Summary. The zone of the thoracolumbar junction is the most susceptible to traumatic injuries due to anatomical and physiological features. Accordingly, the stabilization of this section of the spine requires high reliability. Objective: to study the stress-strain state of the model of the thoracolumbar spine after resection of Th12-L1 vertebrae with different types of transpedicular fixation under lateroflexion. Materials and Methods. Mathematical finite element model of a fragment of the human thoracolumbar spine (Тh9-L5) was developed. We modeled the result of decompressive-stabilizing surgery with total removal of Th12-L1 vertebrae including installation of vertebral body replacing implant and fixation with a transpedicular system using 4 pairs of screws. Lateroflexion was modeled by applying a load of 350 N. Results. When evaluating the model without crosslinks and using monocortical pedicle screws, it was found that the maximum loading values in Th10, Th11, L2, and L3 vertebral bodies were 3.4, 2.0, 3.5, and 8.6 MPa, respectively; loading on pedicle screws installed in the indicated vertebrae was 48.4, 48.3, 23.3 and 43.5 MPa. When using bicortical screws without crosslinks in the vertebral bodies, the values were 3.1, 2.5, 3.8, 9.6 MPa and 49.9, 51.9, 25.8, 44.8 MPa, respectively; when using a combination of short screws and crosslinks in the vertebral bodies, the values were 3.2, 2.0, 2.6, 7.5 MPa and 47.6, 47.5, 22.6, 41.2 MPa, respectively; when using crosslinks and bicortical screws, the values were 3.0, 2.2, 2.7, 8.8 MPa and 48.3, 49.6, 24.3, 42.5 MPa, respectively. Conclusions. In lateroflexion, monocortical pedicle screws cause lower critical loading rates compared to long screws at all control points of the model. Crosslinks help to reduce stress levels. The use of monocortical pedicle screws in combination with transverse ties seems to be the most biomechanically effective in lateroflexion.
Институт нейрохирургии им. акад. А.П. Ромоданова НАМН Украины 1 , г. Киев, Житомирская областная больница им. А.Ф. Гербачевского 2 , г. Житомир, Институт травматологии и ортопедии НАМН Украины 3 , г. Киев, Украина Цель. Определение диагностических критериев для объективизации локализации, характера и степени выраженности патологических изменений, совершенствование лечебной тактики при туннельных невропатиях верхней конечности на проксимальном уровне.Материал и методы. Проведен анализ результатов лечения 77 пациентов с туннельными невропатиями верхней конечности на проксимальном уровне с 2009 по 2018 г. Средний возраст -39,1±2,1 года (M±σ), среди них 46 пациентов (59,7%) -женщины, 31 пациент (40,3%) -мужчины. Из дополнительных методов обследования использовали ультразвуковое исследование (УЗИ) сосудов верхней конечности и периферических нервных стволов; магнитно-резонансную томографию (МРТ) плечевого сплетения, шейного отдела позвоночника; мультидетекторную компьютерную томографию (МДКТ). Нейрофизиологические показатели оценивали по данным игольчатой и стимуляционной электромиографии (ЭМГ). Из методов хирургического лечения использовали как проведение декомпрессии нервов/сплетений, так и резекции проблемного участка нерва с его последующей аутопластикой или дистальной невротизацией. Сочетание декомпрессии нервов с установкой системы для длительной эпиневральной электростимуляции использовано в 25 случаях (32,5%). Оценка ранних результатов хирургического лечения проводилась в первые дни после операции, отдаленных -в сроки от четырех месяцев до шести лет.Результаты. В определении зоны и характера компрессии существенное значение имели данные МРТ. ЭМГ позволяла определить функциональное состояние нервов и мышц и уровень поражения, исключить другие патологические процессы. Положительные результаты хирургического лечения у пациентов с синдромом грудного выхода (СГВ) были отмечены в 42 (76,4%) случаях, с туннельными мононейропатиямив 20 (90,9%) случаях.Заключение. Использование возможностей современных методов диагностики при компрессионных нейропатиях верхней конечности на проксимальном уровне позволяет существенно коррегировать лечебную тактику. Индивидуальный подход к выбору метода лечения позволяет достичь благоприятное восстановление функции структур, которые подверглись компрессии.Ключевые слова: компрессионные нейропатии, синдром грудного выхода, электронейромиография, диагностика, электростимуляция Objective. To determine diagnostic criteria for objectifying the localization, nature and severity of pathological changes, improving treatment tactics for tunnel neuropathies of the upper limb at the proximal level.Methods. The treatment results of 77 patients with the tunnel neuropathies of the upper limb at the proximal level from 2009 to 2018 were analyzed. The average age is 39.1±2.1 years (M±σ), among them 46 patients (59.7%) were women, 31 patients (40.3%) were men. Among the additional methods of examination, the ultrasound of the vessels of the upper limb and peripheral nerve trunks was used as well as magnet...
