RU2711438C1 - Method for assessing risk of developing adverse post-traumatic neuropathy in diaphyseal fractures of humerus - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to neurology, and can be used for assessing the risk of developing an unfavorable outcome of posttraumatic neuropathy in diaphyseal fractures of humerus. Electroneuromyographic examination of the ulnar, median and radial nerves is performed in the affected region combined with the determination of the level of matrix metalloproteinase I (ng/ml) and erythrocyte magnesium level (mmol/l). Method includes determining the level of matrix metalloproteinase I (ng/ml), erythrocyte magnesium level (mmol/l) and determining the average value of the negative amplitude (ms) of the negative M-response phase stimulated ulnar, median and radial nerves twice every 40 days. Ratio of the level of matrix metalloproteinase I to the erythrocyte magnesium level is calculated. If the ratio is increased by 16 % and more in the second study combined with a decrease in the averaged value of the negative phase of the M-response in stimulation of the ulnar, median and radial nerves by 10 % and more in the second study, a high risk of the unfavorable outcome of posttraumatic neuropathy in diaphyseal fractures humerus. Otherwise, the outcome is considered to be favorable.EFFECT: method provides reliable detection of patients with a high risk of the unfavorable outcome of posttraumatic neuropathy in diaphyseal fractures of the humerus by analyzing the results of electroneuromyography examination of the patient and examining the clinical and biochemical laws of the wound process on the background of connective tissue dysplasia.1 cl, 2 ex

Description

FIELD OF THE INVENTION

The invention relates to medicine, namely to neurology.

State of the art

One of the common complications of injuries of the humerus is the development of neurological disorders - post-traumatic neuropathy. The cause of post-traumatic neuropathy may be a violation of the integrity of the nerve during trauma, nerve damage during surgery or other medical interventions, the effect of prolonged edema of surrounding tissues, the development of cicatricial changes in the area of passage of nerve trunks. The treatment and rehabilitation of patients with post-traumatic neuropathy with diaphyseal fractures of the humerus is a lengthy and expensive procedure.

The presence of connective tissue dysplasia is one of the risk factors for complications in the treatment of traumatological and surgical patients. Therefore, it was logical to assume the presence of a direct correlation between the presence of connective tissue dysplasia in the patient and the development of an adverse outcome of post-traumatic neuropathy in case of diaphyseal fractures of the humerus.

Known (analogue) "A method for the diagnosis of vascular disorders in compression-ischemic neuropathies" (RF patent for the invention No. 2050828 of 12.19.1991). The method consists in measuring the degree of scattering of the light flux, the measurement is carried out in the wavelength range of 480 592 nm in the autonomous zones of the innervation of the peripheral nerve in the stream, and when provoking compression of the test limb with a pressure of 160 220 kPa, the ratio of the scattering of the light flux measured at rest to the scattering value is calculated luminous flux during compression of the limb and with values of the obtained ratio above 1.33 ± 0.22, vascular disorders are diagnosed with compression-ischemic neuropathies.

The presence / absence of vascular disorders can indirectly assess the outcome of treatment of neuropathy. The disadvantage of this method is the limitation in its use (compression-ischemic mechanism of nerve damage) and the need to use additional expensive equipment that is not provided for in the standards for the provision of medical services for this category of patients.

As a prototype, we adopted the description of the "Method for predicting an adverse outcome of Guillain-Barré syndrome" (RF patent for the invention No. 4146942 from 10.10.2012). It consists in conducting an electroneuromyographic study of excitation in the patient’s ulnar nerve in the first two weeks from the onset of the disease, with measuring the magnitude of the amplitude of the M-response of the motor portions of the ulnar nerve from one limb, with a magnitude of 2.5 mV or less, an adverse outcome of the syndrome is predicted Guillain-Barre in the form of preservation of pronounced residual paresis in the long-term period of the disease.

However, this method has the following disadvantages:

1) to assess the risk of developing an adverse outcome of post-traumatic neuropathy with diaphyseal fractures of the humerus, this method can be used in a limited way - only if the ulnar nerve is known to be damaged, the damage to the radial and median nerve is not taken into account;

2) only electroneuromyographic research is used;

3) the patient’s presence of signs of a dysplastic process that significantly worsens the prognosis of the outcome of the underlying disease is not taken into account.

