Petronić I, Marsavelski A, Nikolić G, Cirović D
Univerzitetska decija klinika, Beograd.
Acta Chir Iugosl. 2003;50(1):83-6. doi: 10.2298/aci0301083p.
Injuries of extremities can be followed by various neuromuscular complications. Injury of peripheral nerves directly depended on the topographic localization of injury (fractures, cuts, contusions). The neuromuscular complications were diagnosed and under follow-up, based on clinical, x-ray, neurologic and neurophysiological findings. The timing of physical treatment and assessment of the necessary neurosurgical intervention depended on the obtained findings. After surgeries, we continued to apply physical treatment and rehabilitation. The aim of the paper was to assess the significance of proper timing for surgery and adequate postoperative rehabilitation, as well as treatment results, depending on the extent of peripheral nerve injury.
Based on the study condocted in the period from 2000-2002, most surgeries were done on the ulnar nerve (4 pts), median nerve (4 pts), radial nerve (3 pts), peroneal nerve (2 pts) and plexus brachialis (3 pts). Paresis and peripheral nerve paralysis, associated with sensibility disorders, predominated in clinical features. In most patients surgery was done during the first 3-6 months after injury. In early postoperative Postoperative rehabilitation in patients with peripherial treatment positioning of extremities with electrotherapy were most often used in early postoperative treatment, Bioptron and dosed kinesitherapy. Depending on the neurophysiological findings, in later treatment stage we included electrostimulation, thermotherapy, kinesitherapy and working therapy, with the necessary application of static and dynamic orthroses. Study results showed that the success of treatment depended on the extent of injury, i.e. whether suture of liberalization of the nerve had been done, on the adequate timing of surgery, as well as on the adequate timing and application of physical therapy and rehabilitation. More rapid and complete functional recovery was achieved if the interval between injury and surgery was shorter, as well as physical therapy was applied early. Based on the analysis of the achieved results, we concluded that peripheral nerve lesions after fractures and contusions had better prognosis in relation to isolated sections of peripheral nerves, having in mind that these were mostly conductive block transfer and nerve stretching lesion, which do not leave sequelae after completed treatment After neurorrhaphies and applied therapy, motor and sensitive deficit mostly depended on good timing of surgery and continual psychiatric treatment. It is also important to point out the significance of team-work among neurosurgeon, neurologist and psychiatrist necessary in early detection and successful treatment of numerous sequelae and invalidity in patients with peripheral nerve lesions.
肢体损伤后可能会出现各种神经肌肉并发症。周围神经损伤直接取决于损伤的部位（骨折、切割伤、挫伤）。根据临床、X线、神经学和神经生理学检查结果对神经肌肉并发症进行诊断和随访。物理治疗的时机以及必要的神经外科干预的评估取决于所获得的检查结果。手术后，我们继续进行物理治疗和康复。本文的目的是评估手术时机和术后充分康复的重要性，以及取决于周围神经损伤程度的治疗效果。
基于2000 - 2002年期间进行的研究，大多数手术针对尺神经（4例）、正中神经（4例）、桡神经（3例）、腓总神经（2例）和臂丛神经（3例）进行。临床特征以伴有感觉障碍的轻瘫和周围神经麻痹为主。大多数患者在受伤后的前3 - 6个月内接受手术。术后早期，对肢体进行物理治疗定位并结合电疗法是最常用的术后早期治疗方法，还有生物光子疗法和定量运动疗法。根据神经生理学检查结果，在后期治疗阶段，我们采用电刺激、热疗、运动疗法和作业疗法，并必要时应用静态和动态矫形器。研究结果表明，治疗的成功取决于损伤的程度，即是否进行了神经松解缝合，取决于手术时机是否合适，以及物理治疗和康复的时机及应用是否恰当。如果损伤与手术之间的间隔较短且早期应用物理治疗，就能实现更快、更完全的功能恢复。基于对所取得结果的分析，我们得出结论，骨折和挫伤后的周围神经损伤与周围神经孤立节段损伤相比预后更好，因为这些大多是传导阻滞转移和神经牵拉伤，完成治疗后不会留下后遗症。在进行神经缝合和应用治疗后，运动和感觉功能缺损主要取决于手术时机是否合适以及持续的康复治疗。还需要指出的是，神经外科医生、神经科医生和精神科医生之间的团队合作对于早期发现和成功治疗周围神经损伤患者的众多后遗症及残疾具有重要意义。
