RU2360688C1 - Therapeutic method of peripheral nerves involvement - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to traumatology, neurosurgery, and can be used in recovery of motor and sensory functions in therapy of nerves. The therapeutic method of peripheral nerves involvement involving introduction under epineurium within surgical procedure and in first postoperative days of the medicines chosen from Actovegin Cerebrolysin, Proserin, Dibazol, vitamin B complex, adenosine triphosphate, cocarboxylase, Mexidol, Gliatilin, Sermion, Nootropil, Trental, Cavinton. In addition, in first postoperative days, the medicines chosen from listed above and Lydasa and/or vitreous body are introduced into the tissues surrounding a nerve.

EFFECT: given method allows for more rapid revasculisation and conductivity of nerves, as well as restoration of blood circulation and reinnervation of the surrounding tissues.

3 cl, 12 ex, 3 dwg

Description

The invention relates to medicine, in particular to traumatology, neurosurgery, neurology, and can be used to restore motor and sensory functions in the treatment of nerves.

A known method of treating damage to peripheral nerves, protected by RF patent No. 2124889, class. A61K 31/245, A61K 31/485, A61K 31/68, A61K 31/74, publ. 1999.01.20.

In the known method of treating injuries of peripheral nerves in injuries of the extremities, including the introduction of a medicinal mixture of analgesic action, additionally include in a mixture of 1-2 ml of no-shpa, 250-500 μg of vitamin B ₁₂ and 5-10 low molecular weight dextran (reopoliglukin or reoglucan), this is injected intraosseous mixture in the course of treatment of 4-6 injections after 5-7 days.

The disadvantage of this method is that it is mainly used only to relieve pain.

Also known is a method of restoring motor functions, protected by RF patent No. 2062098, class. A61K 31/185, A61K 31/195, publ. 1996.06.20.

According to the known method, the anatomically locomotor points of the atonic muscles corresponding to the lost movements are preliminarily determined, actovegin is introduced into them, which, depending on the nature of the motor disturbances, is combined with the introduction of sodium oxybutyrate and / or the vitreous.

The disadvantage of this method is that actovegin is introduced into the atonic muscles and does not eliminate the root cause of their atonicity - damage to nerve trunks, and in combination with other drugs, the administration of sodium oxybutyrate, which has a sedative and central muscle relaxant effect, is completely unjustified, which in no way can contribute restoration of motor functions.

Also known is a method of treating tunnel syndromes, protected by RF patent No. 2249447, class. A61H 39/08, A61K 31/245, A61K 35/14, publ. 2005.04.10.

According to the known method, over the area of the tunnel by means of infiltration anesthesia with a solution of novocaine or lidocaine, the needle is carried out into the compression zone. After preliminary administration of the anesthetic to the site of nerve damage, Actovegin is administered in a dose of 80-200 mg. Actovegin is administered at 4-6 biologically active points located along the affected nerve.

The disadvantage of this method is that summing actovegin to the site of nerve damage after administration of the anesthetic is administered blindly, and this does not exclude additional trauma to the nerve trunk and does not eliminate the cause of the tunnel syndrome, because To achieve this, drugs such as lidase and vitreous should be used initially.

Closest to the claimed technical solution, selected as a prototype, is a method of treating damage to the peripheral nerve, protected by RF patent No. 2022558, cl. A61K 31/35, publ. 1994.11.15.

In the known method of treatment by surgical intervention, an additional 1: 2 quercetin gel is applied to the area of the operation at a concentration of 1: 2, and at the same time, granules are administered orally at a dose of 2-3 g for 10-12 days.

However, any tubing of the peripheral nerve can lead to the formation of a film that mechanically interferes with the revascularization of both the epineuria and the nerve trunk itself.

The problem solved by the invention is the creation of a highly effective way to restore motor and sensory functions in the treatment of nerves.

The technical result from the use of the invention is to accelerate revascularization and conduction of nerves, as well as restore blood circulation and reinnervation of the surrounding tissues.

