ABSTRACT
Intraneural hematoma can result in the median nerve in the carpal tunnel after trauma or coagulation disorders. The decision for expectant management or descompressive surgical techniques is still controversial. Fifty male Wistar rats were divided into five groups. The sciatic nerve was wrapped around with a silastic device in four groups. In group A, the sciatic nerve was just wrapped by the silastic tube. In group B, an intraneural injection of autologous blood was added. In group C, after the hematoma creation, the silastic device was removed and a longitudinal epineurotomy was performed. In group D, the silastic device was removed after the hematoma, but the nerve was not opened. In group E (sham-operated), the sciatic nerve was exposed without hematoma or compression. Nerve function recovery was assessed periodically over 61 days using the Bain-Mackinnon-Hunter Sciatic Function Index (SFI). Group A (extrinsic compression) presented initial SFI of - 26.29 ± 2.89, with return to baseline values on the fifth postoperative day. Group B (hematoma and extrinsic compression) exhibited the poorest function (SFI of - 85.23 ± 3.51) after surgery and recovery in 23 days. Group C (liberation of silastic and hematoma drainage through epineurotomy) and group D (only removal of the silastic tube) presented similar initial SFI values of - 32.78 ± 7.45 and - 45.13 ± 6.84, respectively. In both the groups, the SFI values returned to baseline level on fifth postoperative day. The statistical analysis of SFI identified a significant difference (P < .0001) between the expectant management (group B) and the descompressive surgery approach (groups C and D) by 1st to 19th postoperative day. The number of degenerative fibers and density of degenerative fibers were statistically significantly longer in group B when compared with the other groups. There was no statistical difference between the other groups when these parameters were analyzed. Thus, immediate descompressive procedures of the intraneural hematoma provide a faster functional recovery and reduce the damage to the axon fibers.
KEYWORDS
Peripheral nerves - intraneural hematoma - compressive neuropathies
REFERENCES
-
1
Faithfull D K, Wallace R F.
Traumatic rupture of median artery an unusual cause for acute median nerve compression.
J Hand Surg [Br].
1987;
12
233-235
-
2
McCormack L J, Cauldwell E W, Anson B J.
Brachial and antibrachial arterial patterns.
Surg Gynecol Obstet.
1953;
95
43-54
-
3
Blodgett R C, Lipscomb P R, Hill R W.
Incidence of haematologic disease in patients with carpal tunnel syndrome.
JAMA.
1962;
182
814-815
-
4
Brown C J, Mackinnon S E, Evans P J et al..
Self-evaluation of walking-track measurement using a sciatic function index.
Microsurgery.
1989;
10
226-235
-
5
Brown C J, Evans P J, Mackinnon S E et al..
Inter- and intraobserver reliability of walking-track analysis used to assess sciatic nerve function in rats.
Microsurgery.
1991;
12
76-79
-
6
Dash H, Kononov A, Prayson R A, Petras S, Browne E Z.
Evaluation of nerve recovery from minimal duration crush injury.
Ann Plast Surg.
1996;
37
526-531
-
7
Hare G MT, Evans P J, Mackinnon S E et al..
Walking track analysis: a long-term assessment of peripheral nerve recovery.
Plast Reconstr Surg.
1992;
89
251-258
-
8
Hare G MT, Evans P J, Mackinnon S E et al..
Walking track analysis: utilization of individual footprint parameters.
Ann Plast Surg.
1993;
30
147-153
-
9 Neter J, Kutner M H, Nachtsheim C J, Wasserman W. Applied Linear Statistical Models. 4th ed. Illinois; Richard D Irwin 1990
-
10 Singer J M, Andrade D F. Analysis of longitudinal data. In: Sen PK, Rao CR Handbook of Statistics. Vol 18: BioEnvironmental and Public Health Statistics. Amsterdam; North Holland 2000: 115-160
-
11 Winer B J. Statistical Principles in Experimental Design. 2nd ed. Tokyo; McGraw-Hill 1971
-
12
Lundborg G.
The intrinsic vascularization of human peripheral nerves: structural and functional aspects.
J Hand Surg [Am].
1979;
4
34-41
-
13
Lundborg G, Meyers R, Powell H.
Nerve compression injury and increased endoneurial fluid pressure: a miniature compartment syndrome.
J Neurol Neurosurg Psychol.
1983;
46
1119-1124
-
14
Lundborg G.
Ischemic nerve injury: experimental studies on intraneural microvascular pathophysiology and nerve function in a limb, subjected to temporary circulatory arrest.
Scand J Plast Reconstr Surg Suppl.
1970;
6
3-113
-
15
Lundborg G.
Structure and function of the intraneural microvessels as related to trauma, edema formation and nerve function.
J Bone Joint Surg Am.
1975;
57
938-948
-
16 Eversmann Jr W W. Entrapment and compression neuropathies. In: Green DP Operative Hand Surgery. 3rd ed. New York; Churchill-Livingstone 1993: 1341-1354
-
17
Gentili F, Hudson A R, Hunter D.
Clinical and experimental aspects of injection injuries of peripheral nerves.
J Can Sci Neurol.
1980;
7
143-150
-
18
Scopel G P, Orpheu S C, Ayari N AM, Bariani R L, Munhoz A M, Busnardo F F.
Recuperação da função nervosa após hematoma intraneural: Estudo experimental comparativo em ratos submetidos à neurólise interna imediata.
Revista de Medicina DCCAOC.
1999;
78
346-352
-
19
Scopel G P, Faria J CM, Alves H RN, Busnardo F F, Ferreira M C.
Experimental intraneural hematoma in rats: assessment by functional recovery and neural histomorphometry.
Acta Ortop Bras..
, In press
-
20
Crawford G P, Cordingley F T.
Ulnar nerve palsy in a haemophiliac due to intraneural haemorhage.
BMJ.
1984;
289
18-19
-
21
Hayden J W.
Median neuropathy in the carpal tunnel compression caused by intraneural haemorrhage.
J Bone Joint Surg Am.
1964;
46
1242-1244
-
22
Richardson R R, Hahn Y S, Siqueira E B.
Intraneural hematoma of the sciatic nerve.
Neurosurgery.
1978;
49
298-300
Gean Paulo ScopelM.D.
Teodoro Sampaio Street
342-AP 92, 05406-000 São Paulo, SP, Brazil
