The dissertation is devoted to topical issues of surgical treatment of the consequences of traumatic injuries of the nerves of the upper extremity, combined with damage to the muscular system, tendons, vessels, bones. The study included 60 patients with sequelae of combined nerve damage who were undergoing treatment in the department of restorative neurosurgery with radiographic surgery, from 2008 to 2017.
In relation to the level of combined nerve damage to the main groups of the muscles of the forearm and the hands of all patients are divided into three groups.
The first group of patients - 22 patients had combined injuries of the upper extremity nerves more proximal to the muscles of the forearm and hand, mainly at shoulder level.
The general characteristic of the patient of the first group was predominant damage of two or more nerves (the median nerve in 86,4% of cases) in combination with damage of the main arterial vessel. In this group of patients, the main neurosurgical reconstructive intervention was autograft of the nerves of the upper extremity and was performed in 16 cases (72,7%) in 19 (86,4%) patients underwent humeral artery angiolysis.
The result of surgical treatment in the first group of patients: in 5 patients (71.4% of the total number of patients with lesions of the LMS) the performance of reconstructive delivery allowed to achieve recovery of the function of the biceps muscle of the shoulder and shoulder muscle to M5 by MRSC. In two cases, regeneration of the LMS was ineffective. In the distant period, they were transposed with Steinler's forearm muscles with a satisfactory functional result.
As the number of damaged nerves increased, the rates of effective recovery of both PFP MA and distal brush muscles decreased significantly. In the case of damage to two nerves, effective recovery was achieved in 80% for PFP MA, 74% for PF MA, 50% for first-finger muscles and 60% for “internal muscles of the hand.
The second group - 28 patients had combined limb nerve damage distal to the MA forearm and proximal to the MA brush.
General characteristics of the patient in Group 2: predominant damage of two nerves (in 100% of cases of the median), which in most cases (89,3%) required the autoneuroplasty; 100% damage to the musculoskeletal system, which in more than half of the cases required reconstructive intervention on the tendons; one third of patients (32.1%) needed re-intervention on both nerves and tendons.
In this group after reconstructive interventions; good results were observed in 16 patients (57.1%); satisfactory - in eight patients (28.6%); negative - in 14.3% of cases.
The third group - 10 patients with consequences of injury of the upper extremity nerves combined with damage to the muscular apparatus at the level of the forearm. General characteristics of the patient in this group: damage of two or more nerves in combination with secondary (indirect) ischemic damage of the muscular apparatus, which in all cases is caused by fracture of the humerus.
In this group, as the main reconstructive neurosurgical intervention, neurolysis of nerve structures was used, which in 80% of cases was supplemented by the installation of a system for chronic electrical stimulation of the injured nerves of the upper extremity.
In the third group of good result (restoration of the function of the MA of the forearm and the "internal muscles of the hand to M4-M5 by MRSC) was noted in 80% of cases. In patients with insufficient restoration of function of the brush significant progress is achieved with the continued use of corrective interventions for CA.
In order to improve the results of treatment of patients with combined nerve damage, it is proposed to use selective nerve repair whose function has the most significant effect on the function of the upper extremity. For this purpose, the technique of distal nerve transfer of the posterior intercostal nerve by the branches of the median nerve on the forearm and the method of distal neuroticization of the deep branch of the ulnar nerve by the branch of the median nerve on the forearm were introduced. The use of forced transposition of the forearm muscles is also suggested.
Statistical analysis of the dependence of the volume of restoration of the main strokes of the brush and own assessment of the results of restoration of the function of the brush by the patients (according to Brief MHQ) showed a significant dependence on the level of damage, the number of damaged structures, the fullness of the restoration of function in the first place of the elbow and middle nerves, the use of stimulated methods» Muscle transposition, subsequent stage corrective treatment.
