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Применение комбинированной электростимуляции при изолированных и сочетанных повреждениях периферических нервов верхних и нижних конечностей

Применение комбинированной электростимуляции при изолированных и сочетанных повреждениях периферических нервов верхних и нижних конечностей

Abstract

The technique of combined implantation of electrodes at the same time instant with osteosynthesis by Ilizarov device is applied in The G.A. Ilizarov Russian research center “The restoring traumatology and orthopedics”. In 2001-2013, the neurosurgery department treated 330 patients with traumatic injuries of peripheral nerves who underwent puncture direct electrostimulation (group of patients I). The results were analyzed concerning operative treatment of 80 patients with combine injury of nerve stem and tubular bone (group of patients II). The courses of electrostimulation by low intensive alternating current through implanted electrodes and cutaneous leads. The good results of treatment were obtained in 76.96% of cases in patients from group I. During the first year after treatment the amplitude of M-responses (A=MR) characterized by expressed positive dynamics i.e. up to fourfold increasing of indicator (p<0.01). The values of average amplitude of total electromyogram increased relatively to previous date of examinations up to 180.1% (p<0.001). In the group II, good results of treatment were obtained in 67.5% of patients. During one year after termination of course of electrostimulation the further increasing of values A=MR was noted related to previous date of examinations up to 52.1%. According criterion of average amplitude of total electromyogram the increase consisted 87%. The results permit made a conclusion that direct electrostimulation of nerve stems by alternating current under combined impact on injured structures is an effective one.

В ФГБУ "РНЦ "ВТО" им. акад. Г.А. Илизарова" применяется метод комбинированной имплантации электродов одномоментно с остеосинтезом аппаратом Илизарова. С 2001 по 2013 г. в нейрохирургическом отделении пролечено 330 пациентов с травматическими повреждениями периферических нервов, которым проведена пункционная прямая электростимуляция (I группа больных). Проанализированы результаты оперативного лечения 80 больных с сочетанным повреждением нервного ствола и трубчатой кости (II группа больных). Проведены курсы электростимуляции низкоинтенсивным переменным электрическим током по установленным электродам и накожным отведениям. Хорошие результаты лечения получены в 76,96 % случаев у больных I группы. В течение первого года после лечения амплитуда М-ответов (А-МО) характеризовалась выраженной положительной динамикой до 4-кратного возрастания (p < 0,01) показателя. Значения средней амплитуды суммарной ЭМГ увеличились относительно предыдущего срока обследований на 180,1% (p < 0,001). Во II группе хорошие результаты лечения получены у 67,5% пациентов. В течение 1 года после завершения курса электростимуляции было отмечено дальнейшее увеличение значений А-МО относительно предыдущего срока обследований на 52,1%, а по критерию средней амплитуды суммарной электромиографии (А-ЭМГ) прирост составил 87%. Полученные результаты позволяют сделать вывод, что прямая электростимуляция нервных стволов низкоинтенсивным переменным электрическим током при комбинированном воздействии на поврежденные структуры является эффективной.

Keywords

ПОВРЕЖДЕНИЕ НЕРВНЫХ СТВОЛОВ И ТРУБЧАТОЙ КОСТИ, ПОСТТРАВМАТИЧЕСКАЯ НЕЙРОПАТИЯ, ЛОКТЕВОЙ НЕРВ, ЛУЧЕВОЙ НЕРВ, СРЕДИННЫЙ НЕРВ, СЕДАЛИЩНЫЙ НЕРВ, БЕДРЕННЫЙ НЕРВ, МАЛОБЕРЦОВЫЙ НЕРВ, БОЛЬШЕБЕРЦОВЫЙ НЕРВ, ЭЛЕКТРОСТИМУЛЯЦИЯ

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average
bronze