Abstract
Background (rationale) Steindler flexorplasty (SF) is aimed at restoring independent elbow flexion in the late stages of dysfunction of the primary elbow flexors. Selection criteria for ...successful SF have been defined.
Objectives The purpose of this study was to redefine the inclusion criteria for successful SF based on functional outcomes.
Methods Eight patients received SF after an average of 50.8 months after injury or dysfunction. Three patients (37.5%) met all five Al-Qattan inclusion criteria (AQIC), and another five patients (62.5%) met four or less AQIC. Patients were followed up for at least 9 months, and the maximum range of active elbow flexion (REF) was measured. Functional results of SF were assessed using the Al-Qattan scale (in accordance with Al-Qattan's scale).
Results The mean maximum REF was 100 degrees (70 to 140 degrees). Five patients reached REF greater than 100 degrees. One patient had a poor outcome, two patients (25%) had a fair outcome, three patients (37.5%) had a good outcome, and two patients (25%) had an excellent outcome of SF on the Al-Qattan scale. The impact of each AQIC on functional outcome has been critically reviewed from a biomechanical point of view.
Conclusions The sufficient number of inclusion criteria required for successful SF can be reduced from five (according to AQIC) to two; Normal or near-normal function (M4 or greater on the MRC scale) of the muscles of the flexor-pronator mass should be considered an obligatory inclusion criterion, while primary wrist extensors may be considered an optional inclusion criterion.
The aim: Improving the effectiveness of patients' treatment with combat injuries of the peripheral nervous system, which consists in the application and development of new methods of reconstructive ...interventions, optimizing a set of therapeutic and diagnostic measures for the most effective management of this category of patients with peripheral nerve injury.
Materials and methods: The research is based on the results of surgical treatment of 138 patients with combat injuries of peripheral nerves for the period from 2014 to 2020. The mean age was 33.5 ± 2.1 years. Patients were treated for 1 to 11 months after injury (median - 8 months). Damage to the sciatic nerve was observed in 26.1%, ulnar - in 20.3%, median - in 18.8%, radial - in 15.9%, tibial - in 10.9%, common peroneal nerve - in 8% of cases.
Results: It was shown that in all patients was significantly improved the recovery of all nerves. In the period from 9 to 12 months, the degree of recovery of motor function to M0-M2 was observed in 40.6%, to M3 - in 35.5%, to M4 - in 16.7%, to M5 - in 7,2%. The degree of recovery of sensitivity to S0-S2 was observed in 36.2%, to S3 - in 42.8%, to S4 - in 17.4%, to S5 - in 3.6%. Regression of pain syndrome after surgery was observed in 81.2% of patients.
Conclusions: The results of surgical treatment of peripheral nerves gunshot injury are generally worse than other types of nerve injuries. The best results of surgical treatment of combat trauma of peripheral nerves are obtained in patients with sciatic nerve damage.
Modern weapons cause severe damage, accompanied by high rates of complications and mortality. The investigation of such kinds of weapons is in high demand considering the ongoing active phase of ...russia's war against Ukraine since February 2022. In order to understand the pathological processes that occur in and outside the gunshot wound, we conducted an experimental study using mathematical simulation. The results presented in the article will help to choose the appropriate surgical management and improve the results of treatment. The aim of this study was to investigate and evaluate the damaging effect of a 5.45 mm 7N6M bullet and a 5.45 mm V-max expansive bullet using numerical modeling of wound canals in ballistic plasticine. The Ansys Explicit Dynamics engineering complex was used to simulate the dynamics of the bullet’s motion. The basic equations, solved by the explicit dynamic analysis, express the conservation of mass, momentum, and energy in Lagrange coordinates. Together with the material model and the set of initial and boundary conditions, they determine the complete solution to the problem. Taking into account that the initial velocity of the bullet is 1185 m/s at a mass of 3.9 g, we obtain energy 2740 J. All this energy acts at the area of the wound canal with a depth of 150 mm. Injury with a conventional 7N6M bullet is characterized by the fact that it passes through the block and loses only part of the kinetic energy. The simulation results showed that the velocity of the bullet at the outlet is 220 m/s. Taking into account the initial velocity of the bullet 918 m/s with a mass of 3.4 g, we obtain the kinetic energy acting on the walls of the wound canal with a depth of 200 mm of about 830 J. Mathematic analyses showed that the expansive bullet has a soft core that deforms and transfers all the kinetic energy to the tissues immediately after penetration into the tissues. The loss of kinetic energy of the bullet (ΔE, J) is defined as the difference between the kinetic energy at the time of injury (Ec, J) and the residual energy of the bullet when leaving the material (Er, J). Numerical modeling of wound ballistics in biological tissue simulators allows us to determine with high accuracy the features of wound canal formation and tissue response to damage of bullets having different kinetic energy, which contributes to the choice of adequate surgical management during surgery for gunshot wounds.
