神经断端肌肉内埋入法治疗汶川地震截肢伤员痛性神经瘤
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摘要
目的探讨神经断端肌肉内埋入法治疗地震伤截肢残端痛性神经瘤的临床疗效。方法应用神经断端肌肉内埋入法治疗汶川地震伤截肢伤员痛性神经瘤12例27处,观察术后症状、体征及患肢功能改变情况。结果 12例全部获随访12～26个月,平均16个月。随访时患者主诉肢体残端疼痛和触电感消失;局部无压痛、叩击痛和Tinel征,残端软组织内未触及硬性结节或包块;患肢功能较术前明显改善。结论 采用神经断端肌肉内埋入法治疗地震伤截肢残端痛性神经瘤,可减轻痛苦,疗效确切。
Objective To investigate the clinical efficacy of a painful stump neuroma treatment by resection and nerve stump implantation into muscle in treating Wenchuan earthquake amputees.Methods In 12 Wenchuan earthquake amputees(27 painful neuromas),painful neuroma underwent resection and implantation into the nearby muscle.Changes of symptoms and limb function were observed.Results All the cases were followed up for 12-26 months with an average of 16 months.It was shown that limb stump pain and "electric - shock" sensation disappeared without any local tenderness,percussion tenderness or Tinel sign.The soft tissue nodule or mass of limb stump disappeared.Limb function improved,compared with preoperative evaluation.Conclusions Resection and nerve stump implantation into muscle is a feasible and effective method for treatment of painful stump neuroma after amputation.
Objective To investigate the clinical efficacy of a painful stump neuroma treatment by resection and nerve stump implantation into muscle in treating Wenchuan earthquake amputees.Methods In 12 Wenchuan earthquake amputees(27 painful neuromas),painful neuroma underwent resection and implantation into the nearby muscle.Changes of symptoms and limb function were observed.Results All the cases were followed up for 12-26 months with an average of 16 months.It was shown that limb stump pain and "electric - shock" sensation disappeared without any local tenderness,percussion tenderness or Tinel sign.The soft tissue nodule or mass of limb stump disappeared.Limb function improved,compared with preoperative evaluation.Conclusions Resection and nerve stump implantation into muscle is a feasible and effective method for treatment of painful stump neuroma after amputation.
引文
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[3]郭义柱,张伯勋,梁雨田,等.截肢时神经断端肌肉内埋入预防残端神经瘤[J].中国临床康复,2003,7 (20):2850-2851.
[4]张伯勋,郭义柱,梁雨田,等.神经断端肌肉埋入防治残端神经瘤的临床应用[J].中国修复重建外科杂志,1998,12(2):86-87.
[5]Kim P S,Ko J,OShaughnessy K K,et al.Novel model for end - neuroma formation in the amputated rabbit forelimb [J].J Brachial Plex Peripher Nerve Inj,2010,5: 6.
[6]曾宪敏,王晓红,徐健,等.四川什邡地震灾后截肢、脊髓损伤、颅脑损伤伤员康复状况调查[J].中国康复医学杂志,2010,25(8):771-774.
[7]Ducic I,Mesbahi A N,Attinger C E,et al.The role of peripheral nerve surgery in the treatment of chronic pain associated with amputation stumps[J].Plast Reconstr Surg,2008,121(3):908-914.
[8]LI Qinglin,XU Zemin,LI Jun,et al.Experimental study of pedicled skeletal muscle to bridge proximal ends of peripheral nerve for prevention and cure of stump pain caused by neuroma[J].J Norman Bethune University Med Sci,2001,27(2):161 -163.
[9]李庆霖.带蒂骨骼肌桥接近端周围神经防治残端痛性神经瘤的实验与临床应用研究[J].中国骨伤, 2004,17(11):650-652.
[10]张伯勋,郭义柱,梁雨田,等.神经断端肌内埋入防治残端神经瘤的实验研究[J].中国修复重建外科杂志,1997,11(6):325-327.
[2]Koch H,Haas F,Hubmer,M,et al.Treatment of painful neuroma by resection and nerve stump transplantation intoavein[J].Ann Plast Surg,2003,51(1):45- 50.
[3]郭义柱,张伯勋,梁雨田,等.截肢时神经断端肌肉内埋入预防残端神经瘤[J].中国临床康复,2003,7 (20):2850-2851.
[4]张伯勋,郭义柱,梁雨田,等.神经断端肌肉埋入防治残端神经瘤的临床应用[J].中国修复重建外科杂志,1998,12(2):86-87.
[5]Kim P S,Ko J,OShaughnessy K K,et al.Novel model for end - neuroma formation in the amputated rabbit forelimb [J].J Brachial Plex Peripher Nerve Inj,2010,5: 6.
[6]曾宪敏,王晓红,徐健,等.四川什邡地震灾后截肢、脊髓损伤、颅脑损伤伤员康复状况调查[J].中国康复医学杂志,2010,25(8):771-774.
[7]Ducic I,Mesbahi A N,Attinger C E,et al.The role of peripheral nerve surgery in the treatment of chronic pain associated with amputation stumps[J].Plast Reconstr Surg,2008,121(3):908-914.
[8]LI Qinglin,XU Zemin,LI Jun,et al.Experimental study of pedicled skeletal muscle to bridge proximal ends of peripheral nerve for prevention and cure of stump pain caused by neuroma[J].J Norman Bethune University Med Sci,2001,27(2):161 -163.
[9]李庆霖.带蒂骨骼肌桥接近端周围神经防治残端痛性神经瘤的实验与临床应用研究[J].中国骨伤, 2004,17(11):650-652.
[10]张伯勋,郭义柱,梁雨田,等.神经断端肌内埋入防治残端神经瘤的实验研究[J].中国修复重建外科杂志,1997,11(6):325-327.
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