Brachial plexus traction injury is common and is an important socioeconomic issue with surgical outcomes being essential for neurosurgery, neurology, trauma, orthopaedic and rehabilitation specialists. The objective was to compare short-term surgical outcomes in patients with closed brachial plexus traction injuries. Material and methods The study involved 61 patients with closed brachial plexus traction injuries who were divided into two homogeneous groups according to sex, age and severity of neurological deficit. Patients of Group I (n = 33) underwent microsurgical neurolysis as a surgical treatment and patients of Group II (n = 28) underwent microsurgical neurolysis in combination with single-level electrical stimulation. Clinical and functional status of the upper limb was assessed in dynamics using scales and electrophysiological monitoring. Results Short-term results of surgical treatment were significantly better in Group II compared to Group I. Discussion A more apparent recovery of the upper limb function was observed in patients of Group II that indicated advantages of microsurgical neurolysis in combination with electrical stimulation to repair closed brachial plexus traction injuries. Conclusion The combination of microsurgical neurolysis and single-level electrical stimulation improves short-term surgical outcomes of patients with closed brachial plexus traction injuries due to a faster pain relief in the postoperative period and positive dynamics in clinical and electrophysiological parameters.
Objective — To investigate the extent of degenerative changes in neurons of spinal ganglion and segmental apparatus in various injuries to sciatic nerve in the experiment on white rats. Material and Methods — The research involved 40 white non-pedigree male rats distributed among four groups. The animals of Group 1 (n=10) underwent the compression of nerve trunks with Mosquito clamp forceps for 15 minutes. In Group 2 (n=10), the animals had their nerve trunks ligated; and in Group 3, they had their nerves completely transected in their middle thirds. The separate group of control animals (n=10) suffered no damage to their sciatic nerves. Spinal cords and spinal ganglia at L4-L6 level were the material for histopathological examination. We calculated the number (percent) of degenerated neurons in spinal cords and spinal ganglia at the affected sides on Day 30, and compared them to those at the intact sides. Results — The number (percent) of degenerated neurons in spinal cord and spinal ganglion, expressed as Me (Q1; Q2), constituted 2.52% (1.92; 2.74) and 3.75% (2.37; 4.74) in Group 1, 9.27% (9.03; 9.94) and 16.74% (16.01; 18.22) in Group 2, 25.59% (24.36; 26.29) and 31.94% (31.44; 33.03) in Group 3, respectively. Depending on the number (percent) of degenerated neurons, we classified three grades of change manifestation: mild (Group 1), medium (Group 2), and severe (Group 3). No degenerated neurons were found in the control animals. Conclusion — The compression, ischemic exposure on the sciatic nerve, and complete anatomical transection of its trunk resulted in Wallerian degeneration, as well as degeneration of segmental apparatus in spinal cord neurons.
Patients with closed injuries of their brachial plexus and sciatic nerves make one of the most challenging cohort of patients as the recovery from the lost functions are rare and the number of disabilities is high. This is due to the damage by axonotmesis type when the anatomical integrity of the nerve trunk is preserved. For these patients the use of microsurgical neurolysis or electrical stimulation alone may turn ineffective, it’s also difficult to figure out the time for starting the procedures and proper stimulation modes. Thus, the investigation of the traumatic damage to peripheral nerves as well as various methods of surgical management of this cohort of patients is an urgent issue in neurosurgery, neurology, traumatology, orthopedics and rehabilitation. This study as aimed to compare the outcomes of various surgical methods in patients with closed injuries of their brachial plexus and sciatic nerves. Material and methods. The study involved 190 patients; 96 had closed injuries of their brachial plexus and 94 had closed injuries of their sciatic nerves. All patients were examined and treated in 2005-2021. These individuals were divided into three groups homogeneous by their gender, age and severity of neurological deficit: Group I (n=62) patients underwent microsurgical neurolysis, Group II (n=60) patients had microsurgical neurolysis followed by the single-level electrical stimulation, and Group III (n=68) patients had microsurgical neurolysis followed by the two-level electrical stimulation. The assessment of the clinical and functional status of the upper limb was carried out in dynamics using scale methods. The changes in clinical and functional status of the extremities were assessed with scale methods. Results. We observed a better recovery of the limb functions in those patients who experienced the combination of microsurgical neurolysis and two-level electrical stimulation. Conclusion. This technique improves surgical outcomes in patients with closed injuries of their brachial plexus and sciatic nerves due to faster pain relief and positive changes in clinical scores.
As the problem of traction injuries to brachial plexus is a common one and of high socio-economic significance, the analysis of the surgical outcomes in patients with this pathology is significant for neurosurgery, neurology, traumatology-orthopedics, and rehabilitation. The aim of the research is to compare the short-term outcomes of using various surgical methods for managing patients with closed traction injuries of brachial plexus. Material and methods. The research involved 61 patients with closed traction injury of brachial plexus divided into two groups homogeneous in sex, age and severity of their neurological deficit: Group I – 33 patients who underwent microsurgical neurolysis, Group II – 28 patients who underwent microsurgical neurolysis combined with one-level electrostimulation. The dynamic assessment of clinical and functional status of upper limbs was performed using scale methods and electrophysiological monitoring. Results. The research revealed a more evident recovery of the upper limb function in Group II patients suggesting the method of microsurgical neurolysis combined with electrostimulation to be preferable in case of closed traction injuries to brachial plexus. Conclusion. The combination of microsurgical neurolysis with one-level electrostimulation improves the short-term outcomes of surgical treatment in patients with closed traction injuries of brachial plexus due to a sooner decrease in pain in postoperative period, and positive dynamics of clinical and electrophysiological parameters.
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