This result is achieved by the fact that in the method of treating peripheral nerve injuries by surgical intervention, additionally during the surgical intervention and in the first postoperative days, medications selected from actovegin, cerebrolysin, proserin, dibazole, B vitamins, ATP, cocarboxylase are administered under the epineurium Mexidol, gliatilin, sermion, nootropil, trental, cavinton, and in the first postoperative days, an additional drug is introduced into the tissues surrounding the nerve s drugs selected from the above, and ligase and / or vitreous.

Introduction under the epineurium is carried out through a pediatric catheter, an injection needle or a perforated polyvinyl chloride tube.

Drugs are injected into the tissue surrounding the nerve through a perforated catheter or perforated polyvinyl chloride tube placed next to the nerve. Actovegin is a deproteinized blood derivative of calves. Stimulates energy needs at the cell level, especially with their increased needs (healing, regeneration). It increases the concentrations of ATP, ADP, phosphocreatine, as well as amino acids - glutamate, aspartate and GABA, while not only morphological but also biochemical parameters are improved, the concentration of DNA, hemoglobin and hydroxyproline is increased. Its secondary effect is an increase in blood supply. It helps to increase the stability and survival of nerve tissue under conditions of hypoxia, restore trophism, microcirculation and, ultimately, restore nerve conduction.

Proserin is an antagonist of curariform drugs, the effect of which is associated with competitive relations with acetylcholine in the area of neuromuscular synapses, has strong anticholinesterase activity and prevents the destruction of acetylcholine, the main neuromuscular mediator.

Dibazole is an antispasmodic, it causes a pronounced vasodilator and stimulating effect on the functions of the spinal cord and peripheral nerves, inhibiting the activity of cholinesterase. It affects the acetylcholine transmission of a nerve impulse, but in a different way than proserin and eserin.

Vitamin B12 - a growth factor, takes part in the synthesis of nucleic acids and acetylcholine metabolism. As well as dibazole (a similarity in the structure of the benzimidazole component) eliminates inhibition in the nervous system, preventing the suppression of the summation of impulses arising from the injury, stimulates the regeneration of nerve trunks, and stimulates the recovery process in pathological conditions of the peripheral and central nervous system.

Cerebrolysin is a complex of low molecular weight biologically active peptides directly delivered to nerve cells. It has a unique organ-specific multimodal effect, manifested in the ability to metabolic regulation, functional neuromodulation and neurotrophic, neuroimmunotrophic activity and to provide neuroprotective effects. It stimulates the formation of synapses, spraigig dendrites and prevents the activation of microglia cells and the induction of astrogliosis. Cerebrolysin protects neurons from the damaging effects of lactic acidosis, prevents the formation of free radicals, increases survival and prevents the death of neurons under conditions of ischemia and hypoxia, and reduces the damaging neurotoxic effect of excitatory amino acids (glutamate). Cerebrolysin is the only nootropic peptidergic drug with proven neurotrophic activity similar to the action of neuronal growth factors (NGF), but manifested under conditions of peripheral administration.

ATP - is a natural component of the body. Participates in the conduct of nerve impulses and improves the conduct of nervous excitement. Also effective for spasms of blood vessels and motor disorders. When ATP is dephosphorylated, the energy necessary for the muscles to perform mechanical work is released.

Vitamin B1 - actively affects the functions of the body, including in metabolism and neuro-reflex regulation. It is able to influence the conduct of nervous excitation in synapses, it has ganglioblocking and curariform properties, expressed to a moderate degree.

Cocarboxylase - is a coenzyme of thiamine, facilitating its bioavailability. Replaces the production of carboxylase in the body resulting from the phosphorylation of vitamin B1.

FIBS is a biogenic stimulator of natural origin. By stimulating the metabolism, it increases the physiological functions of the body, accelerates the regeneration processes.

Vitreous humor is a preparation from the vitreous of the cattle eye; it is used to soften and absorb scar tissue in postoperative and other origin scars.

