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The method of processing the stump of the nerve with amputation of a limb

IPC classes for russian patent The method of processing the stump of the nerve with amputation of a limb (RU 2190367):
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(57) Abstract:

The invention relates to medicine, in particular to surgery. Perform the amputation of limbs on shows for the patient way. Thus emit a nerve trunk, pinch the nerve at a distance of 4 to 7 cm proximal to the level of amputation injection needle and extended in the proximal direction anaesthetize him for the entire length of the injection needle 10-20 ml of 2% lidocaine solution with 3-5 drops of epinephrine, this creates a tight creeping intranasally infiltration. Pull up the injection needle to 1.0-1.5 cm, temporarily tie the nerve at a distance of 0.5 cm proximal to the planned level of truncation nerve durable methodoloy a ligature one simple knot and pull the ends of the ligatures. In the nerve injected 5-8 ml 40-45% ethanol solution simultaneously. Truncate distal to a nerve trunk imposed on the nerve ligatures sharp razor blade at a distance of 0.5 cm from it. Carve out deep and bolshezemelnaya Vienna limb fragment length of 4-6 cm, strung it in the form of a pouch on the stump of the nerve. Its end surface with the adjacent epineurium photocoagulator. During this process the end surface of the nerve from adjacent epineurium who have laser beam at a rate of 0.5 cm/S. Fix the upper section of a fragment autogeny to epineurium four thin kemptville ligatures. Cover the stump of the nerve fragment autogeny, tie fragment autogeny level contouring the edge of the stump of the nerve thick methodoloy a ligature of the surgical site. Leaves distal colon methodoloy ligatures part venous fragment length of 0.4-0.6 see the Method allows to increase the efficiency and quality of processing of the stump of the nerve, resulting in a decrease postoperative complications.

The invention relates to medicine, in particular to surgery.

A method of processing nerve trunks by intersecting nerves with a razor or a sharp scalpel (see Traumatology and Orthopaedics: a Textbook /X. A. Mazaltov, G. S. Yumashev, L. L. Silin and others /edited by H. A. Musatova, G. S. Yumashev. - 4th ed., Rev. and ext. M.: Medicine, 1995. - S. 158).

For reasons that impede the achievement of specified following technical result when using the known method is that in the known method has the following disadvantages:
1. Apply a single effect on the clipping nerve by only crossing of the nerve with a razor or sharp knife that does not exclude the

2. Use impact on the clipping nerve by only crossing of the nerve with a razor or sharp knife that is not sufficient to fully address causalistic and phantom pain.

The closest way to the same destination to the claimed invention by a combination of traits is how to handle the stump of the nerve with amputation by truncation of the nerve trunk, with consequent impacts on the stump of the nerve (see RF patent N2023428, class. And 61 In 17/56, 1994), adopted for the prototype.

For reasons that impede the achievement of specified following technical result when using the known method, taken as a prototype, is that in the known method:
1. Do not specify all the characteristics of the laser radiation and is not illuminated the nature of laser irradiation on the lateral surface of a truncated nerve, and that is very essential.

2. Use single impact on the stump of a truncated nerve by only heat treatment that does not preclude the growth of nerve fibers and their inclusion in the postoperative cicatricial process stump of a limb.

3. Perform only the heat treatment of the lateral surface of a truncated newspecial prevent direct contact of the end of the nerve, although thermally treated, with cicatrizing tissues of the stump of the limb.

The invention consists in the following. The task of the invention is to improve the efficiency and quality of treatment of the stump of the nerve with amputation of a limb.

The technical result - improving the efficiency and quality of treatment of the stump of the nerve with amputation of a limb. This technical result in the implementation of the invention is achieved in that in the known method performs the amputation of limbs on shows for the patient to this produce a nerve trunk, pinch nerve injection needle with a syringe single use with 10-20 ml of 2% lidocaine solution and 3-5 drops of 0.1% solution of epinephrine in place of the scheduled truncation nerve, which is set at a distance of 4 to 7 cm proximal to the level of amputation, and extended in the proximal direction anaesthetize the nerve to the entire length of the injection needle, make the entire volume of anesthetic tight creeping intranasally infiltration, pull up the injection needle and centurybut the end of the nerve, finish tightening the needle in reducing its kontoriruumi in nerve length and 1.0-1.5 cm, vrema nerve with the needle thick and durable methodoloy a ligature one simple knot and pull the ends of the ligatures, produce a shift of the empty syringe on the syringe single use with 5-8 ml of 40-45% ethanol and injected into the nerve simultaneously all the contents of the syringe is removed from the nerve needle with a syringe and simultaneously make a simple knot imposed thick and durable methodoloy ligatures and put the ends of its two simple site truncate distal to a nerve trunk imposed on the nerve is thick and durable methodoloy ligatures sharp razor blade at a distance of 0.5 cm from it, to carve out deep and bolshezemelnaya Vienna outgoing waste limb segment fragment length of 4-6 cm, strung it in the form of a pouch on the stump of the nerve and are used at the ends of thick and durable methodoloy ligatures as conductors and handles, hold the stump of the nerve in a vertical position and its end surface with the adjacent epineurium photocoagulator, while the handle end surface of the nerve from adjacent epineurium defocused high-intensity laser radiation with power density 230-390 W/cm2and move the laser beam at a rate of 0.5 cm/s, fix the upper section of a fragment autogeny to epineurium four thin kemptville ligatures on atraumatic needle, cut to autogeny level contouring the edge of the stump of the nerve thick methodoloy a surgical ligature node, cut distal to its abundance of fragment autogeny and the ends of the thick methodoloy ligatures, while leaving the distal colon methodoloy ligatures part venous fragment length of 0.4-0.6 see

This ensures high efficiency and quality of processing of the stump of the nerve with amputation of a limb.

