Высокоразрешающая ультрасонография в диагностике и хирургии периферических нервов конечностей (обзор литературы)

The diagnosis of peripheral nerve lesions relies on clinical history, physical examination, electrodiagnostic studies, and radiography. The availability of these methods may be limited, and the costs can be significant. By comparison, ultrasonography is a comfortable, sensitive and economic technology, however, until now it is not widespread in Russia. An increasing number of publications have evaluated the role of ultrasonography in peripheral nerve diseases. The authors explored the clinical applicability of high-resolution ultrasonography in the preoperative and intraoperative management of peripheral nerve lesions.Диагностика поражений периферических нервов основывается на данных клинического и инструментального обследований, электрофизиологического исследования и магнитно-резонансной томографии. Возможности этих методов зачастую ограничены, а стоимость высока. ультрасонография является удобным, чувствительным и относительно недорогим методом, который, однако, до сих пор не получил широкого распространения в России. В настоящее время все большее число публикаций посвящено роли ультрасонографии в диагностике и хирургическом лечении травм заболеваний периферической нервной системы. В обзоре представлены данные о применении предоперационной и интраоперационной ультрасонографии при поражении периферических нервов

Evaluationof efficiency of methods of neuromodulation in the treatment of spastic syndromes in patients with spinal cord injury

Objective: to evaluate the efficiency of the neuromodulation methods and to determine their role in complex rehabilitation of patients with spastic syndromes after spinal cord injury. Material and methods: Based on the study and treatment of 105 patients with spastic syndromes after injury of the spinal cord, electrical stimulation of the spinal cord, epidural drug therapy in combination with electrical nerve stimulation and local hypothermia spinal cord have been consistently applied for the treatment of spastic syndrome. Results: Consistent use of methods of neuromodulation in patients with spastic syndromes after spinal cord injuries are given in 88,6% of cases to obtain positive results. Conclusion: The obtained results allow to estimate efficiency of neuromodulation methods and to determine their role in complex rehabilitation of patients with spastic syndromes after spinal cord injur

Intraoperative neurovisualization in the surgical treatment of peripheral nerve injuries

Objective. The present study examines the value of intraoperative neurovisualization as an imaging tool for decision making in the management of traumatic nerve injuries. Materials and methods. 43 patients with traumatic nerve lesions were examined by electrodiagnostic study, ultrasonography and contrast neurography. Results. A complex intraoperative examination have been used to guide surgical decision making in patients with peripheral nerve injuries of limbs. Conclusion. The results of complex intraoperative examination became the basis of diagnosis and treatment algorithm for surgical treatment of peripheral nerves injuries

Algorithm of surgical treatment of pain and spastic syndromes in patients after spinal cord injury

Objective: to develop an algorithm for surgical treatment of pain and spasticity in patients with consequences of spinal cord injury. Materials and Methods. The basis of the algorithm initiated a retrospective study of results of surgical treatment of 273 patients with pain and spastic syndromes after spinal cord injury, which consistently met neuromodula-tion techniques and destructive surgery. Results. The developed algorithm tested in 166 patients with pain and spastic syndromes provided positive results in 88.6% of cases with spastic and in 80.4% of observations for pain and spastic-pain syndromes. Conclusion. The proposed algorithm allows systematizing neuromodulation methods and so-called «radical» destructive operations in the treatment of pain and spasticity, and thereby improving the results of rehabilitation of patients with consequences of spinal cord injury

Differentiated approach to surgical treatment of patients with rigid posttraumatic deformities of thoracic and lumbar spine

The aim: to investigate the outcomes of surgical treatment of patients with rigid posttraumatic deformities in thoracic and lumbar spine on the basis of the comparative analysis of different approaches to the planning of operative intervention management. Material and Methods. A comparative analysis of the results of surgical treatment of 138 patients (main group) with old injuries of thoracic and lumbar spine was carried out with the help of the proposed surgery managing algorithm and 86 patients (comparison group) — without taking the given algorithm into account. The choice of surgery managing in the main group of patients was based on the study of the spinal deformity degree, pain syndrome intensity and life quality indices of patients before and after surgery. Results. In the main group in 122 (88,4%) patients after the surgery spinal deformity correction exceeding 80% was achieved, pain syndrome regressed in accordance with the visual analog scale up to 3 points and less, life quality indices improved up to the level of 0-25%. Conclusion. The application of the proposed algorithm approach enables surgeons to get persistent positive outcomes in the majority of cases.</p

Comprehensive approach to the assessment of the functional status of patients with degenerative joint diseases of the lower extremities

Aim: development of an integrated biomechanical index that reflects the state of kinematic and static function in patients who need replacement of large joints as well as evaluation of the myoneural complex of lower extremities activity of category of patients. Material and Methods. 103 patients with osteoarthrosis of the hip and knee joints. A biomechanical survey included podography, stabilometry and dynamometry. An electrophysiological study of the peripheral nerves of the lower extremities with the determination of the amplitude of the muscle response and late neuronal responses was carried out. The level of activity of the gluteal muscles was determined. Results. The most sensitive indicators reflecting the state of biomechanical status were identified, specialized software for the integral biomechanical index calculation was developed. Conclusion. Methods of clinical biomechanics allow specialists to assess the state of kinematic and static function of the musculoskeletal system, matching of the integral biomechanical index with the data of neurophysiological monitoring makes possible to select individual tactics of treatment.</p

Complex stimulation of peripheral nerve regeneration after deferred neurorrhaphy

The aim is to study the complex stimulation effect including skin autotransplantation and electrical stimulation of the sciatic nerve on microcircular, electrophysiological and morphological changes after deferred neurorrhaphy in rats. Material and methods. The experiment was performed in 50 albino rats divided into control, comparative and experimental groups. In the experimental group, on the background of deferred neurorrhaphy, skin autotransplantation and electrical stimulation of the sciatic nerve had been carried out. In the comparative group only deferred neurorrhaphy was performed. Research methods included laser doppler flowmetry, electroneuromyography and morphological analysis of the operated nerve. Results. Complex stimulation including skin autotransplantation and direct action of electrical pulses on the sciatic nerve after its deferred neurorrhaphy causes restoration of bloodstream in the operated limb, promotes intensification of restoration of nerve fibers. Conclusion. Intensification of sciatic nerve regeneration after deferred neurorrhaphy in rats under the influence of complex stimulation including full-thickness skin graft autotransplantation and direct action of electrical pulses substantiates experimentally appropriateness of clinical testing of the given method for treatment of patients with peripheral nerve injuries.</p