
Современные методы медицинской реабилитации пациентов с травмами периферических нервов и плечевого сплетения (обзор)
Травмы периферических нервов и плечевого сплетения представляют собой одну из наиболее серьезных медицинских проблем ввиду высокой частоты инвалидизирующих последствий. Медицинская реабилитация при таких травмах имеет критически важное значение, поскольку обеспечивает наиболее полное функциональное восстановление пациентов.
Цель настоящего обзора — обобщение и интерпретация литературных данных о методах медицинской реабилитации, а также оценка эффективности реабилитационных стратегий и методов восстановления функций верхних конечностей после травмы периферических нервов и плечевого сплетения.
Представлены сведения о теоретических основах восстановления функций после травмы периферических нервов и нервных сплетений, а также о факторах, которые могут затруднять полноценное функциональное восстановление пациента. Рассмотрены реабилитационные стратегии и методы, направленные на ускорение регенерации нервных волокон, предупреждение осложнений, коррекцию кортикальной пластичности, восстановление функциональных возможностей пациента и качества его жизни. Особое внимание уделено вопросам терапии боли, электростимуляции, коррекции сенсорного дефицита и физической терапии в послеоперационном периоде. Реабилитационные модальности и продолжительность медицинской реабилитации весьма индивидуальны и зависят от множества факторов, определяющих направленность реабилитационных воздействий. При этом значительное число методик реабилитации имеют низкую доказательную базу: многие научные исследования основаны на небольших выборках, не учитывают разнородный характер травм и не оценивают отдаленные результаты. Требуется дальнейшее изучение эффективности как отдельных реабилитационных методик, так и комплексных реабилитационных программ, способствующих восстановлению двигательной активности пациентов с травмами периферических нервов и плечевого сплетения.
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