Lidase - contains hyaluronidase, which depolarizes hyaluronic acid (it is a “cementing” substance of the connective tissue systems of the body), causes its breakdown, causes an increase in tissue permeability and facilitates the movement of fluids in interstitial spaces. The therapeutic effect is manifested by softening of scars, resorption of hematomas, acceleration of absorption of drugs introduced under the skin and intramuscularly. The effect of lidase is more pronounced in the initial stage of the pathological process.

Vitamin B6 - plays an important role in protein, lipid and carbohydrate metabolism, is necessary for the normal functioning of the central nervous system and PNS. As a result of phosphorylation, it turns into pyridoxal-5-phosphate, which is a coenzyme of many enzyme reactions that carry out decarboxylation and transamination of tryptophan, methionine, cysteine, glutamic, and other amino acids, and also participates in the exchange of histamine.

Piracetam (Nootropil) - changes the speed of excitation propagation in nerve tissues, improves metabolic processes in nerve cells and microcirculation, influencing hemorheological characteristics.

Sermion is a vasoactive drug that improves the transmission ability of nerve mediators.

Mexidol is an antioxidant. It is an inhibitor of free radical processes, has a nootropic effect, improves microcirculation, and stabilizes the membrane structures of cells.

Gliatilin is a neuroprotector, improves the transmission of nerve impulses in cholinergic neurons, and positively affects the plasticity of neuronal membranes and the function of receptors. On the one hand, being a choline donor, it increases the synthesis of acetylcholine, which, in turn, has a positive effect on neurotransmission, on the other hand, glycerophosphate, is involved in the synthesis of phosphatidylcholine (membrane phospholipid), as a result, they both have a positive effect on membrane elasticity and on receptor function, which improves synaptic transmission.

Trental - increasing the content of ATP, favorably affects the bioelectric activity of nerve tissue.

Cavinton (Vinpocetine) - has a positive effect on metabolic processes and blood circulation of nerve tissues. It stimulates redox processes, improves regional blood flow in ischemic areas of the nerves, and has neuroprotective activity.

Doses and the scheme of administration of drugs are selected strictly individually, taking into account the nature and extent of nerve damage, concomitant vascular-tissue disorders.

The use of actovegin for the treatment of motor, sensory and speech disorders in children with hyperkinetic and atonic syndromes is known (RF Patent No. 2085197, CL A61K 35/14, A61K 35/30, A61K 31/195, A61K 31/62, A61K 31/395 , A61H 39/00, publ. 1997.07.27). In the case of the hyperkinetic form of the syndrome and spastic diplegia, actovegin or sodium hydroxybutyrate is introduced into the acupuncture points along the meridian in the area of the affected muscles, and Actovegin, or Cronassial or cerebrolysin is introduced into the acupuncture points of the conjugated meridian, while acupuncture points are introduced into the acupuncture point or kronassial, or cerebrolysin, and in the conjugate meridian region - caviton or trental, the drugs are administered at a dose of 0.05-0.3 ml every other day for two weeks, the treatment is repeated after 2-3 months.

However, this method of using Actovegin will not provide a highly effective restoration of limb functions after an injury, since surgical intervention is necessary to release the nerve trunk from its scar tissue and squeeze Actovegin inside the nerve trunk, since the epineurium itself is a barrier to penetration of Actovegin.

Cerebrolysin, proserin, dibazole, B vitamins, ATP, cocarboxylase, mexidol, gliatilin, sermion, nootropil, trental, cavinton were not previously used for administration under epineuria.

The method is as follows.

