Poyntz Stephanie A, Hacking Nicholas M, Dalal Milind, Fowler Stephen
Foundation Year 2 Doctor.
Departments of Plastic Surgery.
Clin J Pain. 2018 Mar;34(3):285-295. doi: 10.1097/AJP.0000000000000533.
Painful stump neuromas in lower limb amputees are a significant burden on a person's quality of life due to interference with wearing prostheses and therefore the ability to walk. Treating painful stump neuromas is a challenge perhaps reflected by the lack of clinical guidelines.
A systematic review was conducted to evaluate the efficacy of all treatments tried in the management of symptomatic neuromas in the lower limb amputation stump in order to establish whether one treatment is superior.
Twenty-two studies were included in the final review which examined 14 different treatments both surgical and nonsurgical. Results showed that no single treatment showed superiority.
The 4 treatments that showed most promise included targeted nerve implantation, traction neurectomy, nerve-to-nerve anastomosis, and perineurial gluing. The short follow-up times and small sample sizes of the studies highlighted the need for more robust clinical studies.
下肢截肢者的疼痛性残端神经瘤会干扰假肢佩戴，进而影响行走能力，给患者的生活质量带来沉重负担。治疗疼痛性残端神经瘤颇具挑战，这或许可从缺乏临床指南中得到体现。
进行了一项系统综述，以评估在下肢截肢残端症状性神经瘤管理中尝试的所有治疗方法的疗效，从而确定是否有一种治疗方法更具优势。
最终综述纳入了22项研究，这些研究考察了14种不同的手术和非手术治疗方法。结果表明，没有单一治疗方法显示出优势。
最具前景的4种治疗方法包括靶向神经植入、牵引性神经切除术、神经对神经吻合术和神经束膜粘合术。研究的随访时间短和样本量小凸显了开展更有力临床研究的必要性。