Thus it is essential that way:
1. Ensures the prevention of the proliferation of nerve fibers at the end of the truncated nerve by processing its end surface with the adjacent epineurium defocused high-intensity laser radiation with power density of it 230-390 W/cm2and moving the laser beam at a rate of 0.5 cm/s

2. Eliminates the appearance in the postoperative period causalistic and phantom pain by the end processing of nerve 40-45% solution of ethyl alcohol and crushing his thick and durable methodoloy a ligature by means of the imposition of the end of the clipping nerve.

3. Provides protection of finding the end of a truncated nerve at the point of generation postoperative scar and close contact with him by finding the end of a truncated nerve in place, which is set at a distance of 4-6 cm proximal to the level of amputation of Konica nerve high-intensity laser radiation with refined and calibrated parameters.

5. Saves tranquilizers and analgesics in the treatment of patients with amputated limbs due to the absence of indications to their destination due to the lack causalistic and phantom pain.

6. Prevents direct contact of the end of the nerve with cicatrizing tissues of the stump of the limb by placing it in the cavity of the fragment waste autogeny.

This provides improved efficiency and quality of treatment of the stump of the nerve with amputation of a limb.

Conducted by the applicant's analysis of the prior art, including searching by the patent and scientific and technical information sources, and identify sources that contain information about the equivalents of the claimed invention, has allowed to establish that the applicant had not found the source, which is characterized by signs, identical to all the essential features of the claimed invention. The definition from the list of identified unique prototype, as the most similar set of features analogue, has allowed to establish the essential towards perceived by the applicant to the technical result of the distinctive features in the proposed method, described in the formula izopet Erki compliance of the claimed invention the term "inventive step", the applicant conducted an additional search of the known solutions to identify signs that match the distinctive features of the prototype of the characteristics of the claimed method. The search results showed that the claimed invention not apparent to the expert in the obvious way from the prior art because the prior art defined by the applicant, not the influence provided the essential features of the claimed invention transformations to achieve a technical result. In particular, the claimed invention does not provide for the following conversions:
- addition of known means of any known part (s), attached (connected) to it according to certain rules, to achieve a technical result, in respect of which it is the effect of such additions;
- replacement of any part (s) of the other known means known part to achieve a technical result, in respect of which it is the effect of such a change;
- the exclusion of any part (element, action) means while the exclusion of its functions and the achievement of a result of such exclusion (simplification, reduction of weight, dimensions, materialteknik action items, to enhance the technical result due to the presence in the vehicle is of such elements, actions;
- execution of a known drug or its part (s) of a known material to achieve a technical result due to the known properties of this material;
- creation of tools, consisting of well-known parts, the choice of which and the relationship between them is carried out on the basis of known rules, recommendations, and achievable technical result is due only to the known properties of the parts of this tool and the relationships between them.

The described invention is not based on the change of the quantitative characteristic (s), the submission of such evidence in the relationship or change its appearance. This refers to the case when the known fact of the influence of each of these features on the technical result, and the new values for these characteristics or their relationship could be obtained from the known dependency relationships.

Therefore, the claimed invention meets the condition of "inventive step".

Information confirming the ability of the invention to provide the above technical R is wny barrel, pinch nerve injection needle with a syringe single use with 10-20 ml of 2% lidocaine solution and 3-5 drops of 0.1% solution of epinephrine in place of the scheduled truncation nerve, which is set at a distance of 4 to 7 cm proximal to the level of amputation, and extended in the proximal direction anaesthetize the nerve to the entire length of the injection needle, make the entire volume of anesthetic tight creeping intranasally infiltration, pull up the injection needle and centurybut the end of the nerve, finish tightening the needle in reducing its kontoriruumi in nerve length and 1.0-1.5 cm, temporarily tie the nerve at a distance of 0.5 cm proximal to the planned level of truncation of the nerve and the space needle stick injury to the nerve with the needle thick and durable methodoloy a ligature one simple knot and pull the ends of the ligatures, produce a shift of the empty syringe on the syringe single use with 5-8 ml of 40-45% ethanol and injected into the nerve simultaneously all the contents of the syringe is removed from the nerve needle with a syringe and simultaneously make a simple knot imposed thick and durable methodoloy ligatures and put the ends of her two common node, truncate distal to a nerve trunk on the up from the deep and bolshezemelnaya Vienna outgoing waste limb segment fragment length of 4-6 cm, strung it in the form of a pouch on the stump of the nerve and are used at the ends of thick and durable methodoloy ligatures as conductors and handles, hold the stump of the nerve in a vertical position and its end surface with the adjacent epineurium photocoagulator, while the handle end surface of the nerve from adjacent epineurium defocused high-intensity laser radiation with power density 230-390 W/cm2and move the laser beam at a rate of 0.5 cm/s, fix the upper section of a fragment autogeny to epineurium four thin kemptville ligatures on atraumatic needle, cut off the ends of thick and durable methodoloy ligatures, cover the stump of the nerve fragment autogeny, tie fragment autogeny level contouring the edge of the stump of the nerve thick methodoloy a surgical ligature knot, cut distal to its abundance of fragment autogeny and the ends of the thick methodoloy ligatures, while leaving the distal colon methodoloy ligatures part venous fragment length of 0.4-0.6 see

