Student, Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.
Hand Therapist, Hand and Wrist Center The Hague, The Hague, The Netherlands.
J Foot Ankle Surg. 2021 Mar-Apr;60(2):386-390. doi: 10.1053/j.jfas.2020.08.016. Epub 2020 Aug 19.
Processed nerve allografts are used increasingly in the treatment of traumatic neuroma in small sensory nerves. The goal of the present study was to investigate the use of an allograft after different intervals between injury and repair and to analyze results, not only for the success of pain relief, but also for potential recovery of sensation in time. Four patients with painful neuroma in small sensory nerves in the lower extremity were surgically treated with a decellularized allograft. Patients were followed prospectively for at least 1 y. Clinical outcome was assessed using the Likert scale. Recovery of sensation was tested using Semmes-Weinstein monofilaments. In all 4 cases an allograft of 3-cm was used to reconstruct a defect in the superficial peroneal (3) or sural nerve (1) after excision of the neuroma. Complete relief of pain symptoms was achieved in 2 patients: 1 case concerned the reconstruction of a neuroma with an interval of less than 1 y between injury and repair and 1 case a neuroma-in-continuity. Sensation recovered completely in these 2 cases. In the other 2 cases, that had an interval between injury and reconstruction of more than 1 y, there was neither successful pain relief nor recovery of sensation. This prospective study shows that processed nerve allografts can be successful for the reconstruction of small sensory nerves after excision of the traumatic neuroma both for recovery of pain and sensation, but in this small case series only if the interval between injury and reconstruction was <1 y.
处理过的同种异体神经在治疗小感觉神经创伤性神经瘤中越来越多地被使用。本研究的目的是研究在损伤和修复之间不同时间间隔后同种异体神经的使用，并分析结果，不仅要考虑到缓解疼痛的成功，还要考虑到感觉的潜在恢复时间。 4 例下肢小感觉神经创伤性神经瘤患者接受了脱细胞同种异体神经移植手术治疗。患者至少随访 1 年。使用 Likert 量表评估临床结果。使用 Semmes-Weinstein 单丝测试感觉恢复情况。在所有 4 例病例中，均使用 3cm 同种异体神经移植物来重建切除神经瘤后腓浅神经（3 例）或腓肠神经（1 例）的缺损。在 2 例患者中完全缓解了疼痛症状：1 例为神经瘤重建，损伤与修复之间的间隔时间小于 1 年，1 例为连续性神经瘤。这 2 例患者的疼痛完全缓解，感觉完全恢复。在另外 2 例损伤与重建之间的间隔时间超过 1 年的患者中，既没有成功缓解疼痛，也没有恢复感觉。这项前瞻性研究表明，处理过的同种异体神经可以成功地用于切除创伤性神经瘤后的小感觉神经重建，无论是在疼痛缓解还是感觉恢复方面，但在这个小病例系列中，只有在损伤和重建之间的间隔时间<1 年的情况下才如此。