Under general anesthesia, the patient is operated on with a damaged limb or facial and additional nerves and a damaged nerve is isolated, which in some cases is anatomically intact, in others it is interrupted. In the first case, the nerve is freed from the scar tissue that squeezes it and gives it a functional anatomical position with the surrounding tissues, in the second, the nerve suture is additionally performed. Then, epineuria is injected with drugs selected from Actovegin, cerebrolysin, proserin, dibazole, B vitamins, ATP, cocarboxylase, mexidol, gliatilin, sermion, nootropil, trental, cavinton, and epineuria is administered through a pediatric catheter, injection needle or perforated PVC tube during surgery (photo No. 1). Drugs and their dosage are selected depending on the diameter of the nerve trunk, the degree of ischemia and surrounding tissues, determined either visually or using a thermal imaging method. The surrounding tissues are punctured with the above substances and a perforated catheter or perforated polyvinyl chloride tube (photo No. 2) is placed next to the nerve, through which additional drugs selected from Actovegin, cerebrolysin, proserin are injected into the tissues surrounding the nerve in the postoperative days (photo No. 3). dibazole, B vitamins, ATP, cocarboxylase, mexidol, gliatillin, sermion, nootropil, trental, cavinton, and to prevent cicatricial adhesions, lidase and / or vitreous are additionally introduced but the body. In the postoperative days, it is recommended to use the drug ASD - fraction 2 according to the methods developed by prof. Road and Aleutian ("Healthy Lifestyle" No. 20, (176), 2000).

The proposed method is used in the neurosurgical department (NHO) OKB them. Semashko, Nizhny Novgorod.

Example No. 1

Chirikov V.V., 42 years old, was admitted to the NDO for surgical treatment on 08/10/07 with a diagnosis of traumatic brachioplexopathy on the left. Concerned about burning pains in the left hand, lack of active movements in the left shoulder joint, weakness when bending the left hand in the elbow joint. In neurological status: causal pain in the left forearm and hand mainly along the left radial nerve, sensitivity changed by hyperpathic type, the absence of active movements in the left shoulder joint, the strength of the left trapezius and deltoid muscles 0 points, the strength of the forearm flexors 2-3 points (S2 , F2, M1).

(shoulder girdle, shoulder joint S4, F0, M0).

(shoulder, elbow joint S3, F2-3, M2).

(forearm, wrist joint, hand S2, F4, M5).

10.11.07 brachial plexus neurolysis was performed, Actovegin 200 mg + cerebrolysin 1 ml + 0.5 mg proserin 500 mg + vitamin B12 was introduced intraoperatively into the left brachial plexus bundles. The next day, there was a decrease in pain, an increase in the strength of the flexors of the forearm to 4 points, there were contractions of the deltoid muscle, the strength of the trapezius muscle 3 points. In order to prevent the scar-adhesion process at the site of neurolysis of the primary trunks of the left brachial plexus three times, every other day, puncture injection of 0.2 + lidocaine lidocaine 8 ml was performed.

At the time of discharge, the pain syndrome was stopped, muscle strength of the flexors of the shoulder 4 points, trapezoidal 5 points, deltoid 2-3 points, there are no sensory disturbances.

(shoulder girdle, shoulder joint S5, F3, M3).

(shoulder, elbow joint S5, F4, M5).

(forearm, wrist joint, hand S5, F5, M5).

Example No. 2

Stepin V.A., 51 years old, case history No. 0713831, was admitted to the NDO for surgical treatment on 05.24.07 with a diagnosis of post-traumatic compression-ischemic neuropathy of the left ulnar nerve at the level of the ulnar nerve canal. Concerned about the lack of sensitivity in the palm and 4.5 fingers of the left hand. In neurological status: anesthesia in the area of the hypotenor and 4.5 fingers of the left hand, decrease in strength of 4.5 fingers of the left hand to 3-4 points, limitation of range of motion in 4.5 fingers of the left hand (S0, F3, M4). 05/30/07 Neurolysis of the left ulnar nerve at the canal of the ulnar nerve. A solution of Actovegin 200 mg + Proserin 0.5 ml was introduced intraoperatively, a perforated catheter was placed in-paranevally. The next day, a solution of 1% - 5 ml dibazole was introduced through the catheter.

At the time of discharge, the strength of 4.5 fingers of the left hand is 5 points, moderate hypesthesia remains in the hypotenor and 4.5 fingers, the patient feels heat, cold, pain irritants (S3, F4, M4).

