa, ui ciaoiaeeeeny ia e?eoaaii? a Aeiiaoeuee?e
iaeani?e o?aaiaoieia?/i?e e?ea?i? c 1985 ii 1999 ?iee.

ssaeua ia?aaeiueiiaaeiaeueii? ianoaa?eueiino? eie?iiiai noaeiaa
iaee i?noea a 121 ( 73,78% ) /ieia?e?a ? 43 ( 26,22%) ae?iie o a?oe?
a?ae 16 aei 66 ?ie?a, a?eueo?noue ( 75,61% ) o a?oe? a?ae 21 aei 50
?ie?a.

Oai?? o?aaio iaea?aeoaaee ia ae?iaieoeoa? ( 20,12% ), i?e
aei?iaeiuei-o?ainii?oieo iiae?yo ( 20,12% ), i?ae /an caiyoue nii?oii (
23,78% ) ? a iiaoo? ( 35,98% ).

Iaoa??aeuei? i?e/eie ooeiaeaeaiue noieiai-cayceiaiai aia?aoa
eie?iiiai noaeiaa, ui i?ecaaee aei ?icaeoeo III, o a?eueoino? aeiaaee?a
( 68,91% ) iaee iai?yiee oa?aeoa? ae?? neee, ui o?aaio?. O ?acoeueoao?
ianooieee ??ciiiai?oi? ooeiaeaeaiiy no?oeoo? eie?iiiai noaeiaa, a?ae
e?eueeino? ? oa?aeoa?o yeeo, a?eo iino?aaeaeaeeo caeaaeaea nooi?iue
ia?aaeiueiiaaeiaeueii? ianoaa?eueiino?, ui ?icaeeany.

Ie aeae?eeee 4 nooiaiy ia?aaeiueiiaaeiaeueii? ianoaa?eueiino?
eie?iiiai noaeiaa: I nooi?iue ianoaa?eueiino? eie?iiiai noaeiaa ( 8,48%
) iaea i?noea o on?o a?eiaeo a?oiao, II nooi?iue ( 67,88% ) ? IV
nooi?iue ( 9,70% ) /ano?oa cono??/aeeny a in?a aei 29 ?ie?a, III
nooi?iue ( 13,94% ) – /ano?oa i?ney 29 ?ie?a. Iaoa aeine?aeaeaiiy
i?aeoaa?aeeei aeniiaee A.I.Eaaaioey ? ss.A.Eeiueei(1989).

?cieueiaaia ooeiaeaeaiiy ia?aaeiuei? o?anoiiiae?aii? caycee(IOC)
a?aecia/aii a 40 niinoa?aaeaiiyo, niieo/aia ooeiaeaeaiiy IOC ?
iaaeiaeueiiai iai?nea – o 70, “iauaneeaa” o??aaea Oo?ia?a – o 16,
niieo/aia ooeiaeaeaiiy IOC ? iaio iai?ne?a – o 8, ?cieueiaaia
ooeiaeaeaiiy aaeeeiaiiieeiai? caycee(AAC) – o 9, ooeiaeaeaiiy AAC o
niieo/aii? c ooeiaeaeaiiyi iaaeiaeueiiai iai?nea – o 4, niieo/aia
ooeiaeaeaiiy IOC ? AAC – o 14, niieo/aia ooeiaeaeaiiy IOC , AAC ? iaio
iai?ne?a – o 1, a?ae?ea iiaeae?inoeiaiai ocaeooy aaeeeiaiiieeiai? e?noee
– o 2, ooeiaeaeaiiy IOC o niieo/aii? c oai?iaith Eaiiaa – 1.

Ae?aaiinoeea ooeiaeaeaiue noieiai-cayceiaiai aia?aoa eie?iiiai
noaeiaa a aino?iio ia??iae? o?aaie ( aei 4 oeaei?a ) aoea ae?ae
oo?oaeiaia caoooiaoaaiiyi iaeieo ee?i?/ieo iciae ?ioeie. O?oaeiino?
ae?aaiinoeee aoee iia’ycai? c :

n iayai?noth ae?aaeaiiai aieth/iai neiae?iio; iayai?noth aaia?o?ica (
niiiaioa );

n ii?i/iith onoaiiaeith eie?iiiai noaeiaa e iaiaaeaiiyi ianyao aeoeaieo
? ianeaieo ?ooia o iueiio.

Iaioaeueia oanooaaiiy noaia cayceiaiai aia?aoa eie?iiiai noaeiaa
a aino?eo aeiaaeeao aoei iiaeeeai aei aeoiaeo ia?oiai oeaeiy, i?ney
noeoaiiy yaeu caiaeaiiy ? aaia?o?ica.

Aeey ioe?iee noaia eie?iiiai noaeiaa ie ei?enooaaeeny noaiith,
oaeineiiaeaii? iaie ia iniia? aiae?co e ocaaaeueiaiiy eeaneo?eaoe?? III
ii aiaoiii-ooieoe?iiaeueiiio i?eioeei?, iieiaeaiue I?aeia?iaeiiai
Eii?oaoo Aeieoiaioaoe?? ii eie?iiiio noaeia? ? anoaiiaeaieo iaie
aeaeo?ioiciieiai/ieo ? a?iiaoai?/ieo e?eoa???a. Oey noaia aeeth/a?
noa’?eoeai?, ui a?aeaeaathoue a?ae/oooy oai?iai, ? ia’?eoeai? iciaee.
Eiaeiee ?c ee?i?/ieo iciae, aeeth/aieo o noaio, aecia/aa nooi?iue, ui
oa?aeoa?eco? noai eie?iiiai noaeiaa. Iaeiaioee nooi?iue aoaeue yeiai c
iciae aecia/aea o?iaeueio ioe?ieo noaia eie?iiiai noaeiaa(oaae.1).

Oaaeeoey 1.

Noaia ae?aaiinoeee ia?aaeiueiiaaeiaeueii? ianoaa?eueiino? eie?iiiai
noaeiaa.

E eeii/ii iciaee
Nooi?iue

I(ii?ia)
II(iaeaea III (iiaaii) IV (aeoaea

ii?ia) iiaaii)

Noa’?eoeaia ioe?iea(o aaeao) 0 1
2 3

O?ce/ia aeoeai?noue

aac neiioiiaoeee aeua na?aaeiy
o?ceoeueoo?ia iiaooiaa

Aeao?oeeo ?icaeiaiiy 10

Aeao?oeeo naeiaiiy 0 – 5 6 –
15 16 – 25 >25

N-ie “ia?aaeiueiai aenoaiiai

yueea” ? Lachman aei 3 ii 4-6 ii
7-10 ii >10 ii

Aaaeoeoeiiiiee oano aei 3 4- 6
7-10 >10

A?o?ic , ui aeaoi?io? – I
no. II no. III no.

Ooieoe?iiaeueiee oano >90% 89%-76%
75%-50% 50%

Aaaiaa iaaaioaaeaiiy >40% 36%-40%
31%-35%

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