RU2494777C2 - Method of treating nerve injuries - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurosurgery, rehabilitation, physiotherapy and may be used in the integrated treatment of the patients suffering compression ischemic neuropathy. The injured nerve is directly exposed to intraoperative low-power red laser light. The operation is followed by the therapeutic course consisting of the daily procedures of the low-power red laser light exposure on the injured light directly.

EFFECT: method enables recovering the injured nerve function, reducing the number of injuries and providing higher therapeutic effectiveness ensured by the direct exposure covering the injured nerve tissue.

1 ex, 5 dwg

Description

The invention relates to medicine, namely to neurosurgery, rehabilitation, physiotherapy and can be used in the complex treatment of patients with compression-ischemic neuropathy.

The main goal of the entire medical care system is to restore and / or maintain the quality of life. Compression ischemic neuropathy (tunnel syndrome, tunnel neuropathy, trap neuropathy) is one of the most common groups of diseases of the peripheral nerves of the extremities. These diseases are quite common (up to 45%) in individuals whose professional activity is associated with prolonged tension of individual muscle groups.

A known method of treating nerve damage by direct electrical stimulation (Bochkarev P.N., Gorshkov R.P., Melamud E.E., Ninel V.G., Korshunova G.A. Many years of experience in direct electrical stimulation of nerve trunks in the treatment of compression and traction injuries of peripheral nerves // Modern aspects of electroneurostimulation and new technologies in neurosurgery and neurology. - Saratov, 1998. - P.61-63). At the same time, during surgery, 2 electrodes are installed and fixed with glue and catgut through the epineurium on the damaged nerve section, which are removed through additional punctures near the surgical wound. From 2 days after the operation, electrical stimulation is carried out for 30 minutes 4 times a day for 3-5 weeks. The disadvantage of this method is the trauma due to the stay in the wound of foreign bodies (electrodes) for a long period, which can cause persistent pain, swelling, suppuration.

There is also a method for treating nerve damage by bringing a fiber through a needle to a nerve and irradiating it with helium-neon low-intensity laser radiation at a power of 0.5-2 W and an exposure of 20 sec - 3 min. (RU 2067012, CL A61N 5/06, A61M 37/00, publ. 09/27/1996).

The injuries and the danger of adverse reactions are due to the introduction of a needle and a fiber (foreign bodies), which have a damaging effect on the nerve and adjacent tissues, including vessels. The result is pain, microbleeding and macrobleeding up to hematomas, swelling, suppuration.

Closest to the claimed technical essence and the achieved result, selected as a prototype is a method of exposure to low-energy scanning red and infrared laser radiation on a damaged nerve and adjacent tissues remotely. A laser beam with a diameter of 1.5 mm, a power of 10 mW scans with a frequency of 200-330 Hz along the trajectories of the Lissajous figure on an irradiated surface of 15-30 cm ² (RU 2185214, class A61N 5/067, publ. 20.07.2002).

The disadvantages of the method are the danger of adverse reactions, the lack of effectiveness of the method.

The lack of effectiveness of the method is due to: isolated exposure only to the damaged area of the nerve; a decrease in the density of the radiation energy flux when the laser beam passes through the tissue; intermittent exposure (characteristic of a helium-neon laser) - not physiological and not stimulating for the nerve and neuro-receptor apparatus; lack of visual exposure control.

The invention is aimed at creating a method of treating nerve damage, providing restoration of the function of the affected nerve and reducing treatment time.

The technical result from the use of the invention is to reduce the morbidity, the risk of adverse reactions and increase the effectiveness of treatment.

This result is achieved by the fact that in the method of treating nerve damage, including exposure to low-energy red laser radiation on a damaged nerve, exposure to low-energy red laser radiation on a damaged nerve is carried out intraoperatively directly into the damaged nerve, and after surgery, a course of treatment is performed from daily procedures of low-energy red laser radiation directly into a damaged nerve.

The essence of the invention is as follows: intraoperatively, after releasing a nerve from scar tissue (photo 1, 2), an optical fiber of the apparatus of low-energy red laser radiation is installed under the epineurium (photo 3). The diameter of the part of the fiber intended for insertion under the epineurium is 0.8 mm (photo 4). Within 20 minutes exposure to low-intensity laser radiation with a wavelength of 0.63 microns and a power of 1.0 mW (photo 5). Without removing the light guide from under the epineurium, its other end is brought out. The wound is sutured. After the optical fiber installed in this way under the epineurium, after the operation, a treatment course of 10 daily procedures of low-energy red laser radiation is carried out for 10 minutes each.

Epineurium is a fairly thick and dense connective tissue membrane that protects nerve fibers from any external influences. And in the case of remote exposure, epineuria will absorb most of the laser radiation. Therefore, it is necessary to introduce a fiber under the epineurium, for direct impact on damaged nerves without loss of radiation energy.

The method is as follows.

A patient with a damaged nerve is operated on according to indications (compression of a nerve, etc.): nerve neurolysis. The damaged nerve is affected by low-energy red laser radiation by introducing a low-intensity laser radiation apparatus into the selected nerve of the subepineural fiber (photo 3). For 20 min, they are exposed to low-energy laser radiation with a wavelength of 0.63 μm and a power of 1.0 mW (photo 4, 5). Without removing the light guide from under the epineurium, its other end is brought out. The wound is sutured. After the optical fiber installed in this way under the epineurium, after the operation, a treatment course of 10 daily procedures of low-energy red laser radiation is carried out by the apparatus for 10 minutes each. At the end of the course, the light guide is removed.

The method has passed clinical trials in the NUZ "Road Clinical Hospital at the station. Gorky JSC "Russian Railways" (Ch. Doctor Kaznin V.M.), Nizhny Novgorod in the treatment of 15 patients with damage to nerves of the extremities.

The following is an example - an extract from a medical history.

Example. Patient Sh., Born in 1961, was admitted to the neurosurgical department with complaints of pain in the right hand, weakness and restriction of movements in 4-5 fingers of the right hand, decreased sensitivity in the right hand. According to the patient, 0.5 years ago she was injured in the area of the right elbow joint, after which weakness and impaired sensitivity in the right hand increased. Objectively: a painful scar in the lower third of the right shoulder, a deep violation of the conduction along the ulnar nerve: paresis of the muscles of the hand 1 point, hypesthesia in the zone of innervation of the ulnar nerve 2 points. The operation was performed: neurolysis of the ulnar nerve, installation of an epineural fiber of the laser therapy apparatus. In the position of the patient on the back in the lower third of the right shoulder, a 10 cm incision was made in the projection of the ulnar nerve. The ulnar nerve was isolated by a sharp and blunt path throughout the incision. The nerve is white in color, without a vascular pattern. A subepineurally introduced fiber of the low-intensity laser radiation apparatus. Within 20 minutes exposure was carried out by low-intensity laser radiation with a wavelength of 0.63 microns and a power of 1.0 mW. Hemostasis, control for the absence of foreign bodies. Without removing the optical fiber from under the epineuria, its other end is brought out of the surgical wound. Intradermal suture. Alcohol. Aseptic wound dressing. In the postoperative period, laser therapy is performed for 10 min No. 10 through the withdrawn end of the fiber. Against the background of laser therapy, a positive dynamics was noted in the form of an increase in strength in 4-5 fingers of the right hand. Thus, the application of the claimed method made it possible to quickly restore impaired functions

For laser therapy, the ALOK-1 low-intensity laser radiation apparatus was used, which makes it possible to act directly on tissues without loss of radiation energy. Technical characteristics of the apparatus of low-intensity laser radiation "ALOK-1" (approved for use by the Ministry of Health of the Russian Federation. Certified: ЩФЗ.050-007 TU, NPO "Plasma" (Ryazan), reg. No. 88 / 576-41) - apparatus of low-intensity laser radiation, compact portable, used in treatment rooms and wards at the patient’s bed in hospitals of cardiological, vascular, general surgical, dermatological and other profiles: radiation wavelength, microns 0.63; food. V, Hz 220.50; power consumption, no more than 45 W; laser radiation power at the output of the fiber, mW, not less than 1.0; exposure time up to min 30; diameter of the part of the light guide, mm, not more than 0.8; dimensions, mm, no more than 410 × 265 × 115; the mass of the device without spare parts and accessories is not more than 6.5 kg; average service life, years, not less than 5.

The proposed method of laser therapy has a comprehensive therapeutic effect directly on damaged nerves: it stimulates nerve function, improves microcirculation and metabolism. This provides effective treatment for severe and combined injuries of nerves, deeply located nerves (for example, the sciatic nerve in the gluteal region, on the thigh), as well as the prevention of adverse outcomes.

Reducing the morbidity and the risk of adverse reactions is achieved due to the small diameter of the fiber and direct exposure only to damaged nerve fibers, since the diameter of the inserted fiber is 2.5 times smaller than the diameters of catheters intended for subepineural injection.

Improving the effectiveness of treatment is provided by:

- the impact of low-energy red laser radiation directly on the damaged nerve tissue, since irradiation stimulates regenerative processes and improves metabolism in ischemic tissues;

- the possibility of constant exposure to damaged nerve tissue.

Claims (1)

A method for treating nerve injuries, including the action of low-energy red laser radiation on a damaged nerve, characterized in that the exposure to low-energy red laser radiation on a damaged nerve is carried out intraoperatively directly into the damaged nerve, and after surgery, a course of treatment is carried out from daily procedures of low-energy red laser radiation directly on the damaged nerve .

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