The dynamics and likely associative link between global warming and the prevalence of preterm births in Ukraine over the years 2009-2018 was studied. to form modern ideas about the prognosis and ...prevention of this pathology. Data on medical care for pregnant women, mothers and parturients and adverse effects of pregnancy on preterm birth (form 21) for the period 2009-2018 were obtained from the municipal non-profit enterprise "Ternopil Regional Center of Public Health of Ternopil Regional Council". The correlation between the number of premature births per 100 births according to the average annual air temperature according to the Global Historical Climatology Network from the US Department of Ocean and Atmospheric Research in the climatically homogeneous regions of Ukraine was estimated. Predictive analysis of time series was performed by the method of integrated auto-regression of the moving average (ARIMA). The model error was estimated by calculating the absolute percentage error of the mean (MAPE). Statistical processing of materials was performed using programs Statistica 6.0 (StatSoft, USA) and open statistical package "R". The study meets modern requirements of moral and ethical standards regarding the provisions of legislative acts of Ukraine. Analysis of these reports of women's counseling shows an increase in the average number of preterm births from 2.88 per 100 births in the total number of births in Ukraine – 491445 in 2009 to 3.33, per 100 births in the total number of 309191 in 2018, which testifies to a significant increase in premature births in our country. Since 2009, there has been an annual, varying degree of increase in average annual air temperature in Ukraine. As a result of the correlation analysis, a significant strong direct correlation was established between the average level of premature birth and the average annual air temperature in Ukraine (r=0.84, p<0.05). Regression analysis revealed a significant increase in the number of premature births (per 100 births) in 1, 2, 5, 6, 7, 8 and 10 climatically homogeneous regions and a tendency to increase in, respectively, 3, 4, 9, 11 and 12 climatically homogeneous regions of Ukraine. Based on the analysis of data on the average annual air temperature in Ukraine for 2009-2018, the average annual air temperature in Ukraine is projected to increase by 0.3 ° С in 3 years (MAPE <10%, p<0.05). The annual number of premature births is expected to increase (cases per 100 births) in 3 years by 0.4 cases per 100 births (MAPE <10%, p <0.05). In the context of global warming, the number of negative consequences of pregnancy is increasing, namely idiopathic premature termination of pregnancy with the birth of premature infants. Strong correlations have been established between the annual number of premature births and the average annual air temperature in Ukraine. Regression models of preterm birth showed a significant increase in 1, 2, 5, 6, 7, 8, and 10 climatically homogeneous regions and a tendency to increase in 3, 4, 9, 11 and 12 climatically homogeneous regions. The annual number of premature births in Ukraine is projected to increase by 2023 by 20 cases per 100 births compared to 2018. The strategy for preventing premature births and related adverse effects of pregnancy should include the identification of global warming as a risk factor for increasing level of this pathology.
