Ultrasound as the main method for diagnosing peripheral nerve injuries in mine blast trauma

Abstract

BACKGROUND: The amount of published data related to peripheral nerve blast injuries is limited.

AIM: The study was aimed at determining the accuracy and sensitivity and assessing the specificity of ultrasound in the diagnosis of peripheral nerve injuries in mine blast trauma.

METHODS: A total of 159 patients (274 peripheral nerves) were examined. Ultrasound was performed according to the standard technique using a HI VISION Avius HITACHI scanner with an EUP-L74M linear transducer (a frequency range of 5–13 MHz) and a preset musculoskeletal system ultrasound program. The duration of nerve injuries ranged from 2 to 273 days. All patients were men aged 20 to 48 years. Peripheral nerves were damaged as a result of mine blast trauma. Statistical analysis was used to assess sensitivity, specificity, and diagnostic accuracy. These characteristics were calculated according to the qualitative assessment of surgical intervention, the results of conservative treatment, and the method under study (ultrasound).

RESULTS: A total of 274 damaged peripheral nerves were examined. The Group 1 included 93 (34%) nerves that required surgical intervention. In Group 2, consisting of 181 (66%) nerves, conservative treatment was used. Most of the nerves (47 [51%]) in Group 1 were damaged due to the compression effects of scarring in the surrounding tissues. Seventeen (18%) partial violations of the anatomical integrity of nerves with the formation of intramural and marginal neuromas were detected. Multiple and single nerve injuries were observed in 95 (59.7%) and 64 people (40.3%), respectively. Peripheral nerves of the upper extremities were damaged more frequently (185 [67.5%]), whereas nerves of the lower extremities were damaged in 89 (32.5%) cases. Ultrasound showed an increase in the cross-sectional area of nerves, blurred contours, decreased echogenicity, and changes in the bundle structure up to the complete absence of differentiation of individual fascioculi. The formation of neuromas was observed in complete and partial nerve ruptures. All 93 nerves in Group 1 underwent surgical intervention, particularly, external neurolysis (32 [34%]), internal neurolysis (15 [16%]), nerve suture (15 [16%]), excision of neuroma followed by microsurgical epineural suture (18 [19%]), and autoneural plasty (11 [12%]). In 2 (3%) cases, a decision was made to abstain from plasty and perform a tendon transposition due to a pronounced diastasis. All patients of Group 2 were shown to have a wait-and-see approach, and conservative therapy was prescribed. In 179 (99%) cases, complete recovery of sensory and motor activity was observed within 21 days. In 2 (1%) patients, a repeated ultrasound was performed due to no effect of treatment. Compression by scar tissues was revealed, and surgical intervention was made.

CONCLUSIONS: In mine-explosive impact, ultrasound is the leading method for diagnosing peripheral nerve injuries. Ultrasound with sensitivity of 97.8% and specificity of 98.8% reveals lesions for which surgical treatment is indicated. The diagnostic accuracy is 98.5%.

Keywords

ultrasound of peripheral nerves / mine-explosive impact / mine blast trauma

References

[1] Leonov SA, Ogryzko EV, Andreeva TM. Dynamics of Traffic Injuries in Russian Federation. N.N. Priorov Journal of Traumatology and Orthopedics. 2009(3):86–91. (In Russ).

[2] Леонов С.А., Огрызко Е.В., Андреева Т.М. Динамика основных показателей автодорожного травматизма в Российской Федерации // Вестник травматологии и ортопедии имени Н.Н. Приорова. 2009. № 3. С. 86–91.

[3] Makarova SI. Lechenie perelomov proksimal’nogo otdela plechevoi kosti [abstract of dissertation]. Nizhniy Novgorod; 2007. 19 p. (In Russ).

[4] Макарова С.И. Лечение переломов проксимального отдела плечевой кости : автореф. дис. ... канд. мед. наук. Нижний Новгород, 2007. 19 с.

[5] Mironovich NI. Obshchie statisticheskie dannye ob ognestrel’nykh raneniyakh perifericheskikh nervov. In: Opyt sovetskoi meditsiny v Velikoi Otechestvennoi voine 1941–1945 gg. Мoscow: Medgiz; 1952. Vol. 20. P. 31–49. (In Russ).

