Classificatory Treatment Study And Delayed Surgery Oil Peripheral Nerve Injuries Due To Earthquake Damage

Part1Objective: To investigate the characteristics of Peripheral Nerve Injuries (PNIs)in Wenchuan Earthquake victims.A classificationtreatment system of PeripheralNerve Injuries (PNI)was introduced. Method:Peripheral nerve injuries due totheEarthquake damage were classified into three types and subjected to threetreatment programs. The diagnosis and surgical treatment was documented andfollowed-up to observation its recovery and prognosis.Result: Of the8626surveyed earthquake victims,503had nerve injuries,72patients developed intoAdvanced Peripheral Nerve Injuries (APNIs),60surgeries were perfomed in level3treatment program, including42neurolysis,21reconstructions,4autografts, and3acellular nerve allografts.Conclusion： Peripheral nerve injuries after theearthquake constitute a relatively high proportion (5.83%). The classificationtreatment system wasproductive to the diagnosis and treatment of PNIs. It issimple, practical,and optimizing resource allocation. For future natural disasters orother large-scaleevents that may occur, theclassificatoryprogram of peripheralnerve injury may havea reference value. Part2Objective: Proximal tibial nerve entrapment syndromeoccurred in somecompartment syndrome patients. For which conservative treatment wereineffective, surgeries were performed to release the soleal tendinous arch.Methods:Each proximal tibial nerve compression was subjected to neurolysiswith division of the soleal tendinous arch.Pain level, numbness in the sole, musclestrength of the flexor hallucis longus and Tinel’s sign were evaluated pre-and post-operatively. Musclestrength and sensory assessed according to the LouisianaState University Health Sciences Center (LSUHSC) grading systerm. Pain levelassessed according to the visual analogue scale (VAS).Results:There were9extremities in9patients included in the study. All patients experienced relief ofpain.At a mean follow-up of22months,87%patients (8) with weakness of theflexor hallucis longus had strength improvement and78%patients (7) had sensoryimprovement in the sole. Subjective pain was reduced from an average score of2.7to0.7based on VAS. Physical examination for Tinel’s sign revealed allpatients experienced relief of radiating pain.Conclusions: ACS can lead to thetibial nerve compression beneath the soleal tendinous arch. Neurolysis mayimprove pain, sensory and motor function. Part3Objective：To investigated the contributory factors of the type Ⅲinjury of PNIs inWenchuan Earthquake victims.Methods:A retrospective case-control study wasconducted to investigate the contributory factors and etiology of the injury. Aquestionnaire was designed to collect information onage, sex, weight, height,smoking status, the hip and knee position.Conditional logistic regression isemployed to analysis the parameter. Results: There were73patients with type Ⅲperipheral nerve injury. A total of47sciatic nerve injuries were investigated,19males and28females, mean age49.3years (±20.5years), time trapped under therubble10.4hours (±9.9hours).94control cases were randomly selected. Logisticregression proved the correlation between positionand the occurance of nerveinjury. The highest probability of sciatic nerve injury occurs when hip flex andknee extent.Conclusion:Constrained body position was the significant contributefactor to these earthquake associated sciatic nerve palsy.