Method of treating sciatic neuropathy following hip replacement or acetabular facture. RU patent 2504412.

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology and neurosurgery. Transient electrodes are implanted under neurophysiological control and by means of an image converter: the first electrode is epidural and implanted in a projection of the segment L3-4 or L4-5 or L5-S1. Soft tissue hydropreparation in a projection of a sciatic nerve is followed by implanting the second epineural electrode under a gluteal fold. If observing the voluntary activity in an innervation zone of a peroneal nerve, a third electrode is placed and fixed in an upper one-third of the shin in a projection of the peroneal nerve. The postoperative electric stimulation is performed 2 times a day for 14 days.

EFFECT: method extends the range of products for treating sciatic neuropathy.

2 tbl, 2 ex

The invention relates to medicine, namely to traumatology and neurosurgery, in particular, is intended for treatment of injuries of nerves of the lower extremities caused fractures of the acetabulum and arthroplasty of the hip joint.

Known method of treatment of acetabular fracture, where to determine the level of damage to the electrical impulses served successively on the peroneal and tibial nerves in the area of the ankle and knee joints, caused by register with the muscles of the foot answers, in the absence or reduction of one of them enter electrodes first in the muscles of the front and back surfaces of the Shin, and then in the biceps muscle of thigh, and if there potentials denervation in all three groups of muscles diagnose high (higher than the average third of the thigh), the level of damage nerve (EN 2038040 C1).

However, the method of treatment requires selective electroneuromyographic testing innervation of the various muscles of the back of the group hips branches of the sciatic nerve, prompt treatment is aimed at open adaptation of bone structures, excluding traction and compression of the nerve.

There is a method of treatment of traumatic neuropathies. The method involves the use of pharmacological drugs and physiotherapy treatments. As pharmaceutical drugs injected neiromidin, vitamins B-1 , B 12 , trental, Physiotherapeutic procedures are the influence of pulse magnetic field on the spinal cord and spinal-brain-roots level occurrences roots, participating in formation of the damaged nerve. Influence carry out rhythmic pulses with a frequency of 3 Hz, with an intensity 1.5-2 T, with the duration of the session 5-7 minutes, the course of treatment is 10-15 procedures (EN 2459642 C2).

However, the proposed method is not the direct impact on bag that is less effective when damage to the sciatic nerve.

Object of the present invention is to restore the function of damaged sciatic nerve after the surgical treatment the increase lower extremity, decrease pain, restore sensitive disorders in the area of innervation of the damaged nerve and improvement of gait.

This problem is solved by a method neuropathy treatment of sciatic nerve after hip replacement surgery or fractures of the acetabulum, including physiotherapeutic procedures of the sciatic nerve, characterized by the fact that under the neurophysiological control and intensification implant temporary electrodes: first - epidural in the projection segment L3-4 or L4-5 and L5-S1, after soft tissues in the projection of the sciatic nerve under the buttock crease set the second - electrode, in the absence of an arbitrary activity in the area of innervation peroneal nerve establish a third electrode, which is fixed to the upper third of the tibia in projection peroneal nerve, in the postoperative period conduct electrical stimulation within 14 days 2 times a day.

The method is illustrated in the detailed description, clinical examples and tables.

The method is as follows.

In patients after total or osteosynthesis of the acetabulum with the sciatic nerve neuropathy under local anesthesia 5 ml of 1% solution novokaina by puncture and aspiration, a needle , under the EMG (electromyography) control and intensification (RSE) implant temporary electrodes: first - epidural electrode set at the level L3-4 or L4-5 and L5-S1 and fixed to the skin capron seam. After soft tissues in the area of the projection of the sciatic nerve under the buttock crease implanted second electrode. In the absence of an arbitrary activity of the muscles of the lower extremities, M-responses (according to the EMG) in the area of innervation peroneal nerve establish a third electrode, which is fixed to the upper third of the tibia in the projection of the peroneal nerve, in the postoperative period conduct electrical stimulation within 14 days 2 times a day.

Then impose aseptic bandage.

In the postoperative period conduct electrical stimulation within 14 days twice a day.

Clinical examples of the process.

The patient B., 30 years old, was on treatment at the Department of neurosurgery diagnosis of Traumatic neuropathy sciatic nerve on the right. Concomitant diagnosis: Rheumatoid arthritis deployed stage, activity II. Anemia is mild. Chronic pyelonephritis, remission. Nefroskleroz. CRF 0 Art.

Complaints at entering the reduction of the active movement in the right foot, numbness in the right foot, pain in the right ankle.

