SU950339A1 - Nerve suturing method - Google Patents

Description

(54) METHOD OF SEALING NERVE

one

The invention relates to medicine, namely to surgery and neurosurgery.

There is a known method of nerve cross-linking by passing the filaments through the ends of the nerve subeventrally in the transverse and longitudinal direction 1.

However, with this method, the eruption of the filaments is possible, and with diastases greater than 4 cm, good matching and retention of the ends in a matched state is not provided. In a number of cases, due to the cutting through of the threads, it is necessary to repeat the refreshing of the sections, which leads to additional traumatization and an increase in diastasis between the ends.

The aim of the invention is to bring the ends of the nerve closer together if there is a diastasis between them more than 4 cm and reliable fixation.

The goal is achieved by the fact that when the nerve crosslinking method is performed by passing the threads through the ends of the nerve subepinevrally in the transverse and longitudinal directions, two pairs of filaments are sub-epinevral in the transverse direction along the anterior and posterior surfaces of the peripheral and central ends of the nerve.

stitched in the longitudinal direction.

The method is carried out as follows.

Claims (2)

After the nerve ends are refreshed to a structure that is clearly visible to the eye, a distance of 1-2 mm from the edge of the cut, two threads are sub-epinerally directed along the atraumatic needle in the transverse direction along the anterior and posterior surfaces of each end. They pull together, align the ends of the nerve and tie the threads, then, supporting the nerve for these ligatures, put longitudinal seams (3-4 grooves on average) along the anterior surface of the subepineurally, retreating 1-2 mm from the edge of the cut. After shrinking and tying up the threads, the ends of the latter are cut off, and with the help of transverse ligatures the nerves are turned 180 ° and along the back surface in the same way, another 3-4 longitudinal sutures are laid. Longitudinal seams provide sufficient tightness of the suture site, nerve. The method was applied in the surgical treatment of 168 patients on 258 nerves, where the diastasis between the ends of the damaged nerve exceeded 4 cm. A good result was obtained in the majority of patients. Example 1. Patient B. 31 was injured in production, resulting in an open comminuted fracture of the middle third of the left humerus, complicated by damage to the radial nerve. Lechils conservatively in plaster dressing. By six months from the moment of injury, the fracture did not return, however, the function of the damaged radial nerve had not recovered, and the patient was hospitalized for this. Clinically and electrophysiologically, the diagnosis was established: complete traumatic injury of the radial nerve at the level of the middle third of the left shoulder without signs of recovery. The patient underwent surgery. The operation revealed complete anatomical damage to the radial nerve. After the nerve ends were separated from the scars and they were refreshed, a diastasis of 6 cm was formed between the ends. An attempt to suture a nerve by known methods failed. Using the proposed method, the nerve is sutured "end to end without difficulty. The postoperative period went smoothly. On the 12th day from the day of the operation, stitches were removed. For three weeks from the moment of the operation, the immobilization of the limb has stopped. By five months from the day of the operation, the beginning of the restoration of the function of the stitched nerve was noted. By eight months from the day of the operation, the function of the stitched nerve and the limb as a whole was restored to the degree of “good. The result of the treatment is good. By this time the patient returned to his previous work as a tractor driver. Example 2. Patient K. 40 liters was injured in everyday life - a torn wound of soft tissues of the volar surface of the lower third of the right forearm, complicated by damage to the dry obstruction and ulnar nerve. During the initial surgical treatment of the wound, not all injured formations were sutured, due to which for a long time the function of the right hand continued to remain sharply impaired. After 3.5 months from the time of the injury, a complete traumatic injury of the ulnar nerve was diagnosed clinically and electrophysiologically at the level of the lower third of the right forearm without signs of recovery. Then the patient was hospitalized, examined and operated on. A complete traumatic damage to the ulnar nerve was found on the operating table. After separation from the scarring and refreshment of the nerve ends, a diastasis formed between the ends of 5.5 cm. It was not possible to suture a nerve by known methods, therefore the proposed method was applied, with the help of which the nerve is easily sutured “end to end. The postoperative period went smoothly. The wound healed by primary tension. On the 12th day of sleep you are right. After 21 days from the day of operation, immobilization with a plaster cant is stopped. By six months since the last operation, the function of the stitched nerve and the right hand as a whole was restored to the degree “good. By this time, the patient was discharged to work - still writes a lot with his right hand. The proposed method improves the matching and fixation of the ends of the nerve in the juxtaposed state with large diastases. The invention of the method of nerve crosslinking by passing filaments through the ends of the nerve subepineurally in the transverse and longitudinal lanpaene, characterized in that, in order to bring the ends of the nerve closer together with diastasis between them more than 4 cm and reliable fixation, in the transverse direction two pairs of filaments are placed in the transverse direction along the anterior and posterior surfaces of the peripheral and central ends of the nerve, and then after the latter approaching, they are sutured in the longitudinal direction. Sources of information taken into account in the examination 1. G. Richter A. A multivolume guide to surgery. V. 10, M., “Medicine, 1964