ECHOGRAPHIC AND MORPHOLOGICAL CHARACTERISTICS OF STRUCTURAL CHANGES IN PERIPHERAL NERVES IN GUNSHOT TRAUMA

 

Dubrovskikh S.N.1, Chursin A.V.1, Tatarina A.V.1, Gumerova E.A.1, Stepanova Yu.A.2

 

1 - National Medical Research Center for High Medical Technologies – A.A. Vishnevsky Central Military Clinical Hospital. Krasnogorsk, Russia.

2 - Vishnevsky National Medical Research Center of Surgery. Moscow, Russia.

P

urpose. To compare the morphological and echographic characteristics of the structural organization of neuromas, to establish significant criteria that can be used as effective signs that make it possible to establish the degree of nerve fiber damage after gunshot injury of peripheral nerves without neurotomy.

Material and methods. The results of ultrasound and histological examination of 30 peripheral nerves, the anatomical integrity of which was restored at various times with the help of reconstructive operations, were analyzed. The cause of the peripheral nerves damage was a gunshot injury. The condition of all injured peripheral nerves was assessed using the ultrasound method of examination, both at the preoperative stage and during surgery. Postoperative material was delivered for histological examination in accordance with the rules of laboratory practice.  Statistical analysis was carried out using StatTech v. 4.0.5 (developed by Stattech LLC, Russia).

Results. In gunshot injuries of peripheral nerves, ultrasound allows you to identify injuries for which surgical treatment is indicated, intraoperative ultrasound is effective in detecting changes in the structure of the nerve fiber, which are not manifested macroscopically and in some cases are not subjected to proper surgical treatment, which can cause unsatisfactory results of surgical interventions performed at a high technical level.

Discussion. Significant criteria have been identified that make it possible to correlate the severity of morphological changes with echographic signs of damage to the structure of peripheral nerves. The expediency of using intraoperative ultrasound to diagnose the degree of traumatic nerve damage and its regenerative potential is shown, which is important when choosing the scope of surgical treatment.

Conclusion. The study of the echographic and microscopic structure of neuromas formed as a result of violation of the anatomical integrity of peripheral nerves in gunshot trauma gave the following results. In all cases, neuromas are formed when the integrity of the peripheral nerve sheath is violated and the integrity of the central parts is preserved, neuromas and perineural fibrosis are located on the side of the greatest impact of the blast wave and over time can cover most of the cross-sectional area of the nerve.  With the preserved fascicular structure of the nerve fiber, most of its fascicules are morphologically unchanged or have moderately pronounced dystrophic changes. Changes are not always noticeable macroscopically, which requires intraoperative ultrasound to exclude neuroma. With thickening of individual or all fascicles, the presence of signs of intratrunk fibrosis, pronounced dystrophic changes in the nerve fiber with a substitutive perineur are morphologically revealed.

 

Keywords: peripheral nerve ultrasound, morphology, neuroma, perineural fibrosis, peripheral nerve damage, gunshot injury.

 


Corresponding author: Dubrovskik S. N., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Dubrovskikh S.N., Chursin A.V., Tatarina A.V., Gumerova E.A., Stepanova Yu.A. Echographic and morphological characteristics of structural changes in peripheral nerves in gunshot trauma. REJR 2024; 14(4):141-152. DOI: 10.21569/2222-7415-2024-14-4-141-152.

Received: 19.09.24 Accepted: 22.10.24