Impact of post- amputation pain syndrome on the results of bone stump formation

Abstract

Background. To the present day, a high rate of unsatisfactory amputation results still exists. The healing of the bone residual limb, the main support element of the residual limb, is of particular importance. Objective. To study the impact of postamputation pain syndrome on the nature of reparative processes in the bone residual limb. Methods. Three series of experiments were performed on 45 rabbits, 15 in each with mid-third thigh amputation and muscular plasty. In series 1 and 2, a perineural catheter was attached to the sciatic nerve stump during amputation, and mechanical irritation of the nerve was performed daily for 20 minutes in series 1 for 20 days. In series 2, 0.3 ml of 1% lidocaine was injected through the catheter into the circumference of the nerve twice daily for 20 days. Animals of series 3 served as a control. The follow-up periods were 1, 3, 6 months. The study method was histological with infusion of the vessels with ink-gelatin mixture. Results. In series 1, there was a sharp disturbance of the reparative process, which consisted in shape changes, resorption of the cortical diaphyseal plate, stump deformity, absence of bone closure plate formation, and microcirculatory disturbances. In most experiments of the 2nd series, organotypic stumps were formed with normalized microcirculation. In series 3, the results of the residual limb formation were better than in series 1, but worse than in series 2. Conclusion. In the absence of pain syndrome, the bone stump after amputation at the diaphysis level over a period of 1, 3, 6 months retains its cylindrical shape, the structure of the cortical diaphyseal plate, the content of the medullary canal with normal microcirculation, the formation of the bone closure plate, and the completion of the reparative process. The presence of postamputation pain syndrome in the stump distorts the course of the reparative process with the development of pathological remodeling of bone tissue.