RU2525635C2 - Method for surgical management of sudeck atrophy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology, orthopaedics and neurosurgery. The median nerve neurolysis is performed. An alloplant is used for the peripheral nerve grafting; it is split longitudinally and stretched in the form of a leaf. The split alloplant is brought under the nerve; the nerve is isolated by wrapping in the form of a cuff; interrupted sutures are applied on the opposite ends of the leaf.

EFFECT: method enables reducing the time for the recovery of motion and sensitive functions of the hand and preventing developing postoperative complications that is ensured by a postoperative reliable nerve isolation, and the regenerative properties of the used alloplant.

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Description

The invention relates to medicine, namely to traumatology, orthopedics and neurosurgery, and is intended for the treatment of Sudeck's syndrome.

There is a method of treating fractures with Turner-Sudek syndrome by surgical treatment - exposure of a nerve, excision of scars and mobilization of nerves (A. V. Kaplan. Damage to bones and joints. M. 1979, S. 195-226). There is also a method of treating peripheral nerve damage (RF patent for the invention No. 2022558 of 11/15/1994). The implementation of the method involves neurolysis or suture of the nerve according to the conventional method. After neurolysis or nerve suture is performed, the damaged area of the nerve trunk is tubulated with quercetin gel at a concentration of 1: 2 (1 part quercetin: 2 parts solvent, for example water). After the operation, along with conventional pharmacological preparations, massage, physiotherapy, electrical stimulation, oral administration of quercetin granules is prescribed.

The disadvantages of these methods are:

1) the re-development of the scar-adhesive process around the nerve;

2) uneven differentiation of connective tissue with the formation of sites of fibrosis;

3) the duration of treatment can reach a year. Patients are in hospital for a long time. There are neurological disorders.

The aim of the invention is the most rapid restoration of motor and sensory hand function, preventing the development of a repeated scar-adhesion process around the median nerve after neurolysis, accelerating the regeneration of the damaged median nerve, increasing the effectiveness of treatment and reducing the number of complications.

This goal is achieved by the fact that after the patient’s treatment with a diagnosis of Sudek’s Syndrome, a thorough examination of the patient and preoperative planning is carried out: medical history, electroneuromyography, determine the level and nature of damage to the median nerve. After processing the surgical field in the projection of the median nerve (1) make a layered S-shaped section (Fig.1, 2). A nerve is isolated and neurolysis is performed according to the conventional technique of the median nerve. (2) Then, an alloplant for plasty of the peripheral nerves is taken (Alloplant. Biomaterials for reparative surgery. Catalog. Ufa, 2010 p.12, 33), the length of which depends on the site of the degenerative-dystrophic process of the median nerve, and an alloplant for plasty of the peripheral nerve is cut along and spread out as a sheet. (3) After which the expanded sheet is carried out under the nerve, wrapped in the form of a sleeve (4) and nodal sutures are placed on opposite ends of the alloplant sheet for plastic surgery of the peripheral nerve (Figs. 3, 4). Layered seams on the wound, aseptic dressing.

The proposed method is illustrated by the following example.

Clinical example

Patient N, 62 years old, turned to the City Clinical Hospital No. 21 of Ufa with complaints of diffuse pain, impaired function and restriction of movement. From the anamnesis: an injury 4 months ago, a fracture of the right ray in a typical place with displacement. Closed manual reposition under local anesthesia was performed at the emergency room, gypsum immobilization was applied for 4-5 weeks. After removal of the gypsum immobilization, exercise therapy was carried out, the development of the right wrist joint. On admission, edema, impaired autonomic functions (atrophy of the skin and subcutaneous tissue, edema, changes in skin temperature and sweating) are noted, a sharp pain syndrome, impaired sensitivity, restriction of movement of the flexor-extensor contracture of the right wrist joint are noted (Fig. 5). The radiograph shows a fusion of the right ray in a typical place with a slight displacement and spotted osteoporosis.

The patient underwent examination: radiography, needle eletroneuromyography (6, 7). A change in PDE (neural type), spontaneous pathological activity (PF, PFC, separate POF) were revealed. On clinical examination, it was decided to carry out surgical treatment: neurolysis of the median nerve using alloplant for plasty of the peripheral nerves around the median nerve in the form of a sleeve. After appropriate preparation, the patient was operated on according to the method described above.

The day after the operation, the disappearance of the pain syndrome was noted, physiotherapy exercises were started, dressings were carried out, symptomatic treatment was carried out. Uncomplicated postoperative period. The postoperative wound healed by primary intention. By the time the sutures were removed, the motor function of the limb appeared, an increase in the amplitude of motion in the right wrist joint, the pain disappeared. After 3 months, a control needle electroneuromyography was performed, in which an improvement in the PDE characteristic was seen, the severity of spontaneous pathological activity decreased (Fig. 8, 9). A good functional result and complete social and medical rehabilitation were obtained.

Thus, the use of an alloplant for plasty of peripheral nerves in the form of a sleeve improves the conditions of recovery of the median nerve, prevents the re-formation of the scar-adhesive process around the nerve and reduces the likelihood of developing complications, the limb motor function is most quickly restored.

Claims (1)

A method of surgical treatment of Sudeck’s syndrome, including median nerve neurolysis, characterized in that, after neurolysis, an alloplant is inserted under the nerve for plastic surgery of the peripheral nerve, which is split longitudinally and straightened in the form of a leaf, additional isolation of the nerve is carried out by wrapping it in the form of a sleeve followed by nodal sutures to the opposite ends of the leaf.

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