Example No. 3

Duplyakov V.A., 40 years old, was admitted to the NDO for surgical treatment on 10/31/07 with a diagnosis of a gunshot wound to the right neck region with damage to the right brachial plexus and the development of traumatic brachioplexopathy with severe motor impairment, severe pain. Worried about burning pains in the right hand, lack of active movements in the right shoulder joint, weakness when bending the right hand in the elbow joint. In neurological status: causal pain in the right forearm and hand, sensitivity changed according to the hyperpathic type in the forearm and hand, lack of active movements in the right shoulder joint, the strength of the right trapezoid and deltoid muscles 0 points, the strength of the flexors of the forearm 2-3 points the strength of the muscles of the hand 3 point (S2, F2, M1).

(shoulder girdle, shoulder joint S4, F0, M0)

(shoulder, elbow joint S4, F2-3, M3)

(forearm, wrist joint, hand S2, F3, M4)

November 12, 2007, brachial plexus neurolysis was performed, an Actovegin 200 mg + cerebrolysin 1 ml + 0.5 mg proserin 500 mg + vitamin B12 solution was introduced intraoperatively into the left brachial plexus bundles. The next day, a decrease in pain was noted. In order to prevent cicatricial adhesions at the site of neurolysis of the trunks of the left brachial plexus three times, every other day, the injection of lidase + lidocaine through an installed paraneural intravenous catheter was performed.

At the time of discharge, 11/23/07, a decrease in the severity of pain, muscle strength of the flexor muscles of the shoulder 3 points, trapezoidal 3-4 points, deltoid 1-2 points, muscle strength of the hand 3-4 points.

(shoulder girdle, shoulder joint S4, F3, M3)

(shoulder, elbow joint S4, F3, M4)

(forearm, wrist joint, hand S3, F4, M4)

Example No. 4

Sheludyakov A.V., 30 years old, was admitted to the NDO for surgical treatment on 05.17.07 with a diagnosis of post-traumatic brachioplexopathy on the right. Dislocation of the right shoulder joint, separation of the tubercle of the right humerus, domestic injury May 2005. Concerned about the lack of active movements in the right elbow joint, the weakness of the right hand. In neurological status: severe hypesthesia of the right forearm and anesthesia of the palmar surface of the right hand, lack of active movements in the right hand, strength 1-2 points.

(shoulder girdle, shoulder joint S5, F4, M4)

(shoulder, elbow joint S5, F4, M4)

(forearm, wrist joint, hand S0, F1, M1)

05/29/07, neurolysis of the right brachial plexus, neurolysis of the long branches of the right brachial plexus, an actovegin solution 200 mg was injected intraoperatively into the long branches of the right brachial plexus, and after 15 minutes, a solution of trental 100 mg. A perforated catheter is brought to the radial nerve through contraperture. The next day, the patient noted the appearance of sensitivity on the palmar surface of the right hand, trental 100 mg (5 ml) was introduced into the catheter.

(shoulder girdle, shoulder joint S5, F4, M4)

(shoulder, elbow joint S5, F4, M4)

(forearm, wrist joint, hand S4, F1, M1)

In order to prevent cicatricial adhesions at the site of neurolysis three times a day, puncture injection of lidase + lidocaine was performed.

November 13, 2007 during the follow-up examination: paresis of the back extension of the fingers of the right hand, hypesthesia on the palmar surface and the rear of the right hand, in the shoulder and elbow joints active movements in full, the strength of the hand 3-4 points. Hospitalized for a course of rehabilitation treatment.

(shoulder girdle, shoulder joint S5, F4, M4)

(shoulder, elbow joint S5, F4, M4)

(forearm, wrist joint, hand S4, F4, M3)

Example No. 5

Mironov MA, 28 years old, medical history No. 633937, was hospitalized for surgical treatment on 12/27/06 with a diagnosis of compression-ischemic neuropathy of the left fibular nerve. In the neurological status, anesthesia in the innervation zone of the left fibular nerve, the absence of back flexion of the left foot, the strength of the flexor of the foot and the flexor of the thumb 0 points (S0, F0, M1). 01/09/07, the suture of the peroneal nerve was performed at the level of the upper third of the left tibia, endoneurolysis with gliatilin solution 1.0, after 15 minutes the cavinton. On the first postoperative day, Actovegin 200 mg + proserin 0.5 ml was injected into the tissues surrounding the nerve through a perforated polyvinyl chloride tube, 1 ml of dibazole was introduced through the pediatric catheter. On the second postoperative day, 1 ml ATP and lidase + lidocaine were introduced into the tissues surrounding the nerve through a perforated polyvinyl chloride tube. On the third postoperative day, FIBS was introduced into the tissues surrounding the nerve through a perforated polyvinyl chloride tube.

