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An experimental study on the repair of peripheral nerve lesions subacute compression neuropathy and neurolysis


, : An experimental study on the repair of peripheral nerve lesions subacute compression neuropathy and neurolysis. Journal of the Japanese Orthopaedic Association 57(12): 1821-1834

Neurolysis is a widely accepted treatment for entrapment neuropathy and other nerve injuries in continuity. The effects of neurolysis on the recovery from subacute compression neuropathy are studied. The sciatic nerves of 49 mongrel dogs were used. The apparatus designed by Horiuchi to compress the nerve with constant force was applied to each nerve for 3 wk. The pressure of compression was 55 mmHg when the thickness of the nerve was 2 mm. According to the degree of injury of the motor nerve in the peroneal funiculus of the sciatic nerve, 18 nerves were classified as 1st-degree injury (Sunderland) and 31 as 2nd-degree injury. After removing the compressing apparatus, either external neurolysis (EN) or internal neurolysis (IN) was performed on these neuropathies under magnification. After the operation, each nerve was electrophysiologically followed up to 24 wk; at 1-wk interval in the early stage and at 4-wk interval in the late stage. Macroscopic and histological observations were made on the 5th, 8th and 24th wk. In the 1st-degree injuries, conduction block at the compressed site had already disappeared at the 1st wk and motor nerve conduction velocity (MNCV) recovered rapidly with no apparent difference among the removal group (removal of apparatus only) and the neurolysis groups. In the 2nd-degree injuries, evoked muscle action potential in the anterior tibial muscle appeared at the 8th wk, .apprx. 1 wk earlier in the IN group than in the removal group. MNCV of the removal group recovered gradually without exception, but that of the neurolysis groups inconstantly in the early stage. In the late stage, MNCV of all groups reached .apprx. 60 m/s gradually and exponentially and never exceeded the average value (75.3 m/s) of normal MNCV. The swelling of the portion adjacent to the compressed site (pseudoneuroma), which was observed until the 8th wk, disappeared at the 24th wk. A scar around the nerve existed even at 24-wk post-operatively, but it became loose and appeared like a mesoneurium and its vessels communicated with epineurial nerve vessels. Reactions of the epineurium, such as cellular infiltration and fibrosis, were most remarkable in the IN group at the 5th wk, but except for fibrosis, they subsided at the 24th wk. No clear difference in the nerve regeneration was observed among the removal group and the neurolysis groups with regard to the caliber of myelinated fibers. In 2nd-degree injury (Sunderland) of the nerve produced by subacute compression, internal neurolysis has a tendency to promote the nerve fibers to regenerate earlier electrophysiologically. After the compressing factor is removed, the swelling adjacent to the compressed site and the flattening of the compressed site disappeared gradually and the scar around and along the operated nerve became loose like a mesoneurium. The procedure of internal neurolysis induced fibrosis in the epineurium but produced no clear disturbance of the nerve regeneration. Neurolysis might be a useful operative procedure for the repair of nerve injuries in continuity.

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