Mechanical damage to the peripheral nerves, especially their transection, is a serious disabling injury, treatment of which and rehabilitation related to the consequences of such traumas are an ...urgent and important medical/social problem. In experiments on animals, we evaluated the effectiveness and safety of multiple-point epineural connection of segments of the transected sciatic nerve using an electric welding technology. Left-side transection of the above nerve at a middle third of the thigh was performed in adult albino mongrel male rats. The experimental groups were the following: intact animals (I,
n
= 5), those subjected to sham surgery (Sh,
n
= 6), rats with neurotomy and no additional interventions (NT,
n
= 21), neurotomy + epineural neurorrhaphy (NT+NR,
n
= 18), and neurotomy + electric welding of the nerve segments (NT+EW,
n
= 21). It was found that the EW connection provided fast and reliable fixation of the nerve segments with subsequent significant recovery of transmission via the injured nerve and progressing partial normalization of morphological characteristics of the fibers within a regenerative neuroma at the site of nerve transection; indices characterizing the density of nerve fibers and mean angle of their deviation from the longitudinal nerve axis were the best in the NT+EW group. Most intense positive changes in the sciatic functional index (SFI), an integrative index characterizing the level of functional disorders of locomotion-related movements performed by the hindlimb at the NT side, were observed in the NT+NR and NT+EW groups. Our data clearly showed that the efficiency of the welding connection of an injured nerve is at least not lower than that provided by neurorrhaphy; the dynamics of recovery after both operations are quite comparable. The EW connection is much simpler and does not require an exclusively high qualification of the surgeon; in the case of operations on nerves in humans, the respective surgery will require less time and will be less expensive.
Mechanical damage to the peripheral nerve is a fairly common type of injury, which is characterized by a complex of long-term neurological disorders and require significant financial costs. The aim ...of this work is to evaluate the efficiency of sciatic nerve (SN) regeneration after neuroraphy using epineural suture (ES), polyethylene glycol hydrogel (PEG), and fibrin glue (FG). The studies were carried out on 30 white outbred male rats, which were divided into six experimental groups: Group №1: intact rats; Group №2: Sham operated; Group №3: complete transection of the SN; Group №4: nerve repair with ES; Group №5: nerve repair with PEG; Group №6: nerve repair with FG. Functional recovery was assessed at 1, 2, 3, 4 postoperative weeks using a walking-track analysis with subsequent determination of the sciatic nerve functional index (SFI). At 4 weeks, electroneuromyography, histological and morphometric analyzes were performed. The combined analysis indicated that PEG significantly improved functional recovery, both in the SFI index and in the skeletal muscle M-response. Compared to ES and PEG, the use of FG was reflected in a lower significance of the indicators compared to PEG. Statistical analysis indicates a positive effect of PEG and FG on nerve regeneration, although significantly greater remyelination (analysis based on fiber diameter) was confirmed only in the PEG group, which explains the faster functional recovery of the limb. PEG in the form of a hydrogel is a more promising agent in microsurgical restoration of damaged nerves as an adhesive, it promotes rapid nerve regeneration, denervated muscle re-innervation and functional limb recovery.
Purpose
The purpose of this study is to justify a new concept of the pathogenesis of secondary changes in the cervical spinal cord, and its correlation with the depth of development of neurological ...disorders in spinal injury.
Methods
Standard magnetic resonance imaging examination and angiography of the cervical and vertebral arteries of four patients were performed to diagnose the prevalence rate of ischemia and edema, and examine the spinal cord vasculature. Correlation of the data obtained with the neurological status was performed.
Results
Collateral circulation is most apparent in the upper-cervical region, above the C4 vertebra. Following occlusion of the vertebral artery, the circulation above the C4 vertebra is performed by collaterals of the ascending cervical artery. With extensive damage to the spinal cord, the intensity of edema and ischemia can be regarded as the effect of damage to radicular medullary arteries, which are injured in the intervertebral foramen. Secondary changes of the spinal cord are most apparent by impaired circulation in the artery of cervical enlargement.
Conclusions
Collateral circulation is a significant factor that limits the damage to the cervical spinal cord. Impaired circulation in the artery of cervical enlargement is significant in extension of perifocal ischemia. The appearance of early arteriovenous shunting in the region of a primary spinal cord injury (contusion focus) by angiography is pathognomonic. The data obtained open a perspective for the endovascular treatment of spinal cord injury.
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