A.V. ZORKOVA, V.N. GRIGORYEVA

Volga research medical University of the Ministry of health of Russia, Nizhny Novgorod

  Contact details:

Zorkova A.V. — postgraduate student of the Department of Neurology, Neurosurgery and Medical Genetics

Address: 10/1 Minin and Pozharsky Square, Russian Federation, Nizhny Novgorod, 603005, tel.: +7-910-891-38-08, е-mail: anna-med@list.ru

The purpose — comparative analysis of the results of neurolysis and neurolysis in combination with the use of artificial epineurium and subepineural nerve stimulation in the treatment of patients with isolated intra-trunk traumatic lesions of the radial nerve.

Material and methods. 29 patients with isolated traumatic injury of the radial nerve at the level of the middle third of the shoulder. The patients were randomly divided into two groups: 1^st group (12 patients) underwent neurolysis; 2^nd group (17 patients) had a neurolysis with the additional artificial epineurium and subepineural intra- and postoperative stimulation of the radial nerve. Before surgery, 1, 3, and 6 months after surgery, all patients underwent clinical and neurological examination with the assessment of muscle strength, assessment of limitations of daily activity with the use of a questionnaire «Measurement of limitations in functional activity due to hand injuries and treatment results» (DASH), electroneuromyography of the upper extremities (ENMG).

Results. During 6 months after the surgical treatment, patients of the 1^st and 2^nd groups showed a statistically significant increase in supracondylar and sub-surface muscles. However, 3 and 6 months after surgery, the improvement was more pronounced in group 2 than in the first group (p = 0,01903 and p = 0,03202, respectively).

Regression of functional disorders of the hand after surgery was also more significant in group 2, compared to the first group (p < 0,05). At the same time, the pulse rate (according to ENMG) in the area from the ERB point to the upper third of the forearm during the observation period in both groups increased equally.

Conclusion. Neurolysis combined with the application of artificial epineurium and subepineural electrical stimulation in isolated intra-trunk traumatic lesions of the radial nerve contributes to a better recovery of muscle strength and function of the hand compared to neurolysis alone.

Key words: neurolysis, radial nerve, artificial epineurium, electrical stimulation, dysfunction of hands, DASH.

 (For citation: Zorkova A.V., V.N. Grigoryeva V.N. Neurolysis, subepineural stimulation and artificial epineurium in the surgical treatment of intra-trunk injuries of the radial nerve. Practical Medicine. 2019. Vol. 17, № 7, P. 121-126)

REFERENCES

1. Lowe J.B., Sen S.K., Mackinnon S.E. Current approach to radial nerve paralysis. Plast. Reconstr. Surg, 2002, vol. 110 (4), pp. 1099–1113.
2. Noble J., Munro C.A., Prasad V.S., Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. Trauma, 1998, vol. 45 (1), pp. 116–122.
3. Keighley G., Hermans D., Lawton V., Duckworth D. Radial nerve palsy in mid/distal humeral fractures: is early exploration effective? ANZ J. Surg, 2018, vol. 88 (3), pp. 228–231.
4. Chen S.R., Shen Y.P., Ho T.Y., Chen L.C. Ultrasound-guided perineural injection with dextrose for treatment of radial nerve palsy: A case report. Medicine (Baltimore), 2018, vol. 97 (23).
5. Chang G., Ilyas A.M. Radial Nerve Palsy After Humeral Shaft Fractures: The Case for Early Exploration and a New Classification to Guide Treatment and Prognosis. Hand Clin, 2018, vol. 34 (1), pp. 105–112.
6. García de Cortázar U., Padilla S., Lobato E. Intraneural Platelet-Rich Plasma Injections for the Treatment of Radial Nerve Section: A Case Report. J. Clin. Med, 2018, vol. 7 (2).
7. Pollock F.H., Drake D., Bovill E.G. Treatment of radial neuropathy associated with fractures of the humerus. J. Bone Joint Surg. Am, 1981, vol. 63 (2), pp. 239–243.
8. Shah J.J., Bhatti N.A. Radial nerve paralysis associated with fractures of the humerus. A review of 62 cases. Clin. Orthop. Relat. Res, 1983, vol. 172, pp. 171–176.
9. Bumbasirevic M., Palibrk T., Lesic A.. Atkinson H.D.E. Radial nerve palsy. Trauma, 2016, vol. 1, pp. 286–294.
10. Shao Y.C., Harwood P. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J. Bone Joint Surg. Br, 2005, vol. 87 (12), pp. 1647–1652.
11. Bleeker W.A., Nijsten M.W., Duis H.J. Treatment of humeral shaft fractures related to associated injuries. A retrospective study of 237 patients. Acta Orthop. Scand, 1991, vol. 62 (2), pp. 148–153.
12. Fu S.Y., Gordon T. Contributing factors to poor functional recovery after delayed nerve repair: prolonged denervation. J. Neurosci, 1995, vol. 15 (5), pp. 3886–3895.
13. Zhivolupov M.M., Odinak S.A. Zabolevaniya i travmy perifericheskoy nervnoy sistemy (obobshchenie klinicheskogo i eksperimental’nogo opyta): rukovodstvo dlya vrachey [Diseases and injuries of the peripheral nervous system (generalization of clinical and experimental experience): a guide for doctors]. Saint Petersburg: SpetsLit, 2009. 367 p.
14. Dreval’ O.N., Ogleznev K.Ya., Kuznetsov A.V. Patologiya perifericheskoy nervnoy sistemy: rukovodstvo po neyrokhirurgii [Pathology of the peripheral nervous system: a guide to neurosurgery]. Moscow: GEOTAR-Media, 2013. Vol. 2. Pp. 635–734.
15. Fedyakov A.G., Dreval’ O.N., Sevast’yanov V.I. Experimental and clinical justification for the use of biodegradable implants in the surgical treatment of peripheral nerve lesions. Voprosy neyrokhirurgii, 2010, no. 3, pp. 15–20 (in Russ.).
16. Filler A.G., Kline D.G., Toussaint C.P. Management of peripheral nerve disorders. Youmans Neurological surgery, 2005, vol. 6, pp. 2361–2546.
17. Russel S.M. Examination of Peripheral Nerve Injuries: An Anatomical Approach. Thieme, 2006. 178 p.
18. Garkavi D., Garkavi A., Lychagin A. A universal method for personalized assessment of treatment results in patients with orthopedic and traumatic profile. Vrach, 2014, no. 7, pp. 31–34.
19. Schwab T.R., Stillhard P.F., Schibli S. Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome. Eur. J. Trauma Emerg. Surg, 2018, vol. 44, pp. 235–243.
20. Zhivolupov S.A., Rashidov N.A, Samartsev I.N., Yakovlev E.V. Modern views on the regeneration of nerve fibers in injuries of the peripheral nervous system. Vestnik Rossiyskoy voenno-meditsinskoy akademii, 2013, no. 3 (43), pp. 190–198.
21. Shchanitsyn I.N., Ivanov A.N., Bazhanov S.P. Stimulation of peripheral nerve regeneration: current status, problems and prospects. Uspekhi fiziologicheskikh nauk, 2017, no. 48 (3), pp. 92–111.
22. Shust Yu.A. Rol’ ul’trazvukovogo issledovaniya v differentsial’noy diagnostike neyropatii pri razlichnykh zabolevaniyakh i otsenka anatomii plechevogo spleteniya v aspekte provedeniya regionarnoy anestezii: avtoref. diss. … kand. med. nauk [The role of ultrasound in the differential diagnosis of neuropathy in various diseases and the assessment of the anatomy of the brachial plexus in the aspect of regional anesthesia. Synopsis of dis. PhD med. sciences]. Krasnoyarsk, 2017.
    

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