Chang Brian L, Harbour Patrick, Mondshine Josh, Kleiber Grant M
Department of Plastic Surgery, MedStar Georgetown University Hospital; Washington, D.C.
Georgetown University School