[6] Миронович Н.И. Общие статистические данные об огнестрельных ранениях периферических нервов // Опыт советской медицины в Великой Отечественной войне 1941–1945 гг. Москва : Медгиз, 1952. Т. 20. С. 31–49.

[7] Eser F. Etiological factors of traumatic peripheral nerve injuries. Neurology India. 2009;57(4):434–437. doi: 10.4103/0028-3886.55614

[8] Eser F. Etiological factors of traumatic peripheral nerve injuries // Neurology India. 2009. Vol. 57, N 4. P. 434–437. doi: 10.4103/0028-3886.55614

[9] Tang P, Wang Y, Zhang L, et al. Sonographic evaluation of peripheral nerve injuries following theWenchuan earthquake. J Clin Ultrasound. 2012;40(1):7–13.

[10] Tang P., Wang Y., Zhang L., et al. Sonographic evaluation of peripheral nerve injuries following theWenchuan earthquake // J Clin Ultrasound. 2012. Vol. 40, N 1. P. 7–13.

[11] Bersnev VP. Osnovnye itogi nauchnoi deyatel’nosti pri vypolnenii otraslevoi nauchno-issledovatel’skoi programmy po neirokhirurgii v 2001–2005 godu. In: Polenovskie chteniya. Saint Petersburg; 2006. P. 8–13. (In Russ).

[12] Берснев В.П. Основные итоги научной деятельности при выполнении отраслевой научно-исследовательской программы по нейрохирургии в 2001–2005 году // Поленовские чтения. Санкт-Петербург, 2006. С. 8–13.

[13] Skoromets A.A., Skoromets T.A. Topicheskaya diagnostika zabolevanii nervnoi sistemy: Rukovodstvo dlya vrachei. Saint Petersburg: Politekhnika; 2000. 400 p. (In Russ).

[14] Скоромец А.А., Скоромец Т.А. Топическая диагностика заболеваний нервной системы: Руководство для врачей. Санкт-Петербург: Политехника, 2000. 400 с.

[15] Sholomov II, Kireev SI, Levchenko KK, et al. Sostoyanie nervno-myshechnogo apparata u bol’nykh s povrezhdeniyami klyuchitsy, kostei plechevogo poyasa i proksimal’nogo otdela plecha. Prakticheskaya nevrologiya i neiroreabilitatsiya. 2008;(3):16–18. (In Russ).

[16] Шоломов И.И., Киреев С.И., Левченко К.К., и др. Состояние нервно-мышечного аппарата у больных с повреждениями ключицы, костей плечевого пояса и проксимального отдела плеча // Практическая неврология и нейрореабилитация. 2008. № 3. С. 16–18.

[17] Gorshkov RP. Reabilitatsiya bol’nykh s povrezhdeniem stvolov plechevogo spleteniya (kliniko-eksperimental’noe issledovanie) [abstract of dissertation]. Saratov; 2009. 45 p. (In Russ).

[18] Горшков Р.П. Реабилитация больных с повреждением стволов плечевого сплетения (клинико-экспериментальное исследование) : автореф. дис. ... д-ра. мед. наук. Саратов, 2009. 45 с.

[19] Panov DE. Diagnostika i taktika lecheniya bol’nykh s povrezhdeniyami sredinnogo i loktevogo nervov [abstract of dissertation]. Мoscow; 2006. 146 p. (In Russ).

[20] Панов Д.Е. Диагностика и тактика лечения больных с повреждениями срединного и локтевого нервов : дис. ... канд. мед. наук. М., 2006. 146 с.

[21] Aitemirov ShM, Ninel VG, Korshunova GA, Shchanitsyn IN. High-resolution ultrasonography in the diagnosis and management of peripheral nerve lesions (review). Travmatologiya i ortopediya Rossii. 2015;(3):116–125. (In Russ).

[22] Айтемиров Ш.М., Нинель В.Г., Коршунова Г.А., Щаницын И.Н. Высокоразрешающая ультрасонография в диагностике и хирургии периферических нервов конечностей (обзор литературы) // Травматология и ортопедия России. 2015. № 3. С. 116–125.

[23] Chin B, Ramji M, Farrokhyar F. Efficient Imaging: Examining the Value of Ultrasound in the Diagnosis of Traumatic Adult Brachial Plexus Injuries. Neurosurgery. 2017;11:217–224. doi: 10.1093/neuros/nyx483

[24] Chin B., Ramji M., Farrokhyar F. Efficient Imaging: Examining the Value of Ultrasound in the Diagnosis of Traumatic Adult Brachial Plexus Injuries // Neurosurgery. 2017. Vol. 11. P. 217–224. doi: 10.1093/neuros/nyx483

[25] Saltykova V.G. Ul’trazvukovaya diagnostika sostoyaniya perifericheskikh nervov (norma, povrezhdeniya, zabolevaniya) [abstract of dissertation]. Moscow; 2011. 397 p. (In Russ).

[26] Салтыкова В.Г. Ультразвуковая диагностика состояния периферических нервов (норма, повреждения, заболевания): дис. ... д-ра мед. наук. Москва, 2011. 397 с.

[27] Komantsev V.N. Metodicheskie osnovy klinicheskoi ENMG: rukovodstvo dlya vrachei. Saint Petersburg; 2006. 362 p. (In Russ).

[28] Команцев В.Н. Методические основы клинической ЭНМГ: руководство для врачей. Санкт-Петербург, 2006. 362 с.

[29] Domomkundwar S, Autkar G, Khadilkar S, et al. Ultrasound and EMG–NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologies. J Ultrasound. 2017;20(2):111–122. doi: 10.1007/s40477-016-0232-3

[30] Domomkundwar S., Autkar G., Khadilkar S., et al. Ultrasound and EMG–NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologies // J Ultrasound. 2017. Vol. 20, № 2. P. 111–122. doi: 10.1007/s40477-016-0232-3

[31] Trescot AM. Peripheral Nerve Entrapments. Switzerland: Springer; 2016. 902 p. doi: 10.1007/978-3-319-27482-9

[32] Trescot A.M. Peripheral Nerve Entrapments. Switzerland: Springer, 2016. 902 p. doi: 10.1007/978-3-319-27482-9

[33] Aitemirov ShM, Ninel VG, Korshunova GA. Intraoperative neurovisualization in the surgical treatment of peripheral nerve injuries. Saratov Journal of Medical Scientific Research. 2015;11(2):178–182. (In Russ).

[34] Айтемиров Ш.М., Нинель В.Г., Коршунова Г.А. Интраоперационная нейровизуализация в хирургическом лечении пациентов с повреждениями периферических нервов конечностей // Саратовский научно-медицинский журнал. 2015. Т. 11, № 2. С. 178–183.

[35] Pedro M, Antoniadis G, Scheuerle A, et al. Intraoperative high-resolution ultrasound and contrast-enhanced ultrasound of peripheral nerve tumors and tumorlike lesions. Neurosurg Focus. 2015;39(3):1237–1243. doi: 10.3171/2015.6.FOCUS15218

[36] Pedro M., Antoniadis G., Scheuerle A., et al. Intraoperative high-resolution ultrasound and contrast-enhanced ultrasound of peripheral nerve tumors and tumorlike lesions // Neurosurg Focus. 2015. Vol. 39, № 3. P. 1237–1243. doi: 10.3171/2015.6.FOCUS15218

[37] Badalyan LO, Skvortsov IA. Klinicheskaya ENMG. Moscow: Meditsina; 1986. 368 p. (In Russ).

[38] Бадалян Л.О., Скворцов И.А. Клиническая ЭНМГ. М. : Медицина, 1986. 368 с.

[39] Gekht B.M., Kasatkina L.F., Samoilov M.I. Elektromiografiya v diagnostike nervno-myshechnykh zabolevanii. Taganrog; 1997. 369 p. (In Russ).

[40] Гехт Б.М., Касаткина Л.Ф., Самойлов М.И. Электромиография в диагностике нервно-мышечных заболеваний. Таганрог, 1997. 369 с.

[41] Dreval’ ON, Kuznetsov AV, Dzhindzhikhadze RS, Puchkov VL, Bersnev VP; Russian Association of Neurosurgeons. Klinicheskie rekomendatsii po diagnostike i khirurgicheskomu lecheniyu povrezhdenii i zabolevanii perifericheskoi nervnoi sistemy. Мoscow; 2015. 34 p. (In Russ).

[42] Древаль О.Н., Кузнецов А.В., Джинджихадзе Р.С., Пучков В.Л., Берснев В.П.; Ассоциация нейрохирургов России. Клинические рекомендации по диагностике и хирургическому лечению повреждений и заболеваний периферической нервной системы. Москва, 2015. 34 с.

[43] Maletskii E.Yu. Vozmozhnosti ul’trazvukovogo issledovaniya pri diagnostike tunnel’nykh nevropatii verkhnei konechnosti [dissertation]. Saint Petersburg; 2017. 168 p. (In Russ).

[44] Малецкий Э.Ю. Возможности ультразвукового исследования при диагностике туннельных невропатий верхней конечности : дис. ... канд. мед. наук. Санкт-Петербург, 2017. 168 с.

[45] Mironov SP, Matveeva NYu, Es’kin NA, et al. Ul’trazvukovoe issledovanie plechevogo spleteniya (pervyi v Rossii opyt 335 vizualizatsii). N.N. Priorov Journal of Traumatology and Orthopedics. 2008;(4):23–28. (In Russ).

[46] Миронов С.П., Матвеева Н.Ю., Еськин Н.А., и др. Ультразвуковое исследование плечевого сплетения (первый в России опыт 335 визуализаций) // Вестник травматологии и ортопедии им.Н.Н. Приорова. 2008. № 4. С. 23–28.

[47] Naumova ES, Nikitin SS, Druzhinin DS. Quantitative sonographic parameters of the peripheral nerves in healthy individuals. Annals of Clinical and Experimental Neurology. 2017;11(1):55–61. (In Russ).

[48] Наумова Е.С., Никитин С.С., Дружинин Д.С. Количественные сонографические характеристики периферических нервов у здоровых людей // Анналы клинической и экспериментальной неврологии. 2017. Т. 11, № 1. С. 55–61.

[49] Saltykova VG, Golubev IO, Merkulov MV, et al. Rol’ ul’trazvukovogo issledovaniya pri planirovanii ob»ema plastiki perifericheskikh nervov. Ultrasound and Functional Diagnostics. 2012;(4):62–68. (In Russ).

[50] Салтыкова В.Г., Голубев И.О., Меркулов М.В., и др. Роль ультразвукового исследования при планировании объёма пластики периферических нервов // Ультразвуковая и функциональная диагностика. 2012. № 4. С. 62–68.

[51] Aggarwal A, Srivastava D, Jana M, et al. Comparison of Different Sequences of Magnetic Resonance Imaging and Ultrasonography with Nerve Conduction Studies in Peripheral Neuropathies. World Neurosurg. 2017;108:185–200. doi: 10.1016/j.wneu.2017.08.054

[52] Aggarwal A., Srivastava D., Jana M., et al. Comparison of Different Sequences of Magnetic Resonance Imaging and Ultrasonography with Nerve Conduction Studies in Peripheral Neuropathies // World Neurosurg. 2017. Vol. 108. P. 185–200. doi: 10.1016/j.wneu.2017.08.054

[53] Peer S, Bodner G. High Resolution Sonography of the Peripheral Nervous System. Berlin; Heidelberg: Springer Verlag; 2008. 207 p.

[54] Peer S., Bodner G. High Resolution Sonography of the Peripheral Nervous System. Berlin ; Heidelberg : Springer Verlag, 2008. 207 p.

[55] Wijntjes J., Borchert A., van Alfen N. Nerve Ultrasound in Traumatic and Iatrogenic Peripheral Nerve Injury // Diagnostics. 2021. Vol. 11. P. 30. doi: 10.3390/diagnostics11010030

RIGHTS & PERMISSIONS

Eco-Vector