Thus, the development of a new method for assessing the risk of an adverse outcome of post-traumatic neuropathy with diaphyseal fractures of the humerus is required. In the claimed method, the listed disadvantages are eliminated.

Disclosure of Invention

The objective of the invention is to improve the quality of medical services for patients with post-traumatic neuropathy with diaphyseal fractures of the humerus, by conducting early prediction of the risk of an adverse outcome of this disease in patients with signs of connective tissue dysplasia.

The technical result of the method is to provide reliable identification of patients with a high risk of an adverse outcome of post-traumatic neuropathy with diaphyseal fractures of the humerus, by analyzing the results of the electroneuromyographic examination of the patient and studying the clinical and biochemical patterns of the development of the wound process, against the background of connective tissue dysplasia.

The implementation of the invention

The claimed technical result can be achieved as follows:

erythrocyte magnesium level (mmol / L), matrix metalloproteinase I level (ng / ml) are determined and the average amplitude (ms) of the negative phase of the M-response is determined upon stimulation of the ulnar, median and radial nerves twice with an interval of 40 days, the ratio is calculated the level of matrix metalloproteinase I to the level of magnesium of red blood cells, with an increase in this ratio by 16% or more in the second study, combined with a decrease in the average value of the amplitude of the negative phase of the M-response during stimulation of the ulnar, median radial nerves more than 10% in the second study reveal a high risk of an adverse outcome posttraumatic neuropathy diaphyseal fractures of the humerus, otherwise the result is favorable.

- When a patient contacts post-traumatic neuropathy with diaphyseal fractures of the humerus to a neurologist, he is assigned a biochemical blood test, which includes determination of the level of magnesium of erythrocytes (mmol / l) and the level of matrix metalloproteinase I (ng / ml), calculate the ratio of the level of matrix metalloproteinase I (ng / ml) to the level of magnesium of red blood cells (mmol / l).

- At the same time, an electroneuromyographic study of the ulnar, median and radial nerves in the lesion area is carried out - the average value of the amplitude of the negative phase of the M-response is determined during stimulation of the ulnar, median and radial nerves.

- After forty days, biochemical and electroneuromyographic studies are repeated.

- The dynamics of the ratio of the level of matrix metalloproteinase I (ng / ml) to the level of magnesium of erythrocytes (mmol / l) and the dynamics of the average value of the amplitude of the negative phase of the M-response during stimulation of the ulnar, median and radial nerves are estimated.

- If a combination of a 16% increase in the ratio of the level of matrix metalloproteinase I (ng / ml) to the level of magnesium of erythrocytes (mmol / l) and a decrease in the average amplitude of the negative phase of the M-response during stimulation of the ulnar, median and radial nerves by 10% more are revealed in the second study, the patient revealed a high risk of an adverse outcome of post-traumatic neuropathy with diaphyseal fractures of the humerus. An individual rehabilitation scheme should be assigned to such a patient, since the risk of disability is very high.

- Otherwise, the risk of an adverse outcome of post-traumatic neuropathy with diaphyseal fractures of the humerus is low and the patient is treated according to the standard treatment regimen.

The novelty of the proposed method is that:

- for the first time, a combined study of metabolic and electroneuromyographic indicators is used to assess the outcome of post-traumatic neuropathy;

- studies are carried out in dynamics;

- takes into account the presence and activity of dysplastic processes in the patient;

- the study is carried out using ready-made factory laboratory test systems, which reduces the risk of an erroneously overestimated or erroneously underestimated analysis result.

