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Aim: to analyze modern professional literature and summarize data on treatment methods for peripheral nerve injuries, taking into account the mechanisms of positive effects. The article presents an overview of possible methods for treatment of peripheral nerve injuries, fundamental classifications of peripheral nerve injuries, their differences are considered, pathophysiological mechanisms and the probability of spontaneous recovery depending on the degree of injury, general principles and conditions for successful regeneration of the peripheral nerve. Options, combinations, advantages and disadvantages of such surgical methods for peripheral nerve injury treatment as neurorrhaphy, autotransplantation and allotransplantation are described in detail, such terms as “small”, “large” and “critical” gaps between the nerve stumps are specified. Classifications and characteristics of conduits are described, types of synthetic conduits are considered. The use of drugs, Schwann cells, growth and neurotrophic factors, neural, embryonic and mesenchymal stem cells of various origins, exosomes of mesenchymal stem cells in the so-called “stem cell-free therapy” in treating this pathology is mentioned. Genetically modified mesenchymal stem cells, optokinetics are also noted, such physical methods for peripheral nerve injury treatment as short-term low-frequency electrical stimulation of the nerve, magnetic stimulation, low-intensity ultrasound, photobiomodulation therapy, photochemical bonding are discussed, indicating some mechanisms of their positive effects. Conclusions. Improving the quality of life and reducing the degree of disability in patients with injuries of the main nerve trunks depends on the combined use of a number of surgical, bioengineering and regenerative technologies. These involve the restoration of the anatomical continuity of the nerve, including through the use of natural or artificial elements, cellular technologies and the management of regenerative processes. Therefore, every time, a surgeon is facing a major challenge to create a combination of various means from the indicated basic components for the treatment of nerve damage in managing a particular patient. However, such a treatment approach requires proper competences of surgeons as well as specific material and technical bases in order to bring down the level of social tension in patients with injuries of the main nerve trunks.

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 513 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%.

Objective: to investigate pathophysiology and biomechanics of the nerve stretching and to form a biomechanical model of a nerve stretch injury. Materials and methods. We analyzed and summarized the data from open access sources (eLibrary, Scopus, Web of Science, PubMed) with unlimited search depth. A search was performed using the following keywords: растяжение нерва (English: nerve stretching), stretching nerve, biomechanical nerve stretching, nerve stretching injury. Results. Here are presented key historical information and biochemical, neurophysiological, and biomechanical events related to a nerve stretch injury. Objective experimental data on the nerve stretching process are summarized. Conclusions. A nerve is a heterogeneous elastic cord, which can be slightly stretched under physiological conditions due to the involvement of its sheath structures. In a stretched nerve, ischemic lesions have an early onset and further become irreversible. Nerve conduction disorders occur, resulting in a severe neurological deficit. When the nerve is stretched by more than a third, it ruptures and the sequence in which fragmented neural structures occur during nerve tension remains unclear.

Based on experience of examination of about 300 patients with n. medianus and n. ulnaris injuries there are generalized new methodic possibilities in anatomical and functional approaches to diagnostics in peripheral neural trunks injuries. It is worth to include into the complex of diagnostic measures not only ENMG, but a set of other effective methods of investigation also. The use of modern clinical anatomical technologies (ultrasonography) permits as to detect areas of damage of the nerves, the sizes of diastasis and the location of the ends of the nerve, the presence and sizes of neuroma, as to evaluate the state of surrounding tissues, to reveal associated pathology. The application new clinical functional technologies (laser Doppler flowmetry with computer wavelet analysis of blood flow oscillations, computer thermography) allows to estimate the condition of the fine autonomous and sensor neural fibers. It empowers as diagnostics of functional condition of the nerve after trauma, as early detection the signs of tissue reinnervation after reconstruction of nerves and choice of the adequate tactics of management of such patients.

Objective. The present study examines the value of intraoperative neurovisualization as an imaging tool for decision making in the management of traumatic nerve injuries. Materials and methods. 43 patients with traumatic nerve lesions were examined by electrodiagnostic study, ultrasonography and contrast neurography. Results. A complex intraoperative examination have been used to guide surgical decision making in patients with peripheral nerve injuries of limbs. Conclusion. The results of complex intraoperative examination became the basis of diagnosis and treatment algorithm for surgical treatment of peripheral nerves injuries.

