From Big Medical Encyclopedia

PERIPHERAL NERVOUS SYSTEM [systema nervosum periphericum (PNA), systema nervorum periphericum (JNA, BNA)] — topographical conditionally allocated extra brain part of a nervous system including back and ventral roots of spinal nerves, spinal nodes and sympathetic trunks, craniocereberal, spinal nerves and their derivatives; neuroplexes of P. of N of page carry out in interaction with c. N of page regulation of movements, sensitivity and a trophicity in somatic and vegetative spheres of an organism. Of N of page ventral and back roots of spinal nerves (on two plank beds from each segment of a spinal cord), 31 pairs of spinal nerves and spinal nodes (8 cervical, 12 chest, 5 lumbar, 5 sacral and 1 coccygeal), humeral, lumbosacral and cervical textures, 12 couples craniocereberal belong to P. (cranial, T.) nerves, peripheral nerves of a trunk and extremities (on hands — elbow, beam, median, etc., on a trunk — intercostal nerves, etc., standing — femoral, sciatic, etc.), the right and left sympathetic trunks, vegetative neuroplexes, nerves and nodes (see. Autonomic nervous system , Ganglion , Nerves and articles devoted to separate craniocereberal, peripheral nerves and textures, e.g. Femoral nerve , Facial nerve , Brachial plexus etc.).

Convention of allocation of the concept «peripheral nervous system» consists that, e.g., bodies of peripheral motor-neurons are in a brain trunk and in front horns of a spinal cord, i.e. in the central nervous system, and their axons form the motive parts of cranial and spinal nerves making part P. of N of page. Thus, the neurocyton is located in c. N of page, and his axon as a part of P. the N of page reaches muscles of the head, a neck, a trunk, top and bottom extremities. On another there is relationship peripheral and central nervous systems at sensitive neurons. Bodies form them spinal nodes (for cranial nerves — sensitive nodes). Dendrites of sensory cells are connected with receptors (see), and their axons as a part of a back root enter a back horn of a spinal cord or respectively a sensitive kernel of a cranial nerve.

Function P. of N of page consists in carrying out nervous impulses from all ekstero-, proprio-and interoretseptor in the segmented device back and a brain and in assignment from c. N of page of the regulating nervous impulses to bodies and fabrics. One sites P. of N of page contain efferent fibers (see. Nerve fibrils ), napr, ventral roots of spinal nerves, cranial nerves (front, wandering, hypoglossal), and others — afferent, napr, back roots of spinal nerves, a sensitive part of a trifacial. However the most part of P. of N of page is mixed and contains motive, sensitive and vegetative fibers.

For detection of pathology of P. of N of page by means of standard practices conduct researches of motive function (see. Paralyses, paresis ) and sensitivity (see). Character and localization of pain, paresthesias, changes of superficial and deep sensitivity, existence of painful points at a palpation of nervous trunks and muscles is important (see. Diagnostic painful points ). Investigate dermographism (see), sweating (see), skin temperature; in the presence of paresis or paralyzes carry out electrodiagnosis (see), hronaksimetriya (see), electromyography (see), measure the speed of carrying out impulses on a nerve. By results of these researches, and also on the nature of paralysis or paresis of these or those muscles, zones of sensitive and vegetative disturbances establish localization patol, the center.

One of the most frequent reasons of defeat of roots of spinal nerves are exchange and dystrophic changes of a backbone. Hernias of intervertebral disks and osteophytes in intervertebral openings squeeze ventral and back roots of spinal nerves (see. Osteochondrosis , Radiculitis ) also lead to a radikuloishemiya. More often the lower lumbar and upper sacral roots are surprised; roots of SU are quite often involved in process (cm. Cervicobrachial syndromes ). So-called «sleepy» defeat beam nerve (see) arises from a prelum of this nerve in a dream.

At various levels P. of N of page there can be tumors. Meet more often neurinoma (see), a neurofibromatosis, Barret's tumor — Masson (see. Glomal tumors ).

Such parts P. of N of page as neuroplexes, and also nerves of extremities: elbow, beam, median, femoral, sciatic and other nerves can be exposed to injuries.