Neurological status on admission: the clinical picture neuropathy sciatic nerve on the right. Determined moderate (3 points) active rear inflexion of the left foot and leg extension of the first finger. Hypoesthesia of the skin in the area of innervation peroneal and tibial nerves to the right.

According to electromyography (EMG) - indicators reduced considerably (table 1 from 26.04.12).

Operation: Under the EMG and RSE control performed combined needle implantation temporary electrodes: epidural - level L3-4, electrode - right sciatic nerve.

In the postoperative period was electrostimulation on the electrodes and leads in different variations; a course of conservative treatment, including: piracetam, Cavinton, neostigmine, Mexidol, , Dibazol in microdoses, massage, physiotherapy, exercise therapy.

In the neurological status noted a positive trend: slightly increased muscle tone left n/a limb, and increased exercise tolerance. Power back left foot increased to 4 points.

Dynamics of EMG indicators sick B. reflected in table 1 (from 15.05.2012).

Name muscles

26.04.2012

15.05.2012

to/from the

to/from the

to/from the

Anterior tibial muscle

Calf muscle

Rectus femoris

*mV - millivolts

**/with - oscillations per second

M-responses:

- anterior tibial muscle to the right of 7.8 MB - 99% of the age limit from 15.05.12;

- the calf muscle to the right 12,4 MB - 39% of the age limit from 15.05.12.

Course of treatment is completed in a satisfactory condition the patient was discharged home for the outpatient monitoring neurologist at the place of residence.

The patient, 37 years, was on treatment at the Department of neurosurgery with a diagnosis of Neuropathy sciatic nerve on the right. Syndrome of partial breach of conductivity on the right fibular and nerve with the level of the knee joint.

When you receive a complaint of pain in the right lower extremity, sharp restriction of active movement and the strength of muscles in the right foot, decrease the sensitivity of the external surface of the right ankle, foot. According to the EMG (table 2 of 01.03.2012), given the lack of an arbitrary activity of the muscles of the right leg in the area of innervation peroneal nerve performed: Combined needle implantation temporary EMG electrodes and RSE control: epidural - on level L5-S1, electrode - right sciatic nerve (under the buttock crease) and third electrode - in area of the upper third of the right tibia.

In the postoperative period was electrostimulation on the electrodes, and leads in different variations; a course of conservative treatment, including: trental, piracetam, Cavinton, Actovegin, neostigmine, Mexidol, , Dibazol in microdoses, massage, physiotherapy, remedial gymnastics, exercises on «».

In the neurological status noted a positive trend: slightly increased muscle tone right n/a limb, and increased exercise tolerance. Power back right foot has increased up to 3-3,5 points, bending the fingers of the foot and 1 toe - at the same level.

Positive dynamics EMG indicators of the patient, is indicated in figure 2 (from 22.03.12).

Name muscles

to/from the

to/from the

to/from the

Anterior tibial muscle

Calf muscle

Rectus femoris

M-responses:

- anterior tibial muscle to the right no from 01.03.12;

- the calf muscle to the right is missing from 01.03.12;

- rectus femoris right 8,3 MB of 01.03.12;

- anterior tibial muscle to the right of 0.55 mV - 7% of the age limit from 22.03.12;

- the calf muscle to the right 0,22 mV - 2.1% of the age limit from 22.03.12.

Course of treatment is completed in a satisfactory condition the patient was discharged home for the outpatient monitoring neurologist at the place of residence.

This method of treatment used in 22 patients after hip joints, accompanied by neurological deficit of the sciatic nerve, often fibula servings, 2 patients diagnosed with neuropathy of femoral nerve.

The proposed method is used in orthopedic and neurosurgical departments FSBO «Russian Ilizarov scientific center. Acad. G.A. Ilizarov. The method allows to perform an intervention aiming to restore the function of damaged sciatic nerve after surgical treatment of hip joint arthroplasty, increase the weight-bearing capacity of the operated lower extremity, improve the quality of gait, reduce pain, restore sensation disorders in the area of innervation of the damaged nerve.

Way neuropathy treatment of sciatic nerve after hip replacement or fractures of the acetabulum, including physiotherapeutic procedures of the sciatic nerve, characterized by the fact that under the neurophysiological control and electron-optical Converter implant temporary electrodes: first - epidural in the projection segment L3-4, or L4-5, or L5-S1, after soft tissues in the projection of the sciatic nerve under the buttock crease set the second - electrode, in the absence of an arbitrary activity in the area of innervation peroneal nerve establish a third electrode, which is fixed to the upper third of the tibia in the projection of the peroneal nerve, in the postoperative period conduct electrical stimulation within 14 days 2 times a day