Short-term surgical outcomes in patients with sciatic nerve injury associated with total hip arthroplasty

Sciatic nerve (SN) injury associated with total hip arthroplasty (THA) is a challenging issue due to the high prevalence of the complications. However, there is no consensus about the injury mechanism, surgical treatments, indications and timing for the surgeries which necessitates the studies. The objective was To perform a comparative analysis of the dynamics in clinical, neurological and electrophysiological parameters in patients with sciatic nerve injuries associated with THA performing various surgical treatments. Material and methods The study included 61 patients who were hospitalized between 2005 and 2021. Patients were divided into two groups being homogeneous in terms of gender, age and severity of neurological deficit. Microsurgical neurolysis of the sciatic nerve trunk was performed in group I (n = 32) and was added by direct electrical stimulation of the sciatic nerve at the level of injury in group II (n = 29). Clinical, neurological status and electroneuromyography parameters of the patients were assessed preoperatively and at 6 months of surgery. Results All patients showed pain relief with VAS score decreasing from 6 (5.5; 8) to 4 (2; 6) in group I and to 3 (1; 5) in group II (p < 0.001). Functionality of the lower limb scored preoperatively 31 (24.5; 40.5) on the ODI scale in group I and 27 (21; 36) in group II. The patients showed positive dynamics postoperatively with improved lower limb function due to decreased neuropathic pain syndrome scoring 28 (20; 34.5) in group I and 16.5 (8.5; 21.75 ) in group II (p < 0.0001). Conclusions The findings suggested the advantages of the electrical stimulation method in combination with microsurgical neurolysis of the sciatic nerve over the use of microsurgical neurolysis alone with decreased intensity of the pain syndrome and functional insufficiency of the lower limb

Effect of local modulation in enzymatic homeostasis on bone turnover marker dynamics in blood at substituting femur defects with vaterite scaffolds

The goal of this research was the investigation of concentration changes in the blood bone turnover markers during local modulation of enzymatic homeostasis by means of targeted delivery of alkaline phosphatase (ALP) with polycaprolactone (PCL) and vaterite (VT) scaffolds implanted into the femur defects in white rats. Material and Methods ― The tests of PCL/VT/ALP scaffold implantations into the bone defects were performed on 30 white rats, and the serum of intact animals was used as the control. ELISA and multiplex assay were used to find inflammatory and bone turnover markers including monocyte chemoattractant-1, sclerostin, fibroblast growth factor-23, connective tissue growth factor (CTGF), osteoprotegerin, osteocalcin, β-сross laps and the activity of tartrate-resistant acid phosphatase-5b in the blood of experimental animals. The activity of serum ALP was tested with the conventional kinetic method. The morphology of the reparative processes was verified by microscopy of specimens taken from the implantation areas and stained with hematoxylin or eosin. Results ― The PCL/VT/ALP scaffold implantations into the bone defects of white rats caused active osteogenesis along with the steady rise in osteocalcin concentration in blood. ALP activity in the blood did not depend on the exogenous enzyme in the scaffold and rose by the 28th day after the implantations. The targeted ALP delivery into the defect area caused the rise in CTGF concentration as well as the decrease in blood sclerostin within a short time after the implantations. Conclusion ― The modulation of the local enzyme homeostasis by means of the targeted ALP delivery with PCL/VT scaffolds stimulated reparative osteogenesis within a short time after the implantations with no changes to the bloodstream or local inflammatory changes suggesting their biocompatibility and the safety in use

Outcomes of various surgical techniques used in patients with closed traction injuries of the brachial plexus

Introduction Traumatic lesions of the brachial plexus and analysis of the outcomes of various surgical techniques in patients with this pathology are the relevant challenges in neurosurgery, neurology, traumatology, orthopedics and rehabilitation due to the high social and economic significance, incidence and poor short- and long-term outcomes in this cohort of patients. This study was aimed at comparing the outcomes of various surgical techniques in patients with closed injuries of the brachial plexus. Material and methods The study involved 96 patients with closed injuries of the brachial plexus divided into three groups according to the method of their surgical treatment. Patients of Group I (n = 33) underwent microsurgical neurolysis of their brachial plexus trunks; patients of Group II (n = 28) had microsurgical neurolysis of their brachial plexus trunks with stimulating multichannel electrodes implanted on the trunks of their brachial plexus; patients of Group III (n = 35) had microsurgical neurolysis with stimulating multichannel electrodes implanted on the trunks of their brachial plexus as well as the segmental spinal cord apparatus at the level of the cervical intumescence. The clinical status and functionality of the upper limb were assessed after 6 months with clinical and neurological tests, scoring methods, and electrophysiological monitoring. Results We analyzed the outcomes of various surgical techniques in patients with closed injuries of the brachial plexus to prove a significant improvement in the outcomes of Group III patients who featured a faster rate of pain regression in the injured upper limb as well as significantly positive changes in clinical, neurological and electrophysiological indicators. Discussion The reduction in the total regional pain syndrome and restoration of the affected limb function was more evident in Group III patients what supports the favor of microsurgical neurolysis in combination with two-level electrical stimulation for closed injuries of the brachial plexus. Conclusions The analysis of various surgical techniques in patients with closed injuries of the brachial plexus revealed a significant efficacy of microsurgical neurolysis in combination with electrostimulation of the injured nerve trunk and segmental spinal cord apparatus (Group III). It improves the outcomes in this cohort of patients