Comparison of surgical outcomes in patients with closed nerve injuries in upper and lower extremities

Abstract

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.