The use of a nerve stimulator to allow safe placement of Ilizarov wires.

摘要: OBJECTIVE Avoidance of potential iatrogenic nerve injury during insertion Ilizarov fine wires into areas high anatomic risk by using a modified stimulation technique. INDICATIONS Application the ring fixator to hazard, in situations where topography may be distorted previous surgery, trauma, or congenital anomalies. CONTRAINDICATIONS Use systemic muscle relaxants. Caution patient with cardiac pacemaker. SURGICAL TECHNIQUE Preliminary experiments showed that standard nerve-stimulating device can deliver negatively charged, monophasic square pulse current through wires. During application an frame potentially hazardous regions, providing no relaxants are used, voltage field sufficient cause nerves close proximity wire depolarize is produced. Identification distal twitch provoked indicate for injury. RESULTS Results show stimulator set at 2.5 mA (pulsed frequency 2 Hz), peripheral stimulated if they lie within 5 mm Should occur, should repositioned so equivalent produces twitch. The technique was used ten patients, only single occurrence twitches lower-leg frame. Following repositioning this case, further were observed, indicating inserted nerves. No neurologic impairment present postoperatively.