An intratissual electrical stimulation, accompanied by irritation of their central neurons, is used to recover the function of damaged peripheral nerves. Treatment results exceeded those with the use of cutaneous electrical stimulation, which is confirmed by comparative results of trial animal experiments. The time and quality of peripheral nerves' function recovery in comparison of intratissual and cutaneous electrical stimulation methods remain unknown., Objective: To evaluate the time and quality of peripheral nerves' functions recovery after their suturing and conducting two different methods of electrical stimulation, namely intratissual and cutaneous, in projection of central neurons of damaged spinal nerves in the postoperative period., Material and Methods: The basic technical parameters of the method of peripheral nerves' functions recovery in the postoperative period were ptacticed. Postoperative rehabilitation treatment was performed in 77 patients with traumatic peripheral nerves' injuries at the level of the forearm: in 42 with intratissual electrical stimulation, in 35 - using cutaneous one with similar characteristics of electrical current and concomitant pharmacological therapy. The follow-up duration was 2 years., Results: A significant (in 4-6 times) reduction in time of treatment and a greater improvement in qualitative indicators when using intratissual electrical stimulation compared to the use of cutaneous stimulation were obtained. The effectiveness of the restorative therapy was dependent on the number of procedures, and a complete recovery of the damaged peripheral nerves' functions was observed after three courses of intratissual electrical stimulation., Conclusion: The time and degree of recovery of peripheral nerves' functions depends on the functional activity of their central neurons at the level of the spinal cord. The activation of these neurons by low-frequency electrical current allows to activate their trophic function. Thus, the cutaneous electrical stimulation does not cause the necessary level of irritation of the neurons due to the fact that the skin is a barrier to electrical current, which reduces its impact in 200-500 times. The intratissual electrical stimulation allows to solve the problem by supplying the needle-electrode much closer to the «target». The proposed method of intratissual electrical stimulation has shown its advantage over cutaneous electrical stimulation, significantly reducing the duration of the restorative treatment and increasing its qualitative indicators.

Introduction. With the growing society urbanization and the associated increase in injuries, the number of damage to the peripheral nerves of the extremities is steadily increasing. Nerve injuries lead to permanent disability in 60–63% of patients, and almost 80% of this group are people of young working age. Research methods. In the Neurosurgical center of Almaty on the basis of State Clinical Hospital №7 in the period 2010-2019 years 757 patients with the peripheral nerves injuries were operated on. Male – 512, female – 245. Most patients (87%) were of working age. Injuries to the upper limbs were 74.4%, lower - 23.8%, cranial nerves 1.8%. Domestic injury prevailed - 51%, tunnel syndromes, road accidents and iatrogeniс injuries accounted for 19.9%, 12.9% and 12.1%, accordingly. Only 54.1% of patients approached within 6 months. The ulnar nerve was most often affected - 23.6%, the radial, median nerves and brachial plexus were noted in 17.9%, 17%, 10.4% of cases, accordingly. During surgical operations neurolysis (31.2%), nerve suture (16.9%), surgical decompression for tunnel syndrome treatment (16.4%) were used most frequently. Results. There is an increasing number of operations tripled in 10 years. This was achieved by expanding the indications for operations using tendon-muscle plastic surgery and plastic closure of soft tissue defects (13%), as well as by the fact that patients were operated on for periods longer than 1-2 years after injury (24%). There is a growing number of cases of elderly patients with tunnel syndromes (19.9%). Conclusion. Using of plastic surgery, along with the reconstruction of nerve trunks, accelerated the rehabilitation and early muscle re-education of the limbs, which made it possible to improve treatment results in 92.8% of patients to a useful recovery of motor function. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the incidence of the development of symptoms of damage to subcutaneous nerves after endovenous laser coagulation (EVLC) of the great saphenous vein (GSV), as well as to determine the effect of these symptoms on quality of life (QoL) of patients. Our retrospective study enrolled a total of 119 patients (mean age 50±13.9 years) subjected to 151 isolated EVLC of the GSV. The average volume of the injected anaesthetic per 1 cm of the vein's length amounted to 8.5±1.9 ml. Puncture of the GSV at the level of the thigh was performed in 37 (24.5%) cases, at the level of the crus in 114 (75.5%) cases. The intervention was performed at the power 5-10 W and linear density of energy approximately 70 J/cm. The median of the follow up period amounted to 264 days. The patients were interrogated by phone. The questionnaire included leading, understandable for patients questions about the presence of postoperative complaints characteristic of damage to subcutaneous nerves, as well as the question about the effect of these complaints on quality of life. The complaints characteristic of damage to subcutaneous nerves were reported for 61 (40.4%) operated limbs, with these symptoms decreasing quality of life only in 7 (4.6%) cases. All respondents noted gradual regression of the symptoms with time. The median of symptom relief amounted to 2 months. The analysis of interrelationship between the level of puncture by the thirds of the femur and crus and the damage of subcutaneous nerves demonstrated no statistically significant association (p=0.108), unlike the analysis by the femur/crus level, wherein the infragenicular puncture significantly increased the risk of traumatisation of subcutaneous nerves (p=0.022). No statistically significant differences by the frequency of damage to subcutaneous nerves depending on the power of energy were revealed (p=0.662). The obtained findings make it possible to recommend EVLC, including with puncture of the GSV below the knee, for patients with varicose veins in this basin.

