Croatian Society of Physical and Rehabilitation Medicine, Croatian Medical Association
Abstract
U uvjetima distenzionih povreda ekstremiteta, a naročito pri kirurškim elongacijama
radi izjednačavanja dužine ekstremiteta, česte su povrede neuro-muskularnih
struktura.
Najteži oblik je anatomski prekid kontinuiteta živca (neurotmesis), koji se
liječi samo kirurškom intervencijom. Potpuni prekid aksona uz održan kontinuitet
konektivnog tkiva živca (aksonotmesis) predstavlja ozljedu, koja se može spontano
regenerirati ako je neuronska cijev sposobna voditi novostvorene izdanke. Najblaža
komplikacija rastezne neuropatije predstavlja blok provodljivosti aksonima kroz
određeno vrijeme (neuropraksija). Najdeblja vlakna miješanih živaca su najvulnerabilnija
i oporavljaju se sporije od tanjih. Progresija oporavka je nepravilna, ne
slijedi anatomski tok živca, ali je u većini slučajeva potpuna.
Naglašava se važnost pravovremene i istovremene interpretacije kliničke slike
rasteznih ozljeda perifernih živaca i mišića, komplikacije koje pri tome nastaju
(kauzalgija, grčevi, kontrakture, ishemične paralize), te principi liječenja , koje determinira
klinička slika, odnosno patomorfološki supstrat.Injuries of the neuro-muscular structures are frequent in the conditions of
extensible injuries of the extremities, particularly in surgical elongations in order
to equalize the lenghth of the extremities.
The anatomic interruption of the nerve continuity (neurotmesis) is considered
to be the most severe injury, which can be treated only surgically. The complete
interruption of the axons with the retained continuity of the connective tissue
of the nerve (axonotmesis) is an injury which can be regenerated spontaneously
if the neuron tube is capable of leading new offsprings. The mildest complication
in extensible neuropathy is the block of the axon conductivity over a definite period
of time (neuropraxis). The thickest fibres of the mixed nerves are most vulnerable
and recover slower than the thinner anes. Progression of the recovery is irregular;
it does not follow the anatomic flow of the nerve, but the recovery is complete
in most cases.
Emphasis has been laid on the due and precise reading of the clinic picture
of extensible injuries of the peripheral nerves and muscles, the complications that
may develop (causalgia, cramps, contractions, ischemic paralysis), and the method
of the treatment which are determined by the clinic picture, i. e. pathomorphological
substrate
