Pet Mitchell A, Ko Jason H, Friedly Janna L, Smith Douglas G
*Division of Plastic and Reconstructive Surgery, Harborview Medical Center, University of Washington, Seattle, WA; and Departments of †Rehabilitation Medicine, and ‡Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
J Orthop Trauma. 2015 Sep;29(9):e321-5. doi: 10.1097/BOT.0000000000000337.
To describe the outcomes of traction neurectomy as a surgical treatment for symptomatic neuroma of the residual lower extremity and to identify clinical and/or demographic factors associated with an increased likelihood of persistent or recurrent pain after surgery.
Retrospective Cohort Study.
Amputee clinic at a Level I Trauma Center.
Inclusion required a history of transfemoral or transtibial amputation and a history of symptomatic neuroma(s) at the residual limb treated with traction neurectomy. Twelve months of clinical follow-up or the recurrence of neuroma-type pains was required for inclusion. Thirty-eight patients (63 nerves) comprised the study group.
Traction neurectomy for treatment of symptomatic neuroma.
The primary outcome was the presence or absence of persistent or recurrent neuroma-type pain at last follow-up. The secondary outcome was reoperation for persistent or recurrent symptomatic neuroma.
Sixteen of 38 patients (42%) had recurrent or persistent neuroma-type pain at a mean follow-up of 37 months (range, 11-91 months), and 8/38 (21%) have undergone subsequent surgical treatment. Among the demographic and clinical features examined, only male gender was found to be a statistically significant predictor of persistent or recurrent neuroma-type pain.
Traction neurectomy results in a high rate of persistent or recurrent neuroma-type and that surgeons should be cautious when considering it for the treatment of symptomatic neuroma of the residual lower extremity. Furthermore, efforts to identify better surgical and nonsurgical treatments for this problem are justified.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
描述牵引神经切除术作为残余下肢症状性神经瘤外科治疗方法的疗效，并确定与术后持续性或复发性疼痛可能性增加相关的临床和/或人口统计学因素。
回顾性队列研究。
一级创伤中心的截肢门诊。
纳入标准要求有经股骨或经胫骨截肢史，且对接受牵引神经切除术治疗的残肢有症状性神经瘤病史。纳入标准还要求有12个月的临床随访或神经瘤型疼痛复发。38名患者（63条神经）组成研究组。
采用牵引神经切除术治疗症状性神经瘤。
主要观察指标是最后一次随访时是否存在持续性或复发性神经瘤型疼痛。次要观察指标是因持续性或复发性症状性神经瘤进行再次手术。
38例患者中有16例（42%）在平均37个月（范围11 - 91个月）的随访中有复发性或持续性神经瘤型疼痛，8/38（21%）接受了后续手术治疗。在所检查的人口统计学和临床特征中，仅发现男性是持续性或复发性神经瘤型疼痛的统计学显著预测因素。
牵引神经切除术导致持续性或复发性神经瘤型疼痛的发生率较高，外科医生在考虑将其用于治疗残余下肢症状性神经瘤时应谨慎。此外，有理由努力寻找针对该问题更好的手术和非手术治疗方法。
治疗性四级证据。有关证据水平的完整描述，请参阅作者指南。
