Presurgical ultrasound-assisted neuroexamination in the surgical repair of peripheral nerve injury
Presurgical ultrasound-assisted neuroexamination in the surgical repair of peripheral nerve injury
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DOI：
10.1055/s-2004-818486
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发表时间：
2004-06-01
影响因子：
--
通讯作者：
Senel, A
中科院分区：
文献类型：
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作者：
Cokluk, C;Aydin, K;Senel, A
尽管进行了电诊断检查，但损伤部位沿受累周围神经的准确定位可能仍不明确或不确定。在开始手术之前，外科医生应该了解损伤的类型，近端和远端神经残端的位置，以及神经瘤和过量的周边疤痕组织的存在或不存在，以便进行手术干预的定位和计划。我们推测，实时超声有助于确定损伤的类型、近端和远端神经残端的位置，以及诊断神经瘤。对14例经神经学检查和电诊断试验证实的外伤性周围神经损伤患者进行手术修复，并在手术前和手术中进行超声检查。超声显示损伤部位、损伤类型、神经残端位置及诊断神经瘤均可靠。轴索肿胀4例(29%)，残端神经瘤3例(21%)，完全神经中断9例(%)，周围瘢痕组织5例(35%)。术前和术中超声辅助神经检查是确定损伤部位、损伤类型、残端位置和诊断神经瘤的一种有用的诊断方法。术前和术中超声的使用可以增强外科医生对手术领域的定向。我们的方法在我们的患者中的应用表明，术前超声神经检查可以用于周围神经损伤的外科修复。
In spite of electrodiagnostic examinations, the determination of the precise localization of the injured site along the involved peripheral nerve may remain obscure or uncertain. Before starting the operation, a surgeon should have knowledge about the type of injury, the position of the proximal and distal nerve stumps, and the presence or absence of a neuroma and excessive perilesional scar tissue formation for orientation and planning of the surgical intervention. We hypothesized that real-time ultrasound could be helpful in the determination of the type of injury, the localisation of proximal and distal nerve stumps, as well as for diagnosing a neuroma. Fourteen patients with traumatic peripheral nerve injuries that were verified by neurological examinations and electrodiagnostic tests underwent surgical repair, and were examined by ultrasound before and during the surgical intervention. Visualisation of the injured site, the type of the injury, the position of the nerve stumps and the diagnosis of the neuroma were reliably feasible in all the patients by using ultra sonography. Axonal swelling of a nerve was diagnosed in 4 (29%) patients, a stump neuroma was diagnosed in 3 (21%) patients, a total nerve interruption (neurotmesis in the Seddon classification) was diagnosed in 9 (64%) patients, and surrounding scar tissue was diagnosed in 5 (35%) patients. Presurgical and intraoperative ultrasound-assisted neuroexamination is a useful diagnostic method in the determination of the precise localisation of the injured site, the type of injury, the position of stumps, and the diagnosis of a neuroma. The use of preoperative and intraoperative ultrasound can enhance the orientation of the surgeon to the surgical field. The application of our method to our patients shows that presurgical ultra sonographic neuroexamination can be used in the surgical repair of peripheral nerve injury.