Інформація призначена тільки для фахівців сфери охорони здоров'я, осіб,
які мають вищу або середню спеціальну медичну освіту.

Підтвердіть, що Ви є фахівцем у сфері охорони здоров'я.



UkraineNeuroGlobal


UkraineNeuroGlobal

Міжнародний неврологічний журнал 6 (60) 2013

Повернутися до номеру

Surgical treatment non-reduced and old-time injuries of the radial nerve

Автори: Luzan B. - National Medical University named after O.O. Bogomolets; Kucheruk O. - Rivnenska Regional Hospital; Suliy L., Tatarchuk M. - State Institution "Institute of Neurosurgery. Acad. A.P.Romodanova "NAMS of Ukraine.

Рубрики: Неврологія

Розділи: Клінічні дослідження

Версія для друку


Ключові слова

chronic and irreparable damage, old-time injuries reconstructive, orthopedic corrective surgery.

Purpose:  Improve the results of the extensor recovery of upper limb function in chronic and irreparable damage to the radial nerve.  Improve surgical tactics and methods of surgical treatment of chronic and irreparable damage to the radial nerve on the basis of clinical and neurological evaluation, taking into account first of all the useful features of functioning limbs.

Materials and methods.  We have analyzed 17 cases of intervention by the radial nerve in the middle-upper third of the arm in terms of greater than 1 year after the injury.  The results of treatment of patients with injuries of the radial nerve, we evaluated taking into account the recovery of the functional state of the extensors of fingers and hands.

Results and discussion.  The majority of patients with this old injury of the radial nerve in the preservation of its anatomic integrity, we achieved a positive result (only 3 patients there was no result) It is functionally beneficial result we received almost 47% of patients (mainly when performing neurolysis).  In all these cases, clinically observed even minimal function of muscles and EMG data retention has been a conductivity greater than 5% and M-response greater than 1.2%, and in some muscle to 5%.  In one case, neurolysis, and we achieved a good one - an excellent result when using an implanted system for electrical stimulation.  Another 35% of patients, we achieved mediocre results restoration, but we were able to simplify the design options orthopedic correction.

Regarding the indications for treatment, we conducted research capabilities of spontaneous recovery of function after closed injuries in 41 patients, some of which was examined as outpatients.  According to our research, the spontaneous recovery of function of the radial nerve after such damage occurs in more than 50% of patients within 1 month or more in about 30% of the up to 3 months.

Restoration of function of the radial nerve after reconstructive interventions were effective enough, even in remote terms after lengthy injury technique was used electrical stimulation in 5 patients with lesions of the radial nerve with the time after the injury of 6 to 18 months.

Positive functional recovery was achieved in four of five patients in whom the above-mentioned mechanism of injury in the survey was provided at least minimal activity extensor muscles (between 5% and higher).  Combining reconstructive operations on the nerve trunk with orthopedic corrective surgery, we were able to achieve almost 100% positive result of restoration of function for isolated lesions of the radial nerve.  In this case, a complex combination of greatly improved not only functional but also cosmetic result.


Список літератури

  1. Ониани А.А. Обоснования сроков оперативных вмешательств при травматических поражениях периферических нервов: Дисс. ...канд. мед. наук.— Тбилиси. — 1987.— 248 с.
  2. Цимбалюк В.І., Лузан Б.М. Стан та перспективи нейрохірургічної допомоги при травматичних ушкодженнях периферичної нервової системи // Ж-л УАН.—2002.—Вип.2.— С.23–27.
  3. Bishop J, Ring D. Management of radial nerve palsy associated with humeral shaft fracture: A decision analysis model. J Hand Surg Am. 2009;34:991.–996.
  4. B. K. Ogawa, R. M. Kay, P. D. Choi, M. V. Stevanovic Complete division of the radial nerve associated with a closed fracture of the humeral shaft in a child. THE JOURNAL OF BONE AND JOINT SURGERY VOL. 89-B, No. 6, JUNE 2007 821-824
  5. Noaman H, Khalifa A, ALam El-den M, Shiha A. Early surgical exploration of radial nerve injury associated with fracture shaft humerus. Microsurgery 2008;28:635–642.
  6. Flores A.J., Lavernia C.J., Owens P.W. Anatomy and physiology of peripheral nerve injury and repair // Am. J. OrthoP.— 2000. — Vol.29 — №3.— P.167-173.
  7. Jerey A. Cohen, Justin Mowchun, Jon Grudem. Peripheral nerve and muscle disease.- Oxford University Press, Inc. 2009  p.184
  8. Julia K. Terzis, M.D., Petros Konofaos, Radial Nerve Injuries and Outcomes:Our Experience Plastic and Reconstructive Surgery • Febr. 127: 739-751, 2011.
  9. Lowe JB 3rd, Tung TR, Mackinnon SE. New surgical option for radial nerve paralysis. Plast Reconstr Surg. 2002;110(3):836-843.
  10. Shao  YC,  Harwood  P,  Grotz  MRW,  Limb  D,  Giannoudis  PV.  Radial  nerve  palsy associated with fractures of the shaft of the humerus: A systematic review. J Bone Joint Surg Br 2005;87:1647–1652.
  11. P. Hahn • U. Lanz. Ersatzoperationen bei Radialisl?hmungen Orthop?de 1997 · 26:666–672
  12. S. Deiler • E. Wiedemann • W. Stock • K. Wilhelm • L. Schweiberer Clinical experiences in tendon transfers for radial nerve palsy by a new method of Wiedemann Orthop?de 1997 · 26:684–689

Повернутися до номеру