Introduction Chronic pain, which usually occurs after traumatic damage to nerves and plexuses, is an additional burden on the patients’ quality of life, which is already impaired due to motor, sensory and autonomic deficits. The aim is to study and clarify changes in immunological parameters and neurotrophic factors in patients with compression, post-traumatic non-gunshot and gunshot neuropathies and plexopathies. Materials and Methods The study included 93 men aged 21 to 59 years with neuropathy and plexopathy of traumatic and non-traumatic origin, which were divided into 3 groups. Patients underwent clinical and neurological examination starting at onset of clinical manifestations and in the dynamics, electromyography, and ultrasound. Immunological examination was performed from 12 to 24 months starting at onset of the disease. Results Differences between the study groups in the concentration of circulating immune complexes and lymphocytotoxicity, decrease in CD4 + T lymphocytes were statistically significant. In the obtained NBT-test results, which characterize the difference between spontaneous and zymosan-stimulated oxygen-dependent phagocytosis, it was found that the cells oxidized granules of nitroblue tetrazolium dye with different degree of intensity, depending on the regenerative capacity of enzymes. We found an increase in the quantitative content of the beta-NGF 303 [35.2; 504.5] pg/ml in the blood of patients of the group III with post-traumatic gunshot neuropathies and plexopathies accompained by chronic neuropathic pain syndrome at a statistically significant level (Kruskal-Wallis test, p=0.0181). Conclusion The study showed a statistically significant (p<0.05) violations of the regulatory link of immune system in patients with post-traumatic gunshot neuropathies and plexopathies, increased circulating immune complexes level, disorders of oxygen-dependent and oxygen-independent phagocytosis, reduced enzymatic regenerative capacity, significant increase in beta-NGF, Thus, as a result of the study, we found statistically significant (p<0.05) violations of the regulatory link of immune system in patients with post-traumatic gunshot neuropathies and plexopathies, increased circulating immune complexes level, disorders of oxygen-dependent and oxygen-independent phagocytosis, reduced enzymatic regenerative capacity, significant increase in beta-NGF 303 [35.2; 504.5] pg / ml, indicating the ongoing process of chronic inflammation, stimulation of the sympathetic nervous system and sensory fibers, which leads to the maintenance and severity of chronic neuropathic pain even after 12 months or more since the injury with damage to nerves and plexuses of the limbs.
Background. The modern concept of quality of life research creates opportunities for studying various aspects of patients’ lives, assessing the patient’s condition in dynamics and raises new questions about developing further approaches to a comprehensive assessment of the quality of life of patients with various neurological pathologies, in our case, the patients with post-traumatic neuropathy and plexopathies. Materials and methods. Seventy-three men with neuropathies and plexopathies were examined, who were divided into two groups. Group I included 44 patients with post-traumatic neuropathy and plexo-pathy. The second (control) group included 29 patients with compression-ischemic neuropathies and plexopathies without manifestations of chronic neuropathic pain. Patients underwent clinical and neurological examination, electroneuromyography, ultrasound. DN4 and PainDetect questionnaires were used to determine the neuropathic nature of the pain, and a visual analog scale was used to assess pain severity. The quality of life was assessed according to the MOS SF-36 questionnaire. Results. The study showed a significant reduction in the quality of life of patients with post-traumatic neuropathy and plexopathy accompanied by chronic neuropathic pain. The quality of life of patients compared to the control group is significantly lower on the scales of physical functioning, role functioning due to physical condition, the intensity of pain, mental health. In both groups, patients with neuropathies and plexopathies according to the MOS SF-36 questionnaire had reduced quality of life. In group I, chronic neuropathic pain was diagnosed in 32 patients (72.7 %). The indicators of pain corresponded to VAS 7.85 ± 1.52 points, according to the questionnaire DN4 — 7.83 ± ± 1.06, PainDetect Test — 23.20 ± 3.55.
The number of traumatic injuries to nerve stems and plexuses is steadily increasing in peacetime during armed conflicts and terrorist acts. In wartime, peripheral nerve injuries are much more common, and a great deal of the knowledge about peripheral nerve damage and repair is based on combat experience. The study of the clinical course of post−traumatic neuropathies and plexopathies contributes to the development of clinical and neurological criteria and compensatory−restorative responses in traumatic lesions of the peripheral nervous system, helps to assess the functional significance of various parts of the nervous system when compensating a damaged functional unit. To study the features of clinical manifestations of post−traumatic gunshot and non−gunshot neuropathies and plexopathies, 63 patients underwent clinical and neurological examination with topical and clinical diagnoses, collection of detailed anamnesis and complaints, electroneuromyography and ultrasound examination. Movement disorders, characterized by peripheral paresis or plegia of the corresponding muscle group and accompanied with a reduced or lost tendon and periosteal reflexes, were common. Sensitivity disorders were a combination of prolapse (anesthesia, hypoesthesia) and irritation (paresthesia, hyperpathy, hyperesthesia). Autonomic disorders (vascular, secretory and trophic) in traumatic neuropathies differ depending on the clinical individuality of peripheral nerves. Vascular disorders were more often detected with partial damage to nerve structures and were accompanied by local edema. Of the secretory disorders, the most constant sign of impaired nerve conduction was sweating disorder. In the clinical picture of the pain syndrome, i.e. causalgia, the pain sensations by type of burning dominated. The intensity of the pain syndrome in severe cases was very high, in some cases the pain was exacerbated by irritation of the senses. The clinical picture of causalgia is characterized by an increased pain when warming the injured limb and it reduced when cooled, that is a "symptom of a wet rag." Knowledge of clinical features allows the detection of the peripheral nervous system lesions at the early stages of pathology, performance of dynamic clinical and neurological observation and treatment, timely use of modern additional research methods to address further treatment tactics that restore limb function, improve quality of life. Key words: post−traumatic neuropathy and plexopathy, peripheral nervous system, gunshot wounds of nerves and plexuses.
The articles consider aspects of the formation of chronic pain in patients with gunshot wounds to the nerves of the extremities, features of their clinical and neurological manifestations, the need for timely diagnosis and treatment.
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