Treatment of sequelae of associated injuries of nerves and tendons

Bersnev V.P., Kokin G.S., Orlov A.Yu.

(Polenov Research Neurosurgical Institute, Saint Petersburg, Russia)

According to the data of the Polenov Research Neurosurgical Institute (PRNI), associated injuries of nerves and tendons make 29%. A number of patients with sequelae of associated injuries of nerves and tendons, treated in the Department of Surgery of the Peripheral Nervous System of PRNI in 1990-2000, was equal to 182. The age of patients varied from 11 up to 67. These injuries were most frequent in young patients, aged 20-40.

As for mechanism of trauma, the majority of cases had injuries of a forearm, hand, shin and foot, inflicted by glass, knives, a circular saw, and injuries of extremities, caught by an operating device, machine, etc.

All patients were subject to clinical-neurologic examination, electrodiagnosis, study of a time of reactive hyperemia and dermal thermometry, electromyography, MRI.

A defect of a nerve trunk was eliminated by extended mobilization of nerve ends with subsequent suturing in 71 patients (39.1%). There were patients with considerable defects of the ulnar nerve. Its transposition into a bed of the median nerve was performed in 32 cases (17.6%). Autoneuroplasty with a bundle of transplants was used in 14 patients (7.7%), as it was impossible to eliminate an existing defect with the help of the above methods. Neurolysis was applied in 65 (35.7%) out of 182 cases.

Interventions on nerve trunks were accompanied by simultaneous tenolysis in 83 patients (45.7%) and suturing of an injured tendon in 25 cases (13.7%). Diastasis between ends of tendons was eliminated by their plasty with an autograft in 74 patients (40.6%).

Complex restorative therapy was carried out in a postoperative period in all patients.