At the time of discharge, sensitivity appeared in the innervation zone of the left fibular nerve, the absence of dorsiflexion of the left foot remained, a distinct reduction in the anterior group of the tibial muscles appeared (S4, F0, M2).

Example No. 6

Duka A.I., 27 years old, medical history No. 633273, 01/17/07 hospitalized in the NDO for surgical treatment with a diagnosis of compression-ischemic brachioplexopathy on the left. In neurological status: lack of sensitivity and movement in the fingers of the left hand, muscle strength of the hand 0 points, lack of active movements in the shoulder, elbow and wrist joint, causal pain in the left hand.

(shoulder girdle, shoulder joint S5, F2, M2)

(shoulder, elbow joint S5, F1, M2)

(forearm, wrist joint, hand S0, F0, M1)

01/22/07 performed neurolysis of the left brachial plexus and its branches. A solution of vitamin B6 1% - 5 ml was introduced into the long branches of the brachial plexus, after 15 minutes vitamin B12 500 mg.

On the first postoperative day, lidase + lidocaine was introduced into the tissues surrounding the nerve through a perforated polyvinyl chloride tube, and Actovegin 200 mg + Vitamin B12 500 mg was introduced through the pediatric catheter. On the second and third postoperative days, 1 ml ATP and 2 ml cocarboxylase were introduced into the tissues surrounding the nerve through a perforated polyvinyl chloride tube.

At the time of discharge, sensitivity appeared in the left hand and fingers of the left hand.

(shoulder girdle, shoulder joint S5, F2, M2)

(shoulder, elbow joint S5, F1, M2)

(forearm, wrist joint, hand S4, F0, M1)

During the follow-up examination on 10.2007, the strength of the muscles of the hand is 2-3 points, there were active movements in the shoulder, elbow, wrist joints and fingers, moderate hypesthesia on the palmar surface of the hand remains. Hospitalized for rehabilitation treatment.

(shoulder girdle, shoulder joint S5, F2, M3)

(shoulder, elbow joint S5, F3, M4)

(forearm, wrist joint, hand S4, F2, M3)

Example No. 7

Borisova V.I., 53 years old, medical history No. 705873, was hospitalized in the NDO for surgical treatment with a diagnosis of damage to the median nerve in the lower third of the left forearm. In neurological status: hypesthesia in the zone of innervation of the left median nerve, causal pain in the zone of innervation of the median nerve, lack of active movements in 1, 2, 3 fingers of the left hand, strength of 1, 2, 3 fingers of the hand 1 point, tenor hypotrophy (S2, F1 , M2).

03/07/07 suture of the median nerve in the lower third of the left forearm, endoneurolysis with a solution of Mexidol 5% - 4 ml, after 15 minutes sermion - 2 ml.

On the first postoperative day, 2 ml of Nootropil was introduced into the tissues surrounding the nerve through a perforated polyvinyl chloride tube, 200 mg + proserin 1 ml of Actovegin was administered through the pediatric catheter. On the second and third postoperative days, 1 ml vitreous and 2 ml dibazole were introduced into the tissues surrounding the nerve through a perforated polyvinyl chloride tube.

At the time of discharge, the pain syndrome was stopped, hypesthesia remains in the innervation zone of the left median nerve, active flexion of 1, 2, 3 fingers of the left hand, strength 2-3 points, there is no opposition to the thumb of the left hand (S4, F3, M3).

Example No. 8

Gagarin EG, 41 years old, case history No. 707561, was hospitalized in the NDO for surgical treatment on 03.20.07 with a diagnosis of compression-ischemic neuropathy of the left tibial and fibular nerve at the level of the popliteal fossa. In neurological status: anesthesia in the innervation zone of the left tibial and tibial nerves, lack of active movements in the foot and toes, strength in the leg muscles of 0-1 point (S0, F1, M2).

