Division of Plastic and Reconstructive Surgery, Department of Surgery, Anschutz Medical Center, University of Colorado, Boulder, Colorado.
Department of Orthopedics, Anschutz Medical Center, University of Colorado, Boulder, Colorado.
J Reconstr Microsurg. 2020 May;36(4):235-240. doi: 10.1055/s-0039-1700559. Epub 2019 Nov 5.
Secondary to vascular disease, oncological resection, or devastating trauma, lower extremity amputations are performed globally at a yearly rate exceeding 1 million patients. Three-quarters of these patients will develop chronic pain or phantom pain, which presents a functional limitation for prosthetic use and contributes to deconditioning and increased mortality. Targeted muscle reinnervation (TMR) presents a surgical solution to this problem as either a primary or secondary intervention.
A review of the existing literature was conducted using a combination of the terms "phantom pain" "chronic pain," "neuroma," and "targeted muscle reinnervation" in Medline and PubMed.
Five articles were found which addressed TMR for pain syndromes, four of which involved lower extremity amputation. Four of the articles were retrospective reviews, and one was a randomized control trial. A total of 149 patients were included, of which 82 underwent lower extremity amputation. Ninety-two of the patients underwent prophylactic TMR, of which 57 were secondary procedures.In patients who underwent TMR at the time of amputation, all studies reported a minimal development of symptomatic neuromas (27%). For secondary TMR, near-complete resolution of previous pain was found (90%). Phantom pain was noted to be similar to other studies in the literature but noted to improve over time with both primary (average drop of 3.5 out of 10 points on the numerical rating scale) and secondary (diminishing from 72% of patients to 13% over 6 months) operations.
Although much of the current literature is limited to retrospective studies with few patients, these data point toward near-complete resolution of neuroma pain after treatment as well as complete prevention of chronic pain if TMR is used as a prophylactic measure during the index amputation. THIS STUDY WAS A LEVEL OF EVIDENCE IV: .
由于血管疾病、肿瘤切除或严重创伤，全球每年有超过 100 万名患者接受下肢截肢手术。这些患者中有四分之三会出现慢性疼痛或幻肢痛，这会对假肢的使用造成功能限制，并导致身体机能下降和死亡率增加。靶向肌肉神经再支配（TMR）作为一种主要或次要的干预措施，为解决这个问题提供了一种手术解决方案。
通过在 Medline 和 PubMed 中使用“幻肢痛”“慢性疼痛”“神经瘤”和“靶向肌肉神经再支配”等术语组合，对现有文献进行了回顾。
共发现 5 篇文章涉及 TMR 治疗疼痛综合征，其中 4 篇涉及下肢截肢。其中 4 篇为回顾性研究，1 篇为随机对照试验。共纳入 149 例患者，其中 82 例接受下肢截肢。92 例患者接受预防性 TMR，其中 57 例为二期手术。在接受截肢时进行 TMR 的患者中，所有研究均报告称症状性神经瘤的发生率较低（27%）。对于二期 TMR，发现先前疼痛几乎完全缓解（90%）。幻肢痛与文献中的其他研究相似，但随着时间的推移，无论是一期（数字评分法平均下降 3.5 分）还是二期（6 个月内从 72%的患者降至 13%）手术，疼痛都有所改善。
尽管目前的大部分文献仅限于患者人数较少的回顾性研究，但这些数据表明，在接受治疗后，神经瘤疼痛几乎完全缓解，如果在指数截肢时将 TMR 用作预防措施，还可以完全预防慢性疼痛。本研究为证据等级 IV。
