neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2021-24-1-69-78neurosurgery-1173Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEАртроскопический транскапсулярный невролиз подмышечного нерва (наблюдение из практики)Arthroscopic transcapsular neurolysis of the axillary nerve (clinical case)https://orcid.org/0000-0003-3915-7796ПасхинД. Л.PaskhinD. L.

Дмитрий Львович Пасхин

Россия, 115516 Москва, ул. Бакинская, 26

Dmitriy Lvovich Paskhin

26 Bakinskaya Str., Moscow 115516, Russia

yas-moe@mail.ruhttps://orcid.org/0000-0002-2542-8308БелякЕ. А.BelyakE. A.

Евгений Александрович Беляк

Россия, 115516 Москва, ул. Бакинская, 26

Evgeniy Aleksandrovich Belyak

26 Bakinskaya Str., Moscow 115516, Russia

belyakevgen@mail.ruhttps://orcid.org/0000-0001-8472-4249АсратянС. А.AsratyanS. A.

Россия, 115516 Москва, ул. Бакинская, 26

26 Bakinskaya Str., Moscow 115516, Russia

ЗагороднийН. В.ZagorodniyN. V.

Россия, 117198 Москва, ул. Миклухо-Маклая, 6

Miklukho-Maklaya Str., Moscow 117198, Russia

https://orcid.org/0000-0001-5292-7930ЛазкоФ. Л.LazkoF. L.

Россия, 115516 Москва, ул. Бакинская, 26

26 Bakinskaya Str., Moscow 115516, Russia

https://orcid.org/0000-0003-3092-9753ПризовА. П.PrizovA. P.

Россия, 115516 Москва, ул. Бакинская, 26

26 Bakinskaya Str., Moscow 115516, Russia

https://orcid.org/0000-0001-5867-5519ШурыгинС. Н.ShuryginS. N.

Россия, 115516 Москва, ул. Бакинская, 26

26 Bakinskaya Str., Moscow 115516, Russia

https://orcid.org/0000-0002-8966-0499МаршалК. В.MarshalK. V.

Россия, 119991 Москва, ул. Трубецкая, 8, стр. 2

Bld. 2, 8 Trubetskaya Str., Moscow 119991, Russia

ГБУЗ г. Москвы «Городская клиническая больница им. В. М. Буянова Департамента здравоохранения г. Москвы»РоссияMoscow City Clinical Hospital after V. M. Buyanov, Moscow Healthcare DepartmentRussian FederationФГАОУ ВО «Российский университет дружбы народов»РоссияRUDN UniversityRussian FederationМеждународная школа «Медицина будущего», ФГАОУ ВО Первый Московский государственный медицинский университет им. И. М. Сеченова Минздрава РоссииРоссияInternational School «Medicine of the Future», I. M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation20222704202224169‑78Copyright © Пасхин Д.Л., Беляк Е.А., Асратян С.А., Загородний Н.В., Лазко Ф.Л., Призов А.П., Шурыгин С.Н., Маршал К.В., 20222022Пасхин Д.Л., Беляк Е.А., Асратян С.А., Загородний Н.В., Лазко Ф.Л., Призов А.П., Шурыгин С.Н., Маршал К.В.Paskhin D.L., Belyak E.A., Asratyan S.A., Zagorodniy N.V., Lazko F.L., Prizov A.P., Shurygin S.N., Marshal K.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1173

Цель работы – представить клинический случай выполнения невролиза подмышечного нерва через артроскопический транскапсулярный доступ.

Клинический случай

Клинический случай. Пациент Ч., 38 лет, получил переломовывих головки левой плечевой кости в результате падения 5 мес назад, до госпитализации. Сразу после травмы появились симптомы повреждения подмышечного нерва. Проводилась консервативная терапия без положительной динамики. Данные ультразвукового исследования и электронейромиографии показали признаки компрессии подмышечного нерва без нарушения его анатомической целостности. Патологический субстрат располагался в области шейки плечевой кости, в «слепой» зоне нерва (“blind” zone). Ситуация осложнялась прогрессированием явлений артроза сустава с формированием болевого синдрома. Выполнен артроскопический транскапсулярный невролиз подмышечного нерва с санацией полости плечевого сустава. Через 2 мес отмечено визуальное увеличение объема дельтовидной мышцы и амплитуды движений в суставе.

Заключение

Заключение. Артроскопический транскапсулярный невролиз подмышечного нерва – перспективное малоинвазивное вмешательство, дающее возможность выполнения симультанной операции мультидисциплинарной бригадой. Необходимо сравнение результатов операций артроскопическим и открытым доступом.

The study objective – to present a clinical case of axillary nerve neurolysis performed through arthroscopic transcapsular access.

Clinical case

Clinical case. Patient Ch., 38 years old, received a fracture of the head of the left humerus as a result of a fall 5 months ago. Immediately after the injury, symptoms of axillary nerve damage appeared. Conservative therapy was carried out without positive dynamics. According to ultrasound and electroneuromyography, signs of compression of the axillary nerve were noted without violating its anatomical integrity. The pathological substrate was located in the neck of the humerus, in the “blind” zone of the nerve. The situation was complicated by the progression of the phenomena of arthrosis of the joint with the formation of pain. Performed acroscopic transcapsular neurolysis of the axillary nerve with sanitation of the cavity of the shoulder joint. After 2 months, a visual increase in deltoid muscle volume and range of motion in the shoulder joint was noted.

Conclusion

Conclusion. Arthroscopic transcapsular axillary neurolysis is, from our point of view, a promising minimally invasive intervention with the ability to perform simultaneous surgery by a multidisciplinary team. It is necessary to compare the results of the operation with arthroscopic and open access.

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The authors declare that there are no conflicts of interest present.