03.22.07 neurolysis of the left peroneal and tibial nerves in the popliteal fossa, endoneurolysis with a solution of cocarboxylase 0.05 g + vitamin B1 - 3 ml. On the first postoperative day, lidase + lidocaine was introduced into the tissues surrounding the nerve through a perforated polyvinyl chloride tube, and Actovegin 200 mg + Vitamin B12 500 mg was introduced through the pediatric catheter. On the second and third postoperative days, actovegin 200 mg + cerebrolysin 1 ml + 0.5 ml proserin was introduced into the tissues surrounding the nerve through a perforated polyvinyl chloride tube.

At the time of discharge, hypesthesia was preserved in the innervation zone of the left tibial and tibial nerves, active back flexion of the foot and fingers was not restored, strength 0 points, distinct contractions of the anterior leg muscle group, plantar flexion of the foot appeared, strength 2 points (S4, F1, M3).

Example No. 9

Kryachko I.A., 31, medical history No. 707659, was admitted to the NHR on 03.21.07 for surgical treatment with a diagnosis of damage to the right ulnar nerve in the middle third of the forearm. In neurological status: anesthesia in the innervation zone of the right ulnar nerve, lack of active movements in 4, 5 fingers of the left hand, strength 4, 5 fingers of the left hand 1 point, minimum range of movements 4, 5 fingers of the left hand, hypotrophy of the hypotenor (S0, F1, M3).

03.23.07 ulnar nerve suture in the middle third of the right forearm, endoneurolysis with ATP solution 1% - 1 ml, after 15 minutes trental - 3 ml.

On the first postoperative day, lidase + lidocaine was introduced into the tissues surrounding the nerve through a perforated polyvinyl chloride tube, and Actovegin 200 mg + Vitamin B12 500 mg + Cerebrolysin 1 ml was introduced through the pediatric catheter. In the second and third postoperative days, 5 ml of dibazole was introduced into the tissues surrounding the nerve through a perforated polyvinyl chloride tube.

At the time of discharge, hypesthesia in the innervation zone of the left ulnar nerve, active flexion of 4.5 fingers, strength of 3 points, extension of strength of 2 points, increased range of motion in 4.5 fingers of the left hand (S4, F3, M4).

Example No. 10

Vakhnin EA, 47 years old, case history No. 709309, was admitted to the NHR on 06.04.07 for surgical treatment with a diagnosis of damage to the superficial and deep branches of the left radial nerve, damage to the tendons of the back surface of the forearm in the middle third of the forearm. In neurological status: anesthesia in the area of the anatomical snuff box on the left, lack of active extension of the left hand and fingers of the left hand, muscle strength of the back surface of the forearm 0 points (S0, F0, M1).

04/11/07 neurolysis of the superficial and deep branches of the left radial nerve in the middle third of the forearm, endoneurolysis with a solution of vitamin B12 - 3 ml of 500 mg each, after 15 minutes of vitamin B6 - 2 ml. On the first postoperative day, cerebrolysin 1 ml, actovegin - 5 ml, proserin - 1 ml, vitamin B12 - 500 mg (1 ml) were introduced endoneurally through the catheter. Through a second catheter, trental - 5 ml was injected neurally. At the time of discharge, hypesthesia is preserved in the innervation zone of the left radial nerve, active extension of the hand with fingers clenched in a fist is restored, the force is 2-3 points, the extension of the fingers of the left hand was not restored, the strength is 0 points (S0, F2, M3).

Example No. 11

Lozhkin A.V., 34 years old, medical history No. 709671, was hospitalized at the Khokhlovsk Oblast Clinical Hospital on 11.04.07 for surgical treatment with a diagnosis of damage to the median and ulnar nerve and flexor tendons in the lower third of the left forearm. In neurological status: anesthesia on the palmar surface of the left hand and in the fingers, lack of active movements in the fingers of the left hand, strength 0 points (S0, F0, M1).

