Avtor/Urednik		Bošnjak, Roman
Naslov		Vloga nevrokirurga pri obravnavi bolezni in poškodb perifernega živca
Tip		članek
Vir		Rehabilitacija
Vol. in št.		Letnik 4, št. 1-2
Leto izdaje		2005
Obseg		str. 82-92
Jezik		slo
Abstrakt		An impotrant quality of peripheral nerve system, as compared to the central nervous system, is its remarkable ability to recover after injury through remyelination and regeneration of the axon. In complete injury, blunt or open, an intime surgical intervention is neccessary to enable the regeneration of axons. Peripheral nerve surgery is a diversity of microsurgical technigtres that respect the fine structure of the peripheral nerve to enhance its regenerative potential to a maximum. Interfascicarlar suturing of the nerve stumps is the,finest type of microsurgical procedure that is used for approximation, orientation and coaptation of the individual fascicles. Autologous nerve grafts are interposed between the stumps to bridge the gaps between them. However, a reinnervation into the distal stumps is random and a large guantity of axons is functionally lost despite vivid regeneration and optimal coaptation of the fascicles. The potential of the spontaneous regeneration should be fully recognized in every blunt peripheral nerve injury before the decision to operate. Spontaneous regeneration provides the best re-establishment of previous anatomical peripheral and central connections and functionality. The follow-up clinical examinations, aided by electrophysiological studies, are crucial for optimal timing in surgical treatment of the periphera! nerve injuries.
Izvleček		Periferno živčevje ima izjemno sposobnost obnavljanja po poškodbi (remielinizacija in regeneracija). Pri odprtih ali zaprtih popolnih poškodbah pa je potrebna pravočasna kirurška intervencija. Kirurgijo perifernega živčevja predstavljajo številne mikrokirurške tehnike, ki upoštevajo notranjo strukturo perifernega živca in omogočijo čim boljšo regeneracijo. Interfascikularni šiv je najbolj fina tehnika za približanje, orientiranje in staknitev posamičnih fasciklov. Avtologne presadke kožnih živcev uporabimo za premostitev defekta med krnoma. Ker je regeneracija v distalni krn naključna, je veliko aksonov izgubljenih za funkcijo, četudi je regeneracija še tako obilna in šiv še tako natančen. Samo spontana regeneracija omogoča prvobitne anatomske povezave in najboljšo funkcionalnost, zato moramo njen potencial pri vsaki poškodbi perifernega živca, še zlasti zaprti, do skrajnosti natančno prepoznati in oceniti, preden se odločimo za operativno terapijo. Zato so redne klinične ocene, ki jih dopolnimo z elektrofiziološkimi testiranji, še vedno najpomembnejše pri odločanju o operativni terapiji.
Deskriptorji		PERIPHERAL NERVES NERVE REGENERATION MICROSURGERY PERIPHERAL NERVOUS SYSTEM DISEASES NERVE COMPRESSION SYNDROMES