A treatment of fractures of distal metadiaphysis of the humeral bone remains an actual problem of modern traumatology at present time. This is associated with immediate proximity of the radial nerve and risk of iatrogenic injury in external fixation, presence of short distal fragment, comminuted nature of fracture, complexity of treatment method selection, need of extensible approach. Biomechanical features of different fixators were analyzed in consideration of presence of short distal fragment, traumatic of. external fixation and risk of iatrogenic injury of the nerve. The authors suggested the method of osteosynthesis of the humerus by using blocking osteosynthesis with preliminary extension of intra-medullary canal of distal fragment for obtaining stable osteosynthesis (priority No 2014105323 from 14.02.2014). The proposed method allowed avoiding the iatrogenic neuropathy of the radial nerve, providing the stability of fixation higher, than in case of external fixation. It excludes the need of external immobilization and combines the period of bony union with the period of rehabilitation and socially integrates the patient in minimal terms.

In pathogenesis of the traumatic disease of the spinal cord, two mechanisms of the injuries of its neuronal apparatus are defined: primary (necrosis) and secondary (apoptosis). In the work a participation of a number of internal causes in the progression of apoptosis in injury of the spinal cord and peripheral nerve trunks, the role of those remains little-studied up to date, is discussed.

We present a clinical case of injury to the flexor tendons of the fingers and wrist and to the median and ulnar nerves at the forearm level. An atypical high bifurcation of the median nerve at the forearm level was revealed during surgery.

This article presents the results of anatomic researches of the innervations of the inguinal area, performed for studying an arrangement of the main nerves of the inguinal area in relation to the operation access and the area of plasty of the posterior wall of the inguinal canal. The method of temporary translocation of inguinal nerves is developed for their preservation at radical operations of inguinal hernias. Long-term experience of surgical treatment of inguinal hernias with the temporary translocation of inguinal nerves is summarized.

Activity of such enzymes, as creatinkinase and lactatdehydrogenase, as well as contents of electrolytes (Na+, K+, Ca2+), were analyzed in biological material (the blood serum and muscular tissue) of patients with the trauma consequences in the extremities nerves. Depending on severity of the disease and duration of pathological process in patients, the changes in indices of energetic metabolism in the extremities were registered, witnessed by results of the activity measurements of certain enzymes-markers and the electrolytes contents.

Experimental and clinical data have shown that there is an increase in the necessity of pyrimidine nucleotides after peripheral nerve injury. The aim of the study was to estimate the neuroprotective efficacy of the Nucleo CMP preparation (Nucleo CMP. Ferrer Internacional) containing cytidine monophosphate and uridine triphosphate nucleotides after unilateral compression of the sciatic nerve of rats. We recorded extracellular spike activity of single motoneurons of the spinal cord on the ipsilateral side towards injury during high frequency stimulation of distal collaterals (nervus tibialis and nervus peroneus communis) of the injured sciatic nerve. The degree of the expression and the ratio of excitation/inhibition responses of motoneurons in the Nucleo CMP group are close to the norm. In the Nucleo CMP group on the 30 day it was revealed a restoration of test reflex abduction indices and the static sciatic index of injured lower extremities. A single administration of therapeutic dose of Nucleo CMP in intact rats caused an increase in the background and evoked spike activity of single motoneurons from 10 to 80 minutes.

