Penna Anthony, Konstantatos Alex H, Cranwell William, Paul Eldho, Bruscino-Raiola Francesco-Raffaele
Department of Plastic, Hand and Faciomaxillary Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
ANZ J Surg. 2018 May;88(5):491-496. doi: 10.1111/ans.14293. Epub 2018 Apr 14.
The painful post amputation neuroma significantly impairs the prosthesis-wearing lower-limb amputee. It remains poorly understood, with literature limited to cohorts of traumatic amputees. This paper reports the incidence and associations of painful neuroma in a modern tertiary centre with a case load of amputations performed for both traumatic and non-traumatic indications.
This retrospective cohort study analysed the records of 304 patients who underwent all-cause lower-limb amputation at The Alfred Hospital between January 2002 and March 2012. Patients were included in our analysis if they completed 1-year follow-up at our Amputee Rehabilitation Clinic, producing a final cohort of 96 patients. In order to identify a painful neuroma post-operatively, both clinical suspicion, and either histopathological or radiological evidence were required.
The overall incidence of symptomatic neuromas was 4.17%. There was no significant difference between patients who underwent amputation for a traumatic indication (6.25% (2/32) versus 3.13% (2/64); P = 0.59) compared to non-traumatic indication (P = 0.59). Visual analogue score at discharge and the presence of phantom limb pain at follow-up showed significant associations with the formation of painful neuroma. Dose of opioid on discharge, history of depression and current smoking did not reach statistical significance.
This study presents a lower incidence of painful post-amputation neuroma to those published in the literature. This may be attributed to improved methodology. The described associations require further investigation into central factors leading to neuroma sensitization.
截肢后疼痛性神经瘤严重影响下肢截肢患者佩戴假肢。目前对此了解甚少，相关文献仅限于创伤性截肢患者队列。本文报告了在一家现代三级中心，因创伤性和非创伤性指征进行截肢手术的病例中，疼痛性神经瘤的发生率及相关因素。
这项回顾性队列研究分析了2002年1月至2012年3月在阿尔弗雷德医院接受全因下肢截肢的304例患者的记录。如果患者在我们的截肢康复诊所完成了1年的随访，则纳入我们的分析，最终队列有96例患者。为了术后确定疼痛性神经瘤，需要临床怀疑以及组织病理学或放射学证据。
有症状神经瘤的总体发生率为4.17%。因创伤性指征截肢的患者与因非创伤性指征截肢的患者之间无显著差异（6.25%（2/32）对3.13%（2/64）；P = 0.59）。出院时的视觉模拟评分和随访时幻肢痛的存在与疼痛性神经瘤的形成显著相关。出院时的阿片类药物剂量、抑郁病史和当前吸烟情况未达到统计学意义。
本研究显示截肢后疼痛性神经瘤的发生率低于文献报道。这可能归因于方法的改进。所描述的相关性需要进一步研究导致神经瘤敏感化的中枢因素。