04.16.07 suture of the median and ulnar nerves in the lower third of the left forearm, endoneurolysis with a solution of 4 mg sermione in each nerve.

On the first postoperative day, cerebrolysin 1 ml, actovegin - 200 mg, proserin - 1 ml, vitamin B12 - 500 mg (1 ml) were injected endoneurally through the catheter on the first postoperative day. Through a second catheter, lidase + lidocaine, as well as 1 ml cavinton, were injected neurally.

At the time of discharge, hypesthesia is preserved in the innervation zone of the left median and ulnar nerves, active movements in the fingers of the hand are minimal, grasping function without contrasting the thumb, strength 2 points (S4, F2, M3).

Example No. 12

Mutovkin V.L., 42 years old, case history No. 710333, was hospitalized at the Khokhlovsk Oblast Medical Center on 04.17.07 for surgical treatment with a diagnosis of compression-ischemic neuropathy of the right median and ulnar nerve in the lower third of the right forearm. In neurological status: hypesthesia on the palmar surface of the right hand and in the fingers, restriction of active movements in the fingers of the right hand, finger strength 2 points (S4, F2, M3).

04/23/07 neurolysis of the median and ulnar nerves in the lower third of the right forearm, endoneurolysis with a solution of cerebrolysin 1 ml + actovegin - 2 ml, proserin - 0.5 ml, vitamin B12 - 500 mg.

On the first postoperative day, cerebrolysin 1 ml, actovegin - 5 ml, proserin - 1 ml, vitamin B12 - 500 mg (1 ml) were injected endoneurally through the catheter. Through a second catheter, dibazole - 5 ml was injected neurally.

At the time of discharge, hypesthesia is preserved in the innervation zone of the left median and ulnar nerves, active movements in the fingers of the hand are minimal, grasping function without contrasting the thumb, the strength of the fingers is 3-4 points (S4, F4, M4).

The scheme for assessing the restoration of limb function was performed according to K.A. Grigorovich:

S sensitivity: 0 - anesthesia, 1 - uncertain pain, 2 - hypesthesia with hyperpathy, 3 - hypesthesia with a decrease in hyperpathy, 4 - hypesthesia with a decrease in hyperpathy, 5 - normal sensitivity.

F strength: 0 - paralysis, 1 - slight contraction, 2 - movement with the exception of the severity of the limb, 3 - movement with overcoming the severity of the limb, 4 - movement with overcoming some resistance, 5 - normal force.

M range of movements: 0 - the absence of contractions, 1 - the appearance of contractions of the proximal muscles, 2 - the contractions of the proximal and distal muscles, 3 - the contractions of the proximal and distal muscles with such force that all important muscles are able to withstand resistance (weak movements in the joints ), 4 - the return of the function, as in stage 3, and the possibility of all synergistic and isolated movements (movements with overcoming some resistance), 5 - full recovery (normal range of movements).

Thus, the proposed invention, in comparison with the prototype, accelerates the revascularization and conduction of nerves, and also allows you to restore blood circulation and reinnervation of the surrounding tissues, which leads to the restoration of muscle strength innervated by this nerve and sensitivity.

Claims (3)

1. A method of treating peripheral nerve injuries, including surgical intervention, characterized in that, additionally, during the surgical intervention and on the first postoperative days, medications selected from actovegin, cerebrolysin, proserin, dibazole, B vitamins, ATP, cocarboxylase are administered under the epineurium , Mexidol, gliatilin, sermion, nootropil, trental, cavinton, and in the first postoperative days, medications are additionally introduced into the tissues surrounding the nerve, selected from the above, as well as lidase and / or vitreous. 2. A method of treating damage to peripheral nerves according to claim 1, characterized in that the introduction under the epineuria is carried out through a pediatric catheter, injection needle or perforated polyvinyl chloride tube. 3. A method for treating peripheral nerve injuries according to claim 1, characterized in that drugs are introduced into the tissue surrounding the nerve through a perforated catheter or perforated polyvinyl chloride tube installed next to the nerve.

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