Objective. To study the results of surgical treatment of patients with the consequences of peripheral nerves damage of limbs using conventional tactics, and with simultaneous use of tendon-muscle plastic and scrappy replacement of scarring tissue in the area of nerve repair. Methods. In the study are given observations of 243 patients with the consequences of peripheral nerves damage of limbs depending on the timing of surgical treatment, tactics using the methods of plastic and reconstructive surgery. Results. Among patients operated on a multidisciplinary approach have been observed relatively better results of motor function restoring of limbs. Conclusion. In the surgical treatment of patients with consequences of limb nerve injury should be considered predictive unfavorable conditions for nerve regeneration, including scarring of soft tissues in the area of nerve, muscle imbalance of antagonists, the severity of Wallerian degeneration of nerve for the purposes of using methods of tendon-muscle plastic and closing of soft tissue defect by flaps with axial blood circulation. [ABSTRACT FROM AUTHOR]

Basic difficulties of the adequate and precise electrophysiological examination of radial nerve injuries are traditionally conditioned by the impossibility to separate the muscle, isolated from the muscles, innervated by the ulnar or medial nerves. The phenomenon of flexor motor units potentials propagation by the stimulating electroneuromyography and M-flow registration from extensor muscles has been described in literature. To prevent the false interpretation of the examination results, 98 patients with radial nerve injuries were examined using the original program of separate assessment of motor and sensor fibers.

The results of rehabilitation of 52 patients with radial nerve injuries were comparatively analyzed: the traditional rehabilitation complex (massage, training, etc.) was compared with the method of functional biomanagement. The technical characteristics of the designed functional cast were thoroughly described. The study demonstrated that reinnervation and functional recovery of the denervated muscles without segmental influence were significantly slower.

The objective of the present neurohistological study using an experimental model of compressive-ischemic neuropathy (40 white rats) was to estimate the influence of photochromotherapy on the injured nerve filament. It was shown that light of different wavelengths had differential effect on the nerve tissue. The exposure to blue light reduced the severity of traumatic lesion as apparent from a decrease in the number of filaments undergoing degenerative changes and their enhanced argentophilia. Irradiation with red light caused a marked decrease in the degree of vacuolization with moderate argentophilia suggesting normalization of ion transport and recovery of nerve conductivity. Green light irradiation promoted remyelinization of nerve filaments (a marked increase of the number of Schwann cells).

The effect of neuromidin on the modulation of peripheral nerve lesions have been studied in 120 patients. Sixty-two patients of the control group received traditional therapy (nonsteroid anti-inflammatory drugs, myorelaxants, vasoactive drugs, proserin, physiotherapy), 58 patients of the main group alongside with traditional therapy received neuromidin instead of proserin (15 mg/d intramuscular for the first 10 days, 20 mg 3 times a day in tablets during the following 20 days). The duration of the study was 30 days. In the 30th day of the treatment, there were the reduction of severity of paresis, pain and anxiety syndrome, the increase of the M-response amplitude and velocity of impulse conduction along the affected nerves (p< or =0.05) in the main group. The results of magnetic diagnostics and assessment of somatosensory evoked potentials revealed the significant decrease of the central motor and sensory conduction time (p< or =0.05). The modulating effect of neuromidin on the neurotransmitter activity (the increase of plasma serotonin concentration in 15th day of the therapy and the decrease of noradrenalin content in the 30th day) was observed. There were no significant side-effects which required the withdrawal of the drug. The stimulating effect of neuromidin on the neuroplasticity both on peripheral and central levels was found.

