RESUMEN
Nerve regeneration and functional recovery are often incomplete after peripheral neurotmetic lesion. Atorvastatin has been shown to be neuroprotective after transient ischaemia or traumatic injury. The aim of this study was to establish if systemic administration of Atorvastatin could improve functional muscle reinnervation after complete sciatic nerve section. Sixteen female Sprague-Dawley rats were used in this study. After a complete right sciatic nerve section, end-to-end microsuture repair was performed and fibrin glue was added. Three groups were studied: (1) sutures (S) + fibrin glue (F) only + saline administration for 14 days; (2) S+F+Atorvastatin administration for 14 days; and (3) uninjured nerve. Five months later, the sciatic nerve and the gastrocnemius muscle were isolated to perform in vivo electrophysiological measurements. Better kinematics was observed in atorvastatin-treated rats 5 months after its administration. Indeed, a larger excursion of the hip-ankle-toe angle during walking was observed. This effect was associated with the preservation of electromyographic activity (2.91 mV vs 0.77 mV) and maximal muscle force (85.1 g vs 28.6 g) on stimulation of the proximal nerve section. Five months after a neurotmetic lesion, the recovery is incomplete when using suture and fibrin glue only. Furthermore, the systemic administration of Atorvastatin for 14 days after lesion was beneficial in improving locomotion capability associated with the re-establishment of muscle strength and EMG activity.
Asunto(s)
Ácidos Heptanoicos/farmacología , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacología , Músculo Esquelético/inervación , Regeneración Nerviosa/efectos de los fármacos , Pirroles/farmacología , Nervio Ciático/fisiología , Nervio Ciático/cirugía , Animales , Atorvastatina , Axones/patología , Fenómenos Biomecánicos , Electromiografía , Femenino , Adhesivo de Tejido de Fibrina , Locomoción , Microcirugia , Modelos Animales , Fuerza Muscular , Músculo Esquelético/patología , Vaina de Mielina/patología , Ratas , Ratas Sprague-Dawley , Recuperación de la Función , Suturas , Adhesivos TisularesRESUMEN
PURPOSE: Nerve regeneration and functional recovery are often incomplete after peripheral nerve damage. The aim of this study was to determine if chondroitinase ABC injection at the lesion site, 1 hour of electrical stimulation and the combination of these treatments at the time of repair could be effective in promoting muscle reinnervation. METHODS: The right sciatic nerve was completely sectioned in 32 female Sprague-Dawley rats. End-to-end microsuture repair was undertaken and fibrin glue was added. Five groups were studied: 1) suture (S) + fibrin glue (F) only; 2) S + F + chondroitinase ABC; 3) S + F + electrical stimulation; 4) S + F + chondroitinase ABC + electrical stimulation; 5) uninjured nerve. RESULTS: Post recovery kinematics showed larger excursion of the hip-ankle-toe angle during walking in groups 2, 3 and 4 than in group 1 (p < 0.05). In vivo electromyographic activity and maximal muscle force were similar between groups 2, 3, 4 and 5, with higher values in all of them compared to group 1 (p < 0.05). Also, the distal stump of the sciatic nerve was excised, and cross-sectioning revealed that the number of axons were similar in all groups. CONCLUSIONS: 150 days after nerve transection, recovery was incomplete with S and F only. Chondroitinase ABC injection at the lesion site and/or 1 hour of electrical stimulation of the proximal nerve stump were beneficial in promoting nerve regeneration and functional muscle reinnervation.
Asunto(s)
Condroitina ABC Liasa/uso terapéutico , Estimulación Eléctrica , Músculo Esquelético/inervación , Músculo Esquelético/fisiopatología , Neuropatía Ciática/fisiopatología , Neuropatía Ciática/terapia , Animales , Fenómenos Biomecánicos , Condroitina ABC Liasa/farmacología , Modelos Animales de Enfermedad , Electromiografía/métodos , Femenino , Fuerza Muscular/efectos de los fármacos , Fuerza Muscular/fisiología , Músculo Esquelético/efectos de los fármacos , Ratas , Ratas Sprague-Dawley , Tiempo de Reacción/efectos de los fármacos , Tiempo de Reacción/fisiología , Recuperación de la Función/efectos de los fármacos , Recuperación de la Función/fisiología , Neuropatía Ciática/tratamiento farmacológico , Neuropatía Ciática/patología , Caminata/fisiologíaRESUMEN
OBJECTIVES: To evaluate the safety and functional outcome of a recently described surgical technique of percutaneous plating for proximal humerus fractures. DESIGN: Prospective clinical trial. SETTING: : Two urban Level 1 university trauma centers. PATIENTS: From February 2002 to December 2003, 34 consecutive patients underwent surgery by 5 trauma surgeons from 2 teaching hospitals. Twenty-seven patients had 1-year follow-up. INTERVENTION: The technique involved 2 minimal incisions with a lateral deltoid split and a more distal shaft incision. A proximal humerus-specific locking plate was implemented. MAIN OUTCOME MEASUREMENTS: DASH (disabilities of the arm, shoulder, and hand) and Constant-Murley evaluation scores were used for functional evaluation. The presence of complications was noted. RESULTS: Specifically, there were no axillary nerve injury injuries and no loss of reduction. The average Constant score at 1 year was 82 and the DASH score was 26. CONCLUSION: This study demonstrated that the functional outcome results correspond to a normal age-adjusted score signifying an acceptable result.