The aim: Improving the effectiveness of patients' treatment with combat injuries of the peripheral nervous system, which consists in the application and development of new methods of reconstructive interventions, optimizing a set of therapeutic and diagnostic measures for the most effective management of this category of patients with peripheral nerve injury. Materials and methods: The research is based on the results of surgical treatment of 138 patients with combat injuries of peripheral nerves for the period from 2014 to 2020. The mean age was 33.5 ± 2.1 years. Patients were treated for 1 to 11 months after injury (median – 8 months). Damage to the sciatic nerve was observed in 26.1%, ulnar – in 20.3%, median – in 18.8%, radial – in 15.9%, tibial – in 10.9%, common peroneal nerve – in 8% of cases. Results: It was shown that in all patients was significantly improved the recovery of all nerves. In the period from 9 to 12 months, the degree of recovery of motor function to M0-M2 was observed in 40.6%, to M3 – in 35.5%, to M4 – in 16.7%, to M5 – in 7,2%. The degree of recovery of sensitivity to S0-S2 was observed in 36.2%, to S3 – in 42.8%, to S4 – in 17.4%, to S5 – in 3.6%. Regression of pain syndrome after surgery was observed in 81.2% of patients. Conclusions: The results of surgical treatment of peripheral nerves gunshot injury are generally worse than other types of nerve injuries. The best results of surgical treatment of combat trauma of peripheral nerves are obtained in patients with sciatic nerve damage.
Актуальність. Стаття присвячена тактиці хірургічного лікування постраждалих з ушкодженням периферичних нервів унаслідок вогнепальних поліструктурних поранень верхньої кінцівки. Визначено, що особливістю вогнепальних ушкоджень нервів є нерівномірність ураження в різних ділянках або на декількох рівнях у різних анатомічних ділянках, що диктує персоніфіковані підходи до лікування. Метою дослідження було удосконалення хірургічної тактики лікування поранених з ушкодженням периферичних нервів унаслідок вогнепальних поліструктурних ушкоджень верхніх кінцівок. Матеріали та методи. Проаналізовані результати хірургічного лікування 202 поранених з ушкодженням периферичних нервів унаслідок вогнепальних поліструктурних ушкоджень верхніх кінцівок. Результати. Важливими аспектами у лікуванні таких пацієнтів є: обов’язкова стабілізація кісткових уламків при вогнепальному переломі перед відновленням нерва, адекватне заміщення м’якотканинних дефектів, що відкриває можливості для створення сприятливих умов оточення ушкодженого нерва та стимуляції регенерації останнього з відновленням тканини «ковзання». Висновки. Своєчасне, раннє відновлення периферичних нервів, яке виконувалось одночасно з остеосинтезом та заміщенням дефекту тканин, дозволяє отримати раннє відновлення функції верхньої кінцівки.
Summary. Our study aimed to optimize the tactics of surgical treatment of wounded with gunshot wounds of the upper extremity by determining the factors influencing the outcome of treatment of servicemen in modern conditions of specialized and highly specialized medical care. Materials and Methods. Surgical treatment of 123 patients with gunshot wounds of the upper extremity who were treated at the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” and the National Military Medical Clinical Center “Main Military Clinical Hospital” of the Ministry of Defense of Ukraine was analyzed. The mean age of patients was (35.3±8.7). At the level III of medical care, the largest share was occupied by wound closure (28.0%) and surgeries on the skeletal system (6.7%). At the level IV of medical care, the largest share was occupied by surgical procedures for closing unhealed wounds – 28%, due to the consequences of gunshot nerve injuries – 11.5%, fractures – 10.7%, and restorative interventions on muscles – 5.5%. Results. By calculating the odds ratio (Odds Ratio, OR), it was found that the presence of compartment syndrome reduces the probability of obtaining a positive result by 11 times (OR=11.3), and late treatment at the level IV of care reduces the effectiveness of treatment by 9 times (OR=9.1). In the group of patients with peripheral nerve damage, satisfactory results were 6.9 times less than in the group without such damage (OR=6.9); the presence of a tissue defect worsened the prognosis of treatment by almost 5 times (OR=4.7). The average time to start surgical treatment after a gunshot wound was 2.8±5.0 days at the level III and 47.2±70.4 days at the level IV. It was found that for patients admitted to the level IV facilities for up to 30 days, the percentage increase in upper extremity function was 42.6±11.8 after treatment and 28.5±10.0 at a later start of treatment. Conclusions. The results of the study of the factors influencing the outcome of treatment prove the need for early (up to 3 weeks) admission of wounded with gunshot wounds to the level IV of medical care.
Background. Pain is one of the most common secondary symptoms seen in patients with spinal cord injury (SCI). Approximately 65 to 85 % of all SCI patients complaining of pain, with a third having severe/excruciating pain. Despite a large number of studies, some aspects that are fundamental for the choice of pain therapy remain practically unexplored. The purpose of our study was to determine the types, subtypes, and intensity of pain in subaxial cervical spine SCI patients. Materials and methods. We performed a retrospective analysis of the patients’ database admitted in Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine from 2010 to 2020 with subaxial cervical spine traumatic injury. The patients’ state was assessed within 12–18 months after the injury. We determined the functional class of neurological disorders using the ASIA scale. Pain sensation was characterized using International Spinal Cord Injury Pain Classification. The Numeric Rating Scale was the instrument for pain intensity assessment. Results. Persistent pain sensations in 12–18 months after subaxial cervical SCI are recorded in 86.42 % of 81 analyzed victims, whereas one subtype of pain is noted in 38.57 % of all patients with pain, two subtypes — in 40 % and three — in 21.43 % subjects. Elements of nociceptive pain were registered in 54.32 % of all patients, and neuropathic pain was recorded in 71.6 % of cases. When assessing pain subtypes, musculoskeletal pain was observed in 54.32 % (95% CI: 44.44–66.16) of all subjects, neuropathic pain at the trauma level in 51.85 % (95% CI: 41.98–63.77), and neuropathic pain below the trauma level was noted in 43.21 % patients (95% CI: 33.33–54.91). Nociceptive visceral and other neuropa-thic types of pain were reported sporadically — in 4.94 % (95% CI: 1.23–9.09) and 3.7 % (95% CI: 1.23–7.94) patients, respectively. When comparing the nature of pain and the ASIA functional class, we determined that the frequency pattern of the pain distribution statistically significantly correlates with the level of neurological disorders. The greatest intensity of pain was observed in patients with the ASIA functional class C of neurological disorders. Conclusions. The obtained results allowed us to reveal the regularities of the clinical picture in patients with different levels of neurological disorders, which is of practical importance for the development of optimal pharmacological treatment schemes.
Introduction. When considering the array of biomedical problems associated with facial nerve palsy (FNP), it is apparent that the problem of choosing an effective type of facial nerve transfer is of paramount relevance. Hence, it is to the pursuit of a solution to the above stated problem that our study is devoted.Materials and methods. We analyzed the data obtained as a result of assessing the outcome of 149 patients with trauma-caused FNP who had undergone surgical treatments in the period between 2001-2018. The FN nerve transfer techniques utilized were as such: for group 1 – the use as a donor nerve the branch of the accessory nerve innervating the sternocleidomastoid muscle (n=87); group 2 – the descending branch of the hypoglossal and the branch of the accessory nerve (n=62).Results. In groups 1–2, the FN nerve transfer significantly improved FN function (p <0.01; Wilcoxon Matched Pairs Test), and most patients (n=135; 90.6%) noted an improvement in the clinical status up to degree II-III on the House-Brackmann scale (good result).Conclusion. The use of the accessory nerve branches to the sternocleidomastoid muscle, as donated, ensures restoration of FN function to levels II-III on the House-Brackmann scale in 89.7% of all operated patients, and the results it achieves do not differ from those of the technically more complex nerve transfer of FN by descending branch of the hypoglossal nerve with combination of branches of the accessory nerve.
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