In traumatic injury of the brachial plexus, neurotization of peripheral nerves of the hand with different nerve donors is indicated at the preganglionary level in order to restore motor function. This communication describes a procedure for preoperatively determining the state of the nerves to be neurotized. This procedure evaluates the, state of the estimated nerve donors and presents a means of planning in advance the way of performing an operation aimed at recovering the lost motor functions, by considerably reducing the time of the operation.

Combined injuries of the forearm occupy an important place in modern structure of functionally severe traumas. Discussions concerning the best time for nerve reconstructions and unsolved questions of a necessity to restore one of the arteries if the other is safe confirms the importance of the problem. An analysis of the domestic and foreign literature data on diagnosing and treatment of the traumas in question is given. Main specific features of treatment depending on the time, character of injuries and functional role of the injured structures are described.

Two hundreds and sixty-seven patients with gunshot injuries of 394 nerves and plexus underwent clinical and electromyographic investigation and H-reflex evaluation as well. Based on the results of the data obtained, 3 types of nerves trunk injuries: neuroapraxia, axonothmesis and neurothmesis, were identified. The reduction of biopotential amplitude and synergic muscular activity, decrease of impulse conduction velocities (ICVeff--up to 30%), M-response amplitude (up to 50% and more) and motor units functioning were characteristic of neuroapraxia of nerve trunks. Axonothmesis of nerve trunks featured by the reduction of the amplitude and frequency of muscular biopotentials, decrease of its synergic activity, marked reduction of ICVeff (30--60%), rough fall of M-response amplitude and motor units functioning. In neurothmesis of nerve trunks, "bioelectrical silence" and disappearance of synergic muscular activity as well as an absence of M-response of denervated muscles were observed. An evaluation of monosynaptic reflex has a substantial significance for the determination of the level of low extremities injuries.

Results of performance of operations with restoration of the nerves using microtechnique in 60 patients during 15 years (from 1985 till 1999) are presented. Autotransplant was applied in 42 patients in damage of peripheral nerves of upper extremity. Restorational operation on peripheral nerves of lower extremity was performed in 14 patients. Facial nerve was restored in 4 patients using autotransplant. The restorational operation effect is more pronounced on the upper extremity than on the lower one. High efficacy of tibial nerve restoration was noted after conduction of operation on the lower extremity. Good result was achieved in restoration of facial nerve. The period duration from the trauma occurrence till the operation performance constitutes the factor, which determines the result of treatment, especially in young patients.

Sciatic and tibial nerves and a femoral osteotomic area were investigated in experiments on 36 adult mongrel dogs during neutral and distractional osteosynthesis. Histological and X-ray studies, computer-assisted image analysis, and statistical methods were used. The morphological basis of hemodynamic features of the nerves and long tubular bones was characterized. The mechanisms responsible for perivascular osteogenesis in the bone marrow cavity and for hypertrophy of perineural cell paravasal spongy structures in the nerves were studied as compensatory and adaptive responses to changes in the hemodynamical components of homeostasis after bone injury and during extremity stretching.

The efficacy of acuelectrostimulation (AES) and some aspects of the mechanism of motor function recovery were studied in 46 patients with gunshot injuries of 66 nerves and plexuses using cliniconeurophysiologic examination. It is shown that AES promotes regression of motor, sensitive and vegetovascular disturbances. A positive effect of AES on structural and restorative processes in the patients with gunshot injuries of peripheral nerves was confirmed by the results of electrophysiologic studies (EMG, ENMG) which register an increase in muscular biopotential amplitude, M-response, recovery of conduction or enhancement of impulse conduction velocity in the motor fibres of the peripheral nerves, an increase of functioning motor units. After a treatment course an increase of H-reflex and M-response amplitudes in the musculus soleus and medial musculus gastrocnemius of calf developed in the patients with gunshot injuries of lower extremity peripheral nerves this indicating improvement of the state of afferent and efferent links of neuromuscular system.

Naphthalan therapy was given to 48 patients with gun-shot injuries of peripheral nervous system. Clinico-electrophysiological assessment stated a regress of motor, sensitivity, vegetovascular and trophic damage after a course of naphthalan therapy, enhancement of regeneration, reinnervation, stimulation of repair in impaired nervous-muscular structures.

