RU2204419C2 - Method for treating the cases of talocrural articulation injury - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out prolonged perineural anesthesia of sciatic nerve before its branching into tibial and general fibular nerves and internal skin nerve of the crus. EFFECT: improved regional blood circulation in injured extremity; accelerated healing. 1 dwg

Description

 The invention relates to medicine, namely to traumatology, and can be used to treat regional circulatory disorders in injuries of the ankle joint (GSS).

 There are various ways to treat regional circulatory disorders in injuries of the lower extremities, however, this task is still relevant, since with injuries of the heartworm some methods are technically difficult to implement, others are highly invasive and can only be used in a hospital.

 There is a method of treating injuries of the lower extremities, which consists in daily intra-arterial administration of anesthetics and antispasmodics to improve regional blood circulation (Collection of scientific papers, Ivanovo, 1979. "Change in peripheral blood circulation in patients with fractures in the process of rehabilitation", as amended by V.V. Kulemina, p. 18-21).

 The method is effective, however, to obtain the proper result, a long drip infusion is necessary, which can be carried out only in stationary conditions. In addition, when performing this manipulation, complications can arise that threaten the patient's health.

 The closest to the achieved positive result is a method of treating lower limb injuries by repeated novocaine blockade of the fracture site with the aim of improving regional blood circulation (V.I. Fishkin, S.E. Lvov, V.V. Udaltsov "Regional hemodynamics in injuries", M. , Medicine, 1981, p. 157-159).

 However, the known method is ineffective, as it relieves pain for a short time and there is a risk of infection of the hematoma when it is performed.

 The authors propose a highly effective method of treating GSS injuries by prolonged perineural anesthesia of the sciatic nerve before it is divided into the tibial and peroneal and internal cutaneous nerve of the lower leg, which improves regional blood circulation.

 A positive result of the proposed method is to increase the effectiveness of treatment by improving macro- and microcirculation in the injured limb due to relief of pain neuroreflex angiospasm, which leads to an acceleration of fracture healing.

 The method is as follows.

 To illustrate conduction anesthesia in case of damage to the distal parts of the leg and foot, a diagram of the projection location of the nerves is given (drawing).

 During anesthesia of the sciatic nerve / 1 / the patient is placed on his stomach, a roller is placed under the front surface of the GSS. Palpation determines the upper corner of the popliteal fossa, limited by the tendons of the biceps and semimembranous muscles of the thigh. The injection site is located 10-15 mm above the upper corner of the popliteal fossa. Before anesthesia, the skin is treated with iodine and alcohol twice. A needle measuring 0.6x40 mm (for individuals with developed subcutaneous tissue - 0.8x60 mm) is inserted perpendicular to the skin surface to a depth of 15-25 mm. After a puncture of the fascia and the appearance of paresthesia in the heel and plantar surface of the foot (less commonly, the rear of the foot and 5 toes), the needle is tightened by 1-2 mm and 10-15 ml of anesthetic is injected perineurally. At the time of needle advancement, an aspiration test is carried out several times to exclude vascular injury and the introduction of anesthetic into the vascular bed. Compliance with these technical features completely eliminates the risk of injury to the popliteal artery.

 Then anesthesia of the inner cutaneous nerve of the leg / 2 / is performed. For this patient, they put it on their back, palpate the inner edge of the tibia and the anteroposterior edge of the soleus muscle. In the projection of the metadiaphyseal zone, a needle of 0.6x80 mm is placed perpendicular to the axis of the tibia and is injected at an angle of 20-30 degrees. 10 ml of anesthetic are injected fan-shaped in the anterior posterior direction. Paresthesia appears on the inner surface of the lower leg, GSS and foot. As anesthetic use 2% solution of novocaine with adrenaline at a concentration of 1: 100 (the amount of adrenaline 1: 1000-1 drop per 10 ml of anesthetic).

 The clinical effect had a duration of 6-8 hours, after 10-20 minutes after the manipulation, the patients noted a decrease or complete disappearance of pain, then a feeling of warmth appeared in the lower parts of the lower leg and in the foot.

 Anesthesia is performed daily, the duration of treatment depends on the severity of the injury, the degree of damage to the soft tissues, the severity of the pain syndrome, the individual response of the patient to the injury and can be 5 days, and if necessary, longer depending on the results, controlled according to instrumental studies of regional blood circulation.

 Clinical example. Patient Sh., 40 years old, was injured on November 17, 2000. Diagnosis: "Closed fracture of the fibula of the right tibia in the lower third with displacement of fragments, rupture of the distal tibia syndesmosis, fracture of the posterior edge of the tibia without displacement, rupture of the deltoid ligament, external subluxation of the foot " In the emergency room under local anesthesia, reposition was performed, elimination of the subluxation, and a plaster cast was applied. Appeal to the clinic 18.11.8000, with complaints of severe pain in the GSS, cold feet and fingers. On examination - pronounced swelling of the GSS, a decrease in skin temperature on the dorsum of the foot by 3.5 degrees in comparison with the intact limb, according to the RVG - a sharp increase in vascular tone and a decrease in pulse blood supply, more on the damaged limb (asymmetry coefficient on the lower leg 77.3 , on the foot - 35.7). The patient underwent conduction anesthesia according to the proposed technique. 20 minutes after this, the pain syndrome significantly decreased, after 1 h the thermo-asymmetry was 1.5 degrees, the asymmetry coefficient for RVG was 56.5 on the lower leg and 28.3 on the foot. Anesthesia was carried out daily for 5 days until the pain was completely stopped, edema by that time had significantly decreased, thermo-asymmetry did not exceed 1 degree, the coefficient of asymmetry in RVG was 40.3 on the lower leg and 26.4 on the foot. Subsequently, the patient received UHF and magnetotherapy, exercise therapy for 1 period. On January 12, 2001, skin thermometry was performed and the absence of thermal asymmetry was revealed, which indicated the completion of reparative processes; performed x-ray confirmed the consolidation of fractures. In view of the formed immobilization contracture of the GSS, the patient underwent a course of rehabilitation treatment for 20 days. GSS function and limb supportability were fully restored by 2.02.2001. The term of immobilization was 54 days, the period of temporary disability was 74 days with average periods of 60 and 90 days, respectively.

 The claimed method is effective, less traumatic, technically simple and can be used on an outpatient basis.

Claims (1)

 A method of treating ankle injuries by administering anesthetics, characterized in that prolonged perineural anesthesia of the sciatic nerve is performed before it is divided into the tibial and common peroneal nerves and the inner cutaneous nerve of the lower leg.