Karabay İlkay, Demir Yasin, Köroğlu Özlem, Gümrük Aslan Sefa, Aydemir Koray, Gürçay Eda
Department of Physical Medicine and Rehabilitation, Health Sciences University, Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey.
Turk J Phys Med Rehabil. 2021 Sep 1;67(3):357-364. doi: 10.5606/tftrd.2021.7926. eCollection 2021 Sep.
This study aims to assess the sciatic nerve (SN), common peroneal nerve (CPN), and tibial nerve (TN) by ultrasound in patients with traumatic lower limb amputation (LLA) and to examine the possible relationship between ultrasonographic and clinical findings.
This cross-sectional study included a total of 33 male patients (mean age: 36.6±8.7 years; range, 21 to 48 years) who had LLA due to traumatic injury between May 2019 and April 2020. Amputation and prosthesis use and functional K level of activity were recorded. Ultrasound examinations were performed to measure the cross-sectional areas (CSAs) of the SN, CPN, and TN bilaterally at the same levels. The values from the normal sides were accepted as controls.
The CSA values were greater on the amputated sides than the non-amputated sides for SN (p=0.001), TN (p=0.001), and CPN (p=0.015), regardless of the activity level. The amputated side SN (p=0.001), TN (p=0.001), and CPN (p=0.016) were thicker in patients with level of K4 activity than the non-amputated side. For the patients with K3 activity level, larger TN CSA values were determined on the amputated side, compared to those at the K4 level (p=0.035). The SN was found to be greater in patients using microprocessor-controlled knee prosthesis (p=0.032) and TN was larger in hypobaric sealing membrane users on the amputated sides (p=0.041).
The SN, CPN, and TN were found to be larger in all patients on the amputated sides and in patients with K4 activity level. Based on these findings, the K3 activity level and the use of hypobaric sealing membrane seems to affect the CSA values of TN. Additionally, the use of microprocessor knee prosthesis affects the CSA values of SN. We believe that these results may be essential for the analysis or prediction of lower extremity nerve involvement according to the K activity level and the use of prosthesis in patients with traumatic LLA.
本研究旨在通过超声评估创伤性下肢截肢（LLA）患者的坐骨神经（SN）、腓总神经（CPN）和胫神经（TN），并探讨超声检查结果与临床发现之间的可能关系。
这项横断面研究共纳入了33例男性患者（平均年龄：36.6±8.7岁；范围21至48岁），这些患者在2019年5月至2020年4月期间因创伤性损伤导致LLA。记录截肢、假肢使用情况以及功能K级活动水平。进行超声检查以双侧测量同一水平的SN、CPN和TN的横截面积（CSA）。将正常侧的值作为对照。
无论活动水平如何，截肢侧的SN（p = 0.001）、TN（p = 0.001）和CPN（p = 0.015）的CSA值均大于非截肢侧。K4活动水平患者的截肢侧SN（p = 0.001）、TN（p = 0.001）和CPN（p = 0.016）比非截肢侧更粗。对于K3活动水平的患者，与K4水平相比，截肢侧的TN CSA值更大（p = 0.035）。发现使用微处理器控制膝关节假肢的患者SN更大（p = 0.032），截肢侧使用低压密封膜的患者TN更大（p = 0.041）。
在所有患者的截肢侧以及K4活动水平的患者中，发现SN、CPN和TN更大。基于这些发现，K3活动水平和低压密封膜的使用似乎会影响TN的CSA值。此外，微处理器膝关节假肢的使用会影响SN的CSA值。我们认为这些结果对于根据创伤性LLA患者的K活动水平和假肢使用情况分析或预测下肢神经受累情况可能至关重要。
