Abstract：
Joint flexion to diminish the gap and avoid nerve grafts fell into disuse for decades, but recently attention for using this technique was regained. We report a case series of nerve suture under joint flexion, ultrasound monitoring, and physiotherapy. Our main objective was to determine how effective this multimodality treatment is.
A retrospective review of 8 patients treated with direct repair with joint flexion was done. Depending on the affected nerve, either the knee or the elbow was flexed intraoperatively to determine if direct suturing was possible. After surgery, the limb was held immobilized. Through serial ultrasounds and a physiotherapy program, the limb was fully extended. If a nerve repair rupture was observed, the patient was re-operated and grafts were used.
Of the eight nerve sutures analyzed, four sustained a nerve rupture revealed by US at an early stage, while four did not show any sign of dehiscence. In the patients in whom the nerve suture was preserved, an early and very good response was observed. Ultrasound was 100% accurate at identifying nerve suture preservation. Early detection of nerve failure permitted early re-do surgery using grafts without flexion, ultimately determining good final results.
We observed a high rate of dehiscence in our group of patients treated with direct repair and joint flexion. We believe this was due to an incorrect use of the immobilization device, excessive movement, or a broken device. In opposition to this, we observed that applying direct nerve sutures and joint flexion offers unusually good and fast results. If this technique is employed, it is mandatory to closely monitor suture status with US, together with physiotherapy providing progressive, US-guided extension of the flexed joint. If nerve rupture occurs, the close monitoring dictated by this protocol should ensure the timely application of a successful graft repair.
A retrospective review of 8 patients treated with direct repair with joint flexion was done. Depending on the affected nerve, either the knee or the elbow was flexed intraoperatively to determine if direct suturing was possible. After surgery, the limb was held immobilized. Through serial ultrasounds and a physiotherapy program, the limb was fully extended. If a nerve repair rupture was observed, the patient was re-operated and grafts were used.
Of the eight nerve sutures analyzed, four sustained a nerve rupture revealed by US at an early stage, while four did not show any sign of dehiscence. In the patients in whom the nerve suture was preserved, an early and very good response was observed. Ultrasound was 100% accurate at identifying nerve suture preservation. Early detection of nerve failure permitted early re-do surgery using grafts without flexion, ultimately determining good final results.
We observed a high rate of dehiscence in our group of patients treated with direct repair and joint flexion. We believe this was due to an incorrect use of the immobilization device, excessive movement, or a broken device. In opposition to this, we observed that applying direct nerve sutures and joint flexion offers unusually good and fast results. If this technique is employed, it is mandatory to closely monitor suture status with US, together with physiotherapy providing progressive, US-guided extension of the flexed joint. If nerve rupture occurs, the close monitoring dictated by this protocol should ensure the timely application of a successful graft repair.
摘要：
关节屈曲以缩小间隙并避免神经移植物被废弃数十年，但是最近使用这种技术的注意力重新获得了。我们报告了一系列在关节屈曲下进行神经缝合的病例，超声监测,和物理治疗。我们的主要目标是确定这种多模式治疗的有效性。
对8例采用关节屈曲直接修复治疗的患者进行回顾性分析。取决于受影响的神经，术中膝盖或肘部弯曲，以确定是否可以直接缝合。手术后,肢体被固定。通过连续的超声波和物理治疗计划，肢体完全伸展。如果观察到神经修复破裂，患者再次手术,并使用移植物.
在分析的8根神经缝线中,四个人在早期阶段被美国发现神经破裂，而四个人没有任何裂开的迹象。在保留神经缝合线的患者中，观察到早期和非常好的反应。超声在识别神经缝合保存方面100％准确。早期发现神经功能衰竭，可以使用无屈曲的移植物进行早期重新手术，最终确定好的最终结果。
我们观察到在我们组的患者中采用直接修复和关节屈曲治疗的裂开率很高。我们认为这是由于错误使用了固定装置，过度运动,或者一个坏掉的装置.与此相对,我们观察到，应用直接神经缝合和关节屈曲提供了异常好和快速的结果。如果采用这种技术，必须与美国密切监测缝合状态，与提供渐进的物理治疗一起，弯曲关节的美国引导延伸。如果发生神经断裂,本方案规定的密切监测应确保及时应用成功的移植物修复.
对8例采用关节屈曲直接修复治疗的患者进行回顾性分析。取决于受影响的神经，术中膝盖或肘部弯曲，以确定是否可以直接缝合。手术后,肢体被固定。通过连续的超声波和物理治疗计划，肢体完全伸展。如果观察到神经修复破裂，患者再次手术,并使用移植物.
在分析的8根神经缝线中,四个人在早期阶段被美国发现神经破裂，而四个人没有任何裂开的迹象。在保留神经缝合线的患者中，观察到早期和非常好的反应。超声在识别神经缝合保存方面100％准确。早期发现神经功能衰竭，可以使用无屈曲的移植物进行早期重新手术，最终确定好的最终结果。
我们观察到在我们组的患者中采用直接修复和关节屈曲治疗的裂开率很高。我们认为这是由于错误使用了固定装置，过度运动,或者一个坏掉的装置.与此相对,我们观察到，应用直接神经缝合和关节屈曲提供了异常好和快速的结果。如果采用这种技术，必须与美国密切监测缝合状态，与提供渐进的物理治疗一起，弯曲关节的美国引导延伸。如果发生神经断裂,本方案规定的密切监测应确保及时应用成功的移植物修复.