Distinctive features of the method:

- conduct the determination of the level of magnesium of red blood cells (mmol / l), the level of matrix metalloproteinase I (ng / ml) and the determination of the average value of the amplitude (ms) of the negative phase of the M-response during stimulation of the ulnar, median and radial nerves twice with an interval of 40 days,

- calculate the ratio of the level of matrix metalloproteinase I to the level of magnesium of red blood cells,

- calculate the average value of the amplitude of the negative phase of the M-response during stimulation of the ulnar, median and radial nerves

- with an increase in the ratio of the level of matrix metalloproteinase I to the level of magnesium of erythrocytes by 16% or more in the second study, in combination with a decrease in the average value of the amplitude of the negative phase of the M response during stimulation of the ulnar, median and radial nerves by 10% or more, in the second study, a high the risk of an adverse outcome of post-traumatic neuropathy with diaphyseal fractures of the humerus, otherwise the outcome is considered favorable.

The proposed method is illustrated by the following examples.

Clinical example No. 1

Patient No. 37, 35 years old, was referred for consultation by a neurologist in connection with a left arm injury - wound (diaphyseal fracture of the humerus). Immobilization. A biochemical blood test was performed: the level of matrix metalloproteinase I is 11.33 ng / ml, and the level of magnesium of red blood cells is 8.18 mmol / l. When conducting an electroneuromyographic study, the average value of the amplitude of the negative phase of the M-response was calculated during stimulation of the ulnar, median and radial nerves - 4.34 ms. Re-examination was carried out after 40 days: the level of magnesium of erythrocytes decreased to 7.59 mmol / l. and the level of matrix metalloproteinase I increased to 12.84 ng / ml, the average value of the amplitude of the negative phase of the M response during stimulation of the ulnar, median, and radial nerves was 3.21 ms. The calculations are made:

Exceeding the ratio of biochemical parameters after 40 days exceeds 16%. there is a decrease in the amplitude of the negative phase of the M-response during stimulation of the ulnar, median and radial nerves by 35%.

A high risk of an adverse outcome of post-traumatic neuropathy with diaphyseal fractures of the humerus was revealed. In the follow-up history (6 months), the loss of motor functions of the left hand remains. The forecast is unfavorable.

Clinical example No. 2

Patient No. 24, 32 years old, was referred for consultation by a neurologist in connection with a left arm injury - an accident (a diaphyseal fracture of the humerus was revealed). Immobilization. A biochemical blood test was performed: the level of matrix metalloproteinase I is 10.12 ng / ml. and the red blood cell magnesium level is 7.69 mmol / L. When conducting an electroneuromyographic study, the average value of the amplitude of the negative phase of the M-response was calculated during stimulation of the ulnar, median and radial nerves - 4.22 ms. Re-examination was carried out after 40 days: the level of magnesium of erythrocytes decreased to 11.71 mmol / l, and the level of matrix metalloproteinase I increased to 8.05 ng / ml, the average value of the amplitude of the negative phase of the M-response during stimulation of the ulnar, median and radial nerves was 4.31 ms The calculations are made:

Exceeding the ratio of biochemical parameters after 40 days does not exceed 16%, there is no decrease in the amplitude of the negative phase of the M response during stimulation of the ulnar, median, and radial nerves.

The absence of a high risk of an adverse outcome of post-traumatic neuropathy with diaphyseal fractures of the humerus was revealed. In the follow-up history (6 months), the motor functions of the left hand are fully preserved. The forecast is favorable.

Claims (1)

A method for assessing the risk of developing an adverse outcome of post-traumatic neuropathy with diaphyseal fractures of the humerus, which consists in conducting an electroneuromyographic study of the ulnar, median and radial nerves in the affected area, in combination with determining the level of matrix metalloproteinase I (ng / ml), the level of magnesium of red blood cells (mmol / l ), characterized in that the average value of the amplitude (ms) of the negative phase of the M-response is determined during stimulation of the ulnar, median and radial nerves twice with an interval of 40 d her, calculate the ratio of the level of matrix metalloproteinase I to the level of magnesium of red blood cells, with an increase in this ratio by 16% or more in the second study, combined with a decrease in the average value of the amplitude of the negative phase of the M-response during stimulation of the ulnar, median and radial nerves by 10% and more in the second study, a high risk of an adverse outcome of post-traumatic neuropathy with diaphyseal fractures of the humerus is identified, otherwise the outcome is considered favorable.