Example 1. Patient P., 62 years. Did the clinic diabetes of the second type of moderate severity in the stage of subcompensation, diabetic angiopathy of the lower extremities, injunction for surgery amputation of the right lower limb at the hip level. In the operating room after the treatment the skin of the right lower limb three times with 2% iodine solution was preparing the surgical field to perform the operation. In the operation of amputation of the right lower extremity at the level of the middle third of the thigh was used the proposed method for the treatment of the stump of the sciatic nerve with amputation of a limb. In the postoperative period with his first hours and before discharge of the patient sensations remote limb and the pain was totally gone. On conservative therapy in the postoperative period General condition of the patient improved rapidly complications in the postoperative period. Discharged on the 12th day from the operation. In the late postoperative period in a patient with pain and feeling remote limb was missing.

Example 2. Patient Z. , 58 years. Did the clinic diabetes of the second type of moderate severity in the stage of subcompensation, diabetic angiopathy of the lower extremities, diabetic gangrene of the left foot. The patient was examined and examined by digital urography is now available. It was exhibited indications for surgery amputation of left leg at the hip level. In the operating room after the treatment the skin right signaali. In the operation of amputation of the left lower extremity at the level of the middle third of the thigh was used the proposed method for the treatment of the stump of the sciatic nerve with amputation of a limb. In the postoperative period with his first hours and before discharge the patient feeling remote limb and the pain was totally gone. On conservative therapy in the postoperative period, the patient's General condition improved quickly, complications in the postoperative period. Issued on the 11th day from the operation. In the late postoperative period, the patient pain and feeling remote limb was missing.

When conducting operations in the presented patients had marked all the manifest positive aspects of our proposed method of processing the stump of the nerve with amputation of a limb.

The expediency of application of the method are obvious.

Thus, the presented data suggest the implementation of the use of the claimed invention (method) the following cumulative conditions:
the tool embodying the claimed method in its implementation, is intended for use in industry, namely, in medicine, in particular in surgery;
retene, confirmed the possibility of its implementation using the steps described in the application or known before the priority date tools and methods.

Therefore, the claimed invention meets the condition of "industrial applicability".

The method of processing the stump of the nerve with amputation of a limb by truncation of the nerve trunk, with consequent impacts on the stump of the nerve, wherein performing the amputation of limbs on shows for the patient to allocate this nervous style, pinch nerve injection needle with a syringe single use with 10-20 ml of 2% lidocaine solution and 3-5 drops of 0.1% solution of epinephrine in place of the scheduled truncation nerve, which is set at a distance of 4 to 7 cm proximal to the level of amputation, and extended in the proximal direction anaesthetize the nerve to the entire length of the injection needle, this creates the entire volume of anesthetic tight creeping intranasally infiltration, pull up the injection needle and centurybut the end of the nerve, finish tightening the needle in reducing its kontoriruumi in nerve length and 1.0-1.5 cm, temporarily tie the nerve at a distance of 0.5 cm proximal to the planned level of truncation nerve and mistakebut the ends of the ligatures, produce a shift of the empty syringe on the syringe single use with 5-8 ml of 40-45% ethanol and injected into the nerve simultaneously all the contents of the syringe is removed from the nerve needle with a syringe and simultaneously make a simple knot imposed thick and durable methodoloy ligatures, and put the ends of its two simple site truncate distal to a nerve trunk imposed on the nerve is thick and durable methodoloy ligatures sharp razor blade at a distance of 0.5 cm from it, to carve out deep and bolshezemelnaya Vienna outgoing waste limb segment fragment length of 4-6 cm, strung it in the form of a pouch on the stump of the nerve and are used at the ends of thick and durable methodoloy ligatures as conductors and handles, hold the stump of the nerve in a vertical position and its end surface with the adjacent epineurium photocoagulator, while the handle end surface of the nerve from adjacent epineurium defocused high-intensity laser radiation with power density 230-390 W/cm2and move the laser beam at a rate of 0.5 cm, fix the upper section of a fragment autogeny to epineurium four thin kemptville ligatures on atraumatic needle, cut off the Kona is Otopeni level contouring the edge of the stump of the nerve thick methodoloy a surgical ligature node, cut distal to its abundance of fragment autogeny and the ends of the thick methodoloy ligatures, while leaving the distal colon methodoloy ligatures part venous fragment length of 0.4-0.6 see

 

 

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