Krishnan Kartik G, Pinzer Thomas, Schackert Gabriele
Department of Neurological Surgery, Carl Gustav Carus University Hospital, Technical University of Dresden, Fetscherstrasse 74, Dresden, Germany.
Neurosurgery. 2005 Apr;56(2 Suppl):369-78; discussion 369-78. doi: 10.1227/01.neu.0000156881.10388.d8.
Our goals are to describe a method of treating painful peripheral nerve neuromas by means of vascularized tissue coverage, report the results in seven patients, and discuss the indications for this treatment modality. An analysis of pain, functionality of the affected body part, professional activities of the patients, and medications before and after surgery is presented.
Seven male patients (mean age, 45.1 yr) with posttraumatic nerve injuries, who had developed painful stump neuromas or neuromas-in-continuity, and who had unsuccessfully undergone several treatment procedures, were selected for the surgery described here. The operation included resection of the stump neuroma (four patients) or neurolysis of the neuroma-in-continuity (three patients) and coverage of the nerve with a vascularized fascial, fasciocutaneous, or perforator flap (three pedicled regional flaps and four free flaps). A modified quadruple visual analog scale was used to quantify pain before and after surgical treatment. The mean follow-up was 16.6 months.
The mean values of the quadruple visual analog scale (pain now/typically/at its best/at its worst) before surgery were 6.5/6.5/4.7/7.9. These values changed to 0.3/0.4/0/0.9 at a mean follow-up of 16.6 months after surgery. Five patients returned to their original profession, one receives a pension, and one began a less demanding job after undergoing surgery. Six of the seven patients received opioids before surgery (one had a spinal cord stimulator). After surgery, all patients stopped taking regular pain killers and the spinal cord stimulator was deactivated in one; two patients still take nonsteroidal anti-inflammatory drugs occasionally, but not on a regular basis.
Vascularized soft tissue coverage of painful peripheral nerve neuromas seems to be an effective and attractive, but also complex, method of treatment. This option may be considered and reserved for patients who have already undergone several pain treatment modalities without success.
我们的目标是描述一种通过带血管组织覆盖来治疗疼痛性周围神经神经瘤的方法，报告7例患者的治疗结果，并讨论这种治疗方式的适应证。本文对患者手术前后的疼痛情况、患侧身体部位的功能、职业活动以及用药情况进行了分析。
选择7例男性患者（平均年龄45.1岁），这些患者均有创伤后神经损伤，已形成疼痛性残端神经瘤或连续性神经瘤，且经过多种治疗方法均未成功，接受了本文所述的手术。手术包括切除残端神经瘤（4例患者）或对连续性神经瘤进行神经松解术（3例患者），并用带血管的筋膜瓣、筋膜皮瓣或穿支皮瓣覆盖神经（3个带蒂局部皮瓣和4个游离皮瓣）。采用改良的四重视觉模拟量表对手术治疗前后的疼痛进行量化。平均随访时间为16.6个月。
手术前四重视觉模拟量表（现在的疼痛/典型疼痛/最佳状态下的疼痛/最严重时的疼痛）的平均值分别为6.5/6.5/4.7/7.9。在术后平均16.6个月的随访中，这些值变为0.3/0.4/0/0.9。5例患者恢复了原来的职业，1例领取养老金，1例术后开始从事要求较低的工作。7例患者中有6例在手术前服用阿片类药物（1例有脊髓刺激器）。术后，所有患者均停止服用常规止痛药，1例患者的脊髓刺激器停用；2例患者仍偶尔服用非甾体抗炎药，但不规律。
带血管软组织覆盖疼痛性周围神经神经瘤似乎是一种有效且有吸引力但也较为复杂的治疗方法。对于已经接受多种疼痛治疗方法但未成功的患者，可以考虑并选择这种治疗方式。