Infectious and infectious and allergic defeats of various sites P. of N of page can be the cause of radiculitis, plexitis (see), ganglionitis (see), neuritis (see), neuralgia (cm). A special form of in-fektsionno-toxic and infectious and allergic defeat P, N of page make polyneurites (see) with preferential distal type of motive, sensitive and vegetative frustration, and also Giyen's polyradiculoneuritis — Barret — Shtrolya. Disturbance. it is quite often noted functions of distal departments of top and bottom extremities and at intoksikatsionny defeats of a nervous system. At the same time exogenous polyneuropathies, including alcoholic, arsenical, etc., and endogenous, napr, diabetic, renal are observed.

Treatment of diseases of P. of N of page is directed to elimination of action etiol, a factor and to improvement of exchange and trophic processes and microcirculation in nervous tissue. For this purpose appoint vitamins of group B, Aminalonum, komplamin, trental, andekalin, stimulators of carrying out nervous impulses apply (prozerin and its derivatives), diathermy (see), impulse currents (see), electrophoresis (see), massage (see), physiotherapy exercises (see), sanatorium treatment (see. Resorts , Sanatorium selection, table ), electrostimulation of nerves and muscles of extremities (see. Electrostimulation ). At indications operational treatment is carried out.

Features of fighting damages, stage treatment. Fighting damages of P. of N of page meet often and have nek-ry features in comparison with damages of peace time. As shows experience of the Great Patriotic War of 1941 — 1945, these damages make 8 — 10% of all fighting injuries. At the same time bullet wounds of P. of N of page were observed in 56,9% of cases, fragmental — in 41,5%, other — in 1,6%. Injuries of nerves of upper extremities (61,6%) were more often noted, is more rare — lower (38,4%). Wounds of nerves are often combined with injuries of bones and joints, and also quite often large blood vessels. At multiple damages with existence of several wound channels on one extremity, the same nerve can be injured at various levels. The gunshot wounds of P. of N of page which are followed by extensive damages of fabrics are, as a rule, infected that negatively influences regeneration of a nerve.

Keeping of the first medical, the first medical and qualified medical aid in the N of page who was injured with P.'s wounds is defined first of all by damages, life-threatening and demanding urgent interventions.

At all stages of medical evacuation at P.'s wounds of N of page imposing of a bandage on a wound and an immobilization of an extremity is carried out; apply analgetic means. Specialized medical aid by the wounded with P.'s damages by N of page appears in to lay down. institutions of a neurologic and neurosurgical profile of hospital base of the front and to lay down. institutions of the back.

In the GO system wounded with P.'s damage by N of page also accommodate in the pro-thinned-out institutions hospital base (see) for receiving the specialized help. Treatment of wounded with P.'s damages by N of page to specialized institutions consists in the correct combination operational and conservative (medicamentous, physiotherapeutic, etc.) methods. When conservative treatment within 1 — 1,5 month did not yield positive takes, wounded with the closed P.'s damages by N of page are subject to operational treatment (see. Neurolysis , Nervous seam ).

Bibliography: Grigorovich K. A. Value of a type of an injury for the result of injury of a nerve, Vestn, hir., t. 117, No. 7, page 128, 1976; R.'s Hares 3. Treatment of injuries of nervous trunks of extremities, L., 1976; M. B. and Fedorov E. A. Crawl. Main neuropathological syndromes, M., 1966; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 20, M., 1952; Sketches of field surgery, under the editorship of Yu. G. Shaposhnikov, M., 1977; Polonsky S. P. Diagnosis of damages of spinal nerves, L., 1957; Culms And. H. The organization of medical care by the wounded with damage of peripheral nerves at stages of evacuation, Voyen. - medical zhurn., No. 1, page 19, 1975; Brain W. R. Brain’s clinical neurology, p. 197, Oxford a. o., 1978; Handbook of clinical neurology, ed. by P. J. Vin-ken a. J. W. Bruyn, v. 7 — 8, Amsterdam — N. Y., 1975; Neurologie, Grundlagen und Klinik, hrsg. v. J. Quandt u. H.Sommer, S. 281, Lpz., 1974.

D. K. Bogorodinsky, A. A. Skoromets; P. 3. Hares (soldier.).