Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Pain. 2010 Dec;151(3):862-869. doi: 10.1016/j.pain.2010.09.032. Epub 2010 Oct 25.
Painful neuromas can cause severe loss of function and have great impact on the daily life of patients. Surgical management remains challenging; despite improving techniques, success rates are low. To accurately study the success of surgical neuroma treatment and factors predictive of outcome, a prospective follow-up study was performed. Between 2006 and 2009, pre- and post-operative questionnaires regarding pain (VAS, McGill), function (DASH), quality of life (SF-36), symptoms of psychopathology (SCL-90), epidemiologic determinants and other outcome factors were sent to patients surgically treated for upper extremity neuroma pain. Pain scores after diagnostic nerve blocks were documented at the outpatient clinic before surgery. Thirty-four patients were included, with an average follow up time of 22 months. The mean VAS score decreased from 6.8 to 4.9 after surgery (p<0.01), 19 (56%) of patients were satisfied with surgical results. Upper extremity function improved significantly (p=0.001). Neuroma patients had significantly lower quality of life compared to a normal population. Employment status, duration of pain and CRPS symptoms were found to be prognostic factors. VAS scores after diagnostic nerve block were predictive of post-operative VAS scores (p=0.001). Furthermore, smoking was significantly related to worse outcome (relative risk: 2.10). The results could lead to improved patient selection and treatment strategies. If a diagnostic nerve block is ineffective in relieving pain, patients will most likely not benefit from surgical treatment. Patients should be encouraged to focus on activity and employment instead of their symptoms. Smoking should be discouraged in patients who will undergo surgical neuroma treatment.
疼痛性神经瘤可导致严重的功能丧失，极大地影响患者的日常生活。尽管手术技术不断改进，但成功率仍然较低。为了准确研究手术神经瘤治疗的成功率和预测结果的因素，进行了一项前瞻性随访研究。2006 年至 2009 年期间，对接受上肢神经瘤疼痛手术治疗的患者，术前和术后分别通过问卷（视觉模拟评分法、麦吉尔疼痛问卷）、功能（残疾程度指数量表）、生活质量（SF-36 量表）、心理病理学症状（症状自评量表）、流行病学决定因素和其他结局因素进行前瞻性随访。手术前在门诊记录诊断性神经阻滞后的疼痛评分。共纳入 34 例患者，平均随访时间为 22 个月。术后 VAS 评分从 6.8 分降至 4.9 分（p<0.01），19 例（56%）患者对手术结果满意。上肢功能显著改善（p=0.001）。神经瘤患者的生活质量明显低于正常人群。就业状况、疼痛持续时间和复杂性区域疼痛综合征症状被认为是预后因素。诊断性神经阻滞后的 VAS 评分可预测术后 VAS 评分（p=0.001）。此外，吸烟与预后较差显著相关（相对风险：2.10）。这些结果可能导致更好的患者选择和治疗策略。如果诊断性神经阻滞不能缓解疼痛，患者很可能无法从手术治疗中获益。应鼓励患者关注活动和就业，而不是关注症状。应劝阻即将接受手术神经瘤治疗的患者吸烟。