The exposure to paired electric impulses and vibromassage promotes completeness of repair in the treatment of injured peripheral nerves of the limb. The effect is achieved due to marked stimulation of myelinization and differentiation of the nerve fibers, regeneration of the nerve system in the denervated muscle.

The effect of hydrocortisone on the neurogenic pain syndrome induced by damage to the peripheral nerves was studied in 40 male Wistar rats. Intraperitoneal administration of 10 mg/kg of the drug caused both hyperalgesia and hypoalgesia. The direction of the hydrocortisone effect on the neurogenic pain syndrome depended on the time of administration: chronic administration before the damage to the nerves promoted the development and intensity of the syndrome; treatment applied after the nerve damage delayed the development of the syndrome. It is suggested that the mechanism of the hydrocortisone effect on the neurogenic pain syndrome may be realized via the central link through the effect of the hormone on the glucocorticoid receptors of the brain structures.

The outcomes of traditional epineural, microsurgical epineural and interfascicular sutures of the median and ulnar nerves in the lower third of the forearm were compared in children. Evidence is provided for the differential approach to applying an interfascicular and microsurgical epineural suture, as well as for limitations in the use of an interfascicular suture. The authors show it necessary to make investigations to clarify whether the fascicles on the ends of a diseased nerve may be more validly identified and whether the studies into connective and nerve tissue relationships in the suture line.

An analysis of clinico-neurological and electrophysiological examinations of 88 patients before and during the operation enabled the authors to establish substantial pathomorphological and functional distinctions of gunshot and not gunshot injuries of the nerves, difference in results of various operative procedures.

The purpose of this article was the gustatory perception state study (NaCl solution perception) in patients with one-sided damages of branchial plexus as well as of radial, facial and ulnar nervous trunks. The decrease of gustatory perception was observed in 78 (70.3%) cases, while the lack of such alterations in 33 (29.7%) patients. The gustatory perception disturbances (increase of the absolute threshold on the ipsilateral tongue's half) took place in 82.2% and 69.6% at right and left limbs damages respectively. The results presented testified the strengthening of normally existing asymmetry in gustatory perception especially in patients with left-sided denervation. The degree of gustatory perception restoration may serve as a prognostic test at surgery of such patients.

Infrared imaging of the hands has been conducted in kinesitherapy of patients with injured finger flexor tendons and hand nerves as compared to healthy subjects. A trend to normalization of the infrared images was recorded in the regimens without force loading, duration of the exercise schedule not less than 1 week, start of the treatment in the early postoperative period.

Examined were 106 sufferers with multiple injuries to the peripheral nerves of the extremities. The expediency to use the different methods of surgical intervention, depending on the level and nature of injury have been substantiated. An adequate tactics for surgical treatment of the sufferers with regard for the level and severity degree of an injury to the extremity has been developed. The immediate and long-term results of treatment of the patients were studied.

A resection of sciatic nerve in 25 dogs was performed out and the ends of cut nerve were connected by sutures with special apparatus for quantified traction of nerve stumps. 5 days after resection traction was stented at the rate of 0.25 mm twice a day. A histological analysis performed in 5, 12, 19, 26, 33 days after resection an 2-12 months after nerve suture has shown that stress strain effects on intercalation of nerve structures (Ilizarov's effect). Newly formed Schwann chains free of products of axonal and myelin disruption have got a perfect longitudinal orientation and that's why can be considered as an optimum substratum for axonal regeneration.

Fractures of the shin are often accompanied by injuries of muscular and cutaneous branches of the tibial and fibular nerves. In patients with a similar trauma there appears a polyvalent complex of pathological reactions and functional disorders. An experience with treatment of patients with the above pathology allows a conclusion to be made that treatment of neurites should be started from the very first days of admittance of the patients to the hospital.

Among 388 patients with mononeuropathies staying at the neurosurgical department, lesions of the nerves in 47 were induced by treatment manipulations. This group of iatrogenic neuropathies was made up of 15 cases of injection neuropathies, 19 cases of postoperative and 13 cases of positional end compression neuropathies. 39 patients were operated on. The interval from the development of neuropathy to operation ranged from 1 month to 15 years and constituted 23.7 months on the average. Complete convalescence was recorded in 13 operated patients, improvement in 22; 4 patients manifested no changes.