RU2149585C1 - Intraoperative method for elongating a peripheral nerve - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves performing three cycles of distraction during 10 min and nerve fragments distraction with 10 min long pause during operation before suturing the nerve. The force applied is to be two times as high as the load invoking arterial blood circulation to stop in nerve trunk capillaries. When done, neuromae are exsected and the nerve is sutured. EFFECT: accelerated treatment course.

Description

 The invention relates to medicine, namely to neurosurgery, and specifically relates to the extension of peripheral nerves.

 A known method of lengthening peripheral nerves by the distraction method [1]. The method consists in applying a load to the nerve that does not cause microcirculatory disturbances in the nerve vessels, which is maintained during the treatment phase, which lasts an average of 3 weeks. After the nerve is extended to a distance corresponding to diastasis, a second operation is performed, in which neuromas are excised and the nerve is sutured. The disadvantage of this method is that it takes a relatively long time to lengthen the nerve. In addition, a second operation is necessary, which significantly increases the duration of treatment of the patient.

 Closest to the technical solution to the proposed one is the method adopted for the prototype and consisting in the simultaneous distraction of soft tissues of the limb after osteotomy using the Ilizarov apparatus [2]. However, this method allows the distraction of only an intact peripheral nerve. In addition, the maximum permissible traction force, which does not have a negative effect on subsequent regeneration of the nerve, is unknown.

 The essence of the invention lies in the combination of essential features sufficient to achieve a technical result, namely, to shorten the treatment time for patients, and consists in the fact that the nerve extension is performed in one operation stage, which includes three cycles of distraction, and with each cycle repeated with an interval of 10 minutes, traction of the nerve by ligatures carried out through neuromas is carried out, the traction force is brought to a value twice as high as the force causing the cessation of arterial blood flow in the capillaries the nerve trunk, and support it also for 10 minutes, after which they reduce traction to the level of physiological tension of the nerve, and after the third cycle of distraction, the neuromas excise and suture the nerve using one of the existing methods.

 The traction mode described above (strength, number of cycles and their duration) was chosen empirically. According to experiments [3] we conducted on rats before testing the method in the clinic, the applied traction mode of 600 grams, when converted to a human nerve, does not adversely affect its regeneration. This method allows to lengthen the nerve in one operation stage and reduce the treatment time for patients with traumatic nerve injuries.

 The method is as follows. Proximal and distal fragments of the damaged nerve are isolated. Neuromas are stitched with ligatures. After that, a load is applied to them by suspending weights of 600 grams to the ligatures thrown over the blocks, and support it for 10 minutes. Further, the load is reduced to the level of physiological tension of the nerve itself and its tension is maintained for 10 minutes. The indicated ten minute distraction cycles are repeated twice more at 10 minute intervals. After the third cycle of distraction, neuromas are excised and the nerve is sutured in one of the existing ways.

 Using this method, four patients with peripheral nerve damage on the forearm were operated on. All patients received a positive dynamics of restoration of muscle function of the hand and sensitivity in the area of nerve innervation.

 Clinical example. Patient L., 28 years old, East. disease N 2556, was admitted 08/15/96 with a diagnosis of traumatic damage to the median nerve in the right ulnar region. Condition after autogenous prosthesis of the brachial artery. In the department of microsurgery NICT "WTO" performed the operation: suture of the median nerve with preliminary distraction according to the proposed method. During surgery, a diastasis between the ends of the nerve of 53 mm was detected, which did not allow the nerve to be stitched without tension. After intraoperative nerve distraction of 600 grams was performed according to the described scheme in three cycles, the diastasis between the ends of the nerve was 30 mm, which made it possible to sew the median nerve in the position of flexion of the forearm in the elbow joint at an angle of 155 degrees.

Claims (1)

 A method of intraoperative peripheral nerve lengthening, including the isolation of the proximal and distal ends of the damaged nerve, ligature application to neuromas and application of load to nerve fragments, characterized in that the nerve lengthening is performed in one operation stage, which includes three distraction cycles, each in a cycle repeated with an interval of 10 min, traction of the nerve by ligatures carried out through the neuromas is carried out, the traction force is brought to a value twice as large as the force causing the artery to stop lingual blood flow in the capillaries of the nerve trunk, and it is also maintained for 10 minutes, after which the traction is reduced to the level of physiological tension of the nerve, and after the third cycle of distraction, the neuromas excise and suture the nerve.