conservative and operative treatment
G.V. Yarovenko, S.E. Katorkin, P.N. Myshentsev, Ya.V. Sizonenko
Lymphedema of limbs leads to changes in microcirculation and tissue metabolism, a sharp de-crease of the intensity of energy processes in muscles, decrease of contractive ability of thigh and shin, a significant decrease of muscle tone and evident weakening of their functional ability.
To estimate the characteristics of nerve conduction and muscle contractility of patients with lymphedema of the lower extremities before and after conservative and surgical treatment.
The patients were divided into two groups: 1 group - 25 patients with 1-2 stages of secondary lymphostasis of lower extremities and 2 group - 32 patients with 3-4stages. We studied the changes of the parameters ENMG before and after conservative (43 patients) and surgical treatment (15 patients). We used surface bipolar electrodes with fixed interelectrode distance. We were rating physiological state of m. vastus medialis and m. gastrocnemius medialis before and after conservative treatment and surgical application of limfonodulovenoznogo anastomosis. We studied the sensory conduction of n. safenus. The following parameters were measured by M-response: the amplitude of the M-response, rate of spread of excitation in the motor nerve fibers, residual latency. While studying the response of sensory nerve portions, we were analyzing: amplitude of sensory response, rate of spread and the area of excitation. The current of stimulation was on the average 12 mA. The obtained data were averaged and evaluated the amplitude of the response and speed of impulse conduction in sensitive departments of the nerve.
The patients with 1-2 stages characterized by reduced amplitude of motor and sensory re-sponses, but with little changing terminally latency. The decrease of the amplitude of motor re-sponse in the affected limb was on 36,7%, the amplitude of sensory response was on 18%, but with insignificant increase in the rate of spreading of sensory stimulation was on 3,9%. Patients with 3-4 stage had the decreasion of the amplitude of motor response on 65.9%, slowing down the spread of excitation by an average of 74.7% and 31.9%, respectively, as well as the decrease in the values of terminal latency on 45.7%. In the study of sensory response on n. saphenus the patients in group I mentioned the lowering of amplitude of sensory response on 26%, the reduction of spread rate of excitation on 39.1%. In group II- on26.8% and 58.7% respectively. The mean value of top amplitude of peak 1 and 2 of m. vastus medialis was 84,95 ± 13,19 mV and 100,81 ± 20,81 mV on the left, and on the right- 110,14 ± 15,31 mV and 126,58 ± 22,53 mV. For m. gastrocnemius medialis average top amplitude determined 135,24 ± 22,52 mV and 113,62 ± 24,51 mV to the left and 127,24 ± 20,57 mV and 110,02 ± 20,75 mV on the right. The functional electromyography of m. gastrocnemius medialis recorded a significant reduction in the top amplitude of peak 1 on the left and right on 84,3% and 86,1% respectively. The top amplitude of a maximum of 2 decreased less - on the left on 43,3%, and on 4,3% on the right. The findings are the evidencesof dysfunction of the studied muscles from both sides - the functional insufficiency of internal portion of m. vastus medialis from the left and m. gastrocnemius medialis on both sides. The patients with secondary lymphedema before and after surgical treatment had most clearly manifested changes in Group II for the touch response: increasing the amplitude of sensory response (on 30,9%) and increase the speed of spreading of excitation (on 75,4%)of m.vastus medialis. In the study of m. gastrognemius medialis before and after surgical treatment, we got the following data: increased amplitude of motor response (on 48,6%), reduced terminal latency (on 65.3%), rate of spread of excitation (35,6%), but little has changed amplitude sensory response (on 7,3%).
The patients with disorders of the peripheral lymph outflow have functional insufficiency of whole affected extremity, consisting in muscles dystrophy and a violation of sensory conduction. The use of functional electroneuromiography in the diagnosis of lymphatic insufficiency of the lower extremities is useful for dynamic control of the effectiveness of the treatment.