The way to restore conduction in peripheral nerves at large anatomical defects

 

(57) Abstract:

The invention relates to medicine, namely to neurosurgery, and is intended to restore conduction in peripheral nerves at large anatomical defects. The defect of the nerve trunk replaces neuroarthropathy. Then in the distal and proximal ends of the nerve subepidermal implanted electrodes. Spend the stimulation constant electric current that changes its direction. The duration of action of the current in different directions varies in the range of 0 to 5 independently from each other. The magnitude of the current varies within 0 - 250 µa 9 depending on the subjective sensations of the patient. The method allows to reduce the time of recovery of large anatomical defects of peripheral nerves. 5 Il.

The invention relates to medicine, namely to neurosurgery, mikrochirurgie, neurotraumatology, and is intended for patients in a large, 20 cm or more, anatomical defects of peripheral nerves.

There is a method of treating peripheral nerve defect by neurolysis, splitting its proximal end into two equal parts according to the size deathstalker known method is the use of healthy section of the nerve to replace the damaged section, that does not fully restore the function of damaged nerve. It should also be noted that the known method it is possible to recover the relatively small areas of damaged nerve.

Known way to restore the function of damaged nerve, including the introduction of drugs into the area of damage and electrical stimulation of the nerve trunk [2].

However, this method has several disadvantages: a known manner it is possible to recover relatively small, up to 8 cm of nerve defects, the electrodes are superimposed on a nerve trunk that does not guarantee continuous and full contact with axoneme nerve, often observed migration of the electrodes, the special design of the electrodes-of yarns made of carbon filaments on their properties not aerogene, the parameters of the electric current is insufficient to restore large, 20 cm or more, defects nerves.

Closest to the present invention is a method of treatment of compressive lesions of the nerve trunks including surgical decompression and electrical stimulation through implanted in the affected area electrodes with established threshold values of the amplitude, dlitelnost is emulatie through implanted in the affected area of the electrodes.

The disadvantage of this method is the implementation of the electrostimulation pulse current (current: amplitude from 1 to; frequency from 30 to 80 Hz; duration from 0.5 to 0.75 MS), surgical decompression exclude compensation of large anatomical defects nerves, which does not allow to restore peripheral conductivity.

The proposed method aims to improve treatment outcomes, reduce treatment time.

According to the proposed method, the defect of peripheral nerve replaced nerve autograft taken from n.suralis. Above and below the damage subepidermal embedded electrodes made of silver wire with a diameter of 0.1 mm, in the postoperative period (the first day) are constant stimulation electric current that changes its direction. Duration in different directions varies from 1 to 5 seconds from each other. The magnitude of the current varies from 0 to 250 μa when the voltage changes from 0 to 9 Century

The proposed method can recover pain and tactile sensitivity starting with 3-5 days of the postoperative period, with subsequent restoration of all kinds of sensitivity.

nerve.

In Fig. 2 depicts the true anatomical defect.

In Fig. 3 depicts a transplant from n.suralis laid in the cable.

In Fig. 4 shows the graft to the defect.

In Fig. 5 depicts a restored section of the nerve with implanted electrodes.

The proposed method is as follows.

During surgical intervention reveal the site of the anatomic defect of the peripheral nerve (Fig. 1). After excision of the distal and proximal ends of the nerve within the "healthy" tissues determine the true defect nerve. Defect size required for replacement can be more than 20 cm (Fig. 2). Intakes neuroarthropathy (n.suralis) with tibia, three times the size of the defect. Taken transplant is divided into three equal parts, put in the form of "cable" and fix the seam thread 8/0 using a surgical microscope (Fig. 3). Then the graft is placed in the prepared bed and stitched to the Central and peripheral ends of the damaged nerve (Fig. 4). Perform hemostasis. Outside of skin wounds, to the Central and peripheral ends of the damaged nerve, implanted electrodes subepidermal (Fig. 5). the cue catheter for intravenous infusion of the smallest size. Electrodes attached to the skin two silk sutures for the "ears" of the catheter and to him catholisim seam. Alternatively, the electrode can be used silver needle for acupuncture. Every wound sutured. Limb immobilized.

In the postoperative period, starting from the first day, twice a day for up to 30 minutes to conduct the electrical stimulation of nerve constant current that changes its direction. The duration of current from 1 to 5 seconds. The magnitude of the current change from 0 to 250 μa when the voltage changes from 0 to 9, depending on the subjective sensations of the patient in the form of tingling in the area of the graft and distal to it that ensures the recovery of pain and tactile sensitivity already at 30 days after surgery. After 10-15 days, depending on the speed of recovery of sensitivity, the electrodes are extracted without the second surgical procedure.

The proposed method of treatment in experimental and clinical radiation was used in 12 patients with defects of peripheral nerves from 15 to 20 cm In all cases, the treatment was carried out in the remote terms after injury (up to 3 years). All patients after treatment was noted to restore nerve function.

C. was discharged in satisfactory condition. Control examination after 6 months. Sick work on the previous work, the result of the operation are satisfied.

Example 2. Patient M., 46 years old, medical history, 12685, 1997

Clinical diagnosis: post-traumatic anatomic defect of the ulnar nerve of the right forearm (20 cm). The Madelung's disease is described on the right. State after multiple surgical interventions on the bones, muscles, nerves. Ill for 4 years. Conservative treatment without defect. Operations diagnosed the defect of the ulnar nerve of the right forearm 20 see Held plastic defect with the introduction of the electrodes. On the 2nd day of stimulation occurrence of paresthesia in the area of innervation of the ulnar nerve.

On the 10th day hypesthesia to the base.

Sources of information

1. A. S. N 1806629, IPC A 61 B 17/00, a Method of treating peripheral nerve defect.

2. A. S. N 1146061, IPC A 61 N 1/36, the Method of restoring the function of damaged peripheral nerve.

3. RF patent N 2004265, IPC A 61 N 1/36, the Method of treatment of compressive lesions of the nerve trunks.

The way to restore conduction in peripheral nerves at large anatomical defects, including electrical stimulation through implanted in the affected area of the electrodes, characterized in that the defect nerve replace nitroammofosfata, electrodes are implanted subepidermal in the distal and proximal ends of the affected nerve, exercise, electrical stimulation constant electric current that changes its direction, with duration of 1 - 5, amperage 0 - 250 μa at a voltage of 9V.

 

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