Boroumand M Reza, Schulz Dirk, Uhl Eberhard, Krishnan Kartik G
Division of Reconstructive Neurosurgery, Department of Neurosurgery, Justus Liebig University, Giessen, Germany.
Division of Reconstructive Neurosurgery, Department of Neurosurgery, Justus Liebig University, Giessen, Germany.
World Neurosurg. 2015 Sep;84(3):681-7. doi: 10.1016/j.wneu.2015.04.038. Epub 2015 Apr 30.
Stump neuroma pain in amputees can be quite challenging. Surgical treatment may be largely subdivided into neuromodulative and non-neuromodulative methods. The latter includes neurocapsis, insertion of nerve stump into the bone marrow, centro-central short circuit (CCSC), and coverage with vascularized soft tissue flaps. CCSC was shown to be extremely effective in alleviation of pain. Reports on CCSC for the treatment of stump neuroma pain have disappeared from the literature, with a shift toward neuromodulation for the treatment of pain irrespective of etiology.
We observed 8 lower limb amputees undergoing CCSC of the sciatic nerve during a follow-up of 12 years. All had the same stump neuroma pain rendering them unable to wear their prostheses. The sciatic nerve was explored at the midthigh area, much proximal to the amputation site, and a short circuit was established between the tibial and peroneal parts of the nerve. Assessment was by means of pain quantification as per the quadruple visual analogue scale, medication intake, and ability to use prostheses.
The median worst quadruple visual analogue scale before surgery was 8.0. After surgery it decreased to 2.5 (P = 0.00094). Medication intake was reduced from regular intake of a combination of opioids, nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, and pregabalin in all patients to irregular intake of nonsteroidal anti-inflammatory drug alone in 3 of 8 patients. All patients were able to wear their limb prosthesis since surgery.
CCSC is a simple, effective, and long-lasting method to treat painful stump neuromas in amputees. It should be strongly considered in deserving cases before resorting to neuromodulative methods.
截肢者的残端神经瘤疼痛极具挑战性。手术治疗大致可分为神经调节和非神经调节方法。后者包括神经包埋、将神经残端插入骨髓、中枢-中枢短路（CCSC）以及用带血管的软组织瓣覆盖。已证明CCSC在缓解疼痛方面极为有效。关于CCSC治疗残端神经瘤疼痛的报道已从文献中消失，转而倾向于无论病因如何均采用神经调节来治疗疼痛。
我们观察了8例下肢截肢者，在12年的随访期间对其坐骨神经进行CCSC。所有人都有相同的残端神经瘤疼痛，导致他们无法佩戴假肢。在大腿中部区域（远高于截肢部位）探查坐骨神经，并在神经的胫部和腓部之间建立短路。通过四重视觉模拟量表进行疼痛量化评估、药物摄入情况以及使用假肢的能力。
术前四重视觉模拟量表的最差中位数为8.0。术后降至2.5（P = 0.00094）。药物摄入从所有患者常规服用阿片类药物、非甾体抗炎药、三环类抗抑郁药和普瑞巴林的组合，减少到8例患者中有3例仅不定期服用非甾体抗炎药。自手术以来，所有患者都能够佩戴假肢。
CCSC是一种治疗截肢者疼痛性残端神经瘤的简单、有效且持久的方法。在采用神经调节方法之前，对于合适的病例应强烈考虑使用该方法。
