Prantl Lukas, Schreml Stephan, Heine Norbert, Eisenmann-Klein Marita, Angele Peter
Regensburg, Germany From the Institute of Plastic Surgery and Department of Trauma and Reconstructive Surgery, University Hospital Regensburg.
Plast Reconstr Surg. 2006 Dec;118(7):1562-1572. doi: 10.1097/01.prs.0000233048.15879.0e.
Therapy for phantom sensation and phantom limb pain following amputation is still difficult, because pathophysiologic mechanisms have not been clarified. This report illustrates a simple and useful surgical intervention. The authors propose that changes at the peripheral nerve site can influence the central feeling of phantom sensation and pain.
Fifteen patients (mean age, 56 years) with lower limb amputation were included in the study. In all patients, the sciatic nerve was split at a point approximately 3 cm proximal to the popliteal fossa, and the two parts were reconnected in a sling fashion using an epiperineurial technique under microscopic vision. The nerves were covered with a fibrin patch and anesthetics were applied by means of a local pain catheter. Frequency, duration, intensity, and quality of phantom pain were compared preoperatively and 1 week, 3 months, 6 months, and 1 year postoperatively.
Fourteen of 15 patients defined the procedure as very helpful. Average, maximum, and minimum pain intensity were significantly reduced 1 week, 3 months, 6 months, and 1 year postoperatively (p < 0.001). Pain intensity scores decreased significantly over the long term after surgical intervention (median visual analogue scale score: preoperatively, 7; 1 year postoperatively, 4) (p < 0.001). The duration of pain attack shortened from approximately 120 minutes to 5 to 10 minutes.
This study shows that accurate treatment of the peripheral nerve can help to successfully reduce phantom limb pain. The authors feel encouraged to perform future investigations to test their operative method in a prospective, randomized, matched control study including electrophysiologic tests for more objective pain assessment.
截肢后幻肢感觉和幻肢痛的治疗仍然困难，因为其病理生理机制尚未阐明。本报告介绍了一种简单且有用的手术干预方法。作者提出，周围神经部位的变化会影响幻肢感觉和疼痛的中枢感受。
本研究纳入了15例下肢截肢患者（平均年龄56岁）。在所有患者中，坐骨神经在腘窝近端约3 cm处进行分离，然后在显微镜下采用神经外膜技术将两部分以吊带方式重新连接。神经用纤维蛋白贴片覆盖，并通过局部疼痛导管应用麻醉剂。比较术前以及术后1周、3个月、6个月和1年时幻肢痛的频率、持续时间、强度和性质。
15例患者中有14例认为该手术非常有帮助。术后1周、3个月、6个月和1年时，平均、最大和最小疼痛强度均显著降低（p < 0.001）。手术干预后，疼痛强度评分长期显著降低（视觉模拟量表评分中位数：术前为7分；术后1年为4分）（p < 0.001）。疼痛发作的持续时间从约120分钟缩短至5至10分钟。
本研究表明，准确治疗周围神经有助于成功减轻幻肢痛。作者鼓励在未来进行研究，以在前瞻性、随机、匹配对照研究中测试他们的手术方法，包括进行电生理测试以进行更客观的疼痛评估。
