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

Cover Page


Cite item

Full Text

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%.

Full Text

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%.

×

About the authors

Svetlana N. Dubrovskikh

A.A. Vishnevsky Central Military Clinical Hospital

Author for correspondence.
Email: dwetlana1975@icloud.com
ORCID iD: 0009-0000-9498-006X
Russian Federation, Krasnogorsk

Alena V. Tatarina

A.A. Vishnevsky Central Military Clinical Hospital

Email: Tatarina.74@mail.ru
ORCID iD: 0009-0003-4452-6012
Russian Federation, Krasnogorsk

Elmira A. Gumerova

A.A. Vishnevsky Central Military Clinical Hospital

Email: Elmiragumerova1992@yandex.ru
ORCID iD: 0009-0003-1277-2614
Russian Federation, Krasnogorsk

Anna D. Koryagina

A.A. Vishnevsky Central Military Clinical Hospital

Email: anik1999@mail.ru
ORCID iD: 0009-0005-3628-971X
Russian Federation, Krasnogorsk

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. Makarova SI. Lechenie perelomov proksimal’nogo otdela plechevoi kosti [abstract of dissertation]. Nizhniy Novgorod; 2007. 19 p. (In Russ).
  3. 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).
  4. Eser F. Etiological factors of traumatic peripheral nerve injuries. Neurology India. 2009;57(4):434–437. doi: 10.4103/0028-3886.55614
  5. 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.
  6. 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).
  7. Skoromets A.A., Skoromets T.A. Topicheskaya diagnostika zabolevanii nervnoi sistemy: Rukovodstvo dlya vrachei. Saint Petersburg: Politekhnika; 2000. 400 p. (In Russ).
  8. 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).
  9. Gorshkov RP. Reabilitatsiya bol’nykh s povrezhdeniem stvolov plechevogo spleteniya (kliniko-eksperimental’noe issledovanie) [abstract of dissertation]. Saratov; 2009. 45 p. (In Russ).
  10. Panov DE. Diagnostika i taktika lecheniya bol’nykh s povrezhdeniyami sredinnogo i loktevogo nervov [abstract of dissertation]. Мoscow; 2006. 146 p. (In Russ).
  11. 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).
  12. 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
  13. Saltykova V.G. Ul’trazvukovaya diagnostika sostoyaniya perifericheskikh nervov (norma, povrezhdeniya, zabolevaniya) [abstract of dissertation]. Moscow; 2011. 397 p. (In Russ).
  14. Komantsev V.N. Metodicheskie osnovy klinicheskoi ENMG: rukovodstvo dlya vrachei. Saint Petersburg; 2006. 362 p. (In Russ).
  15. 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
  16. Trescot AM. Peripheral Nerve Entrapments. Switzerland: Springer; 2016. 902 p. doi: 10.1007/978-3-319-27482-9
  17. 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).
  18. 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
  19. Badalyan LO, Skvortsov IA. Klinicheskaya ENMG. Moscow: Meditsina; 1986. 368 p. (In Russ).
  20. Gekht B.M., Kasatkina L.F., Samoilov M.I. Elektromiografiya v diagnostike nervno-myshechnykh zabolevanii. Taganrog; 1997. 369 p. (In Russ).
  21. 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).
  22. Maletskii E.Yu. Vozmozhnosti ul’trazvukovogo issledovaniya pri diagnostike tunnel’nykh nevropatii verkhnei konechnosti [dissertation]. Saint Petersburg; 2017. 168 p. (In Russ).
  23. 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).
  24. 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).
  25. 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).
  26. 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
  27. Peer S, Bodner G. High Resolution Sonography of the Peripheral Nervous System. Berlin; Heidelberg: Springer Verlag; 2008. 207 p.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2023 Eco-Vector

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 79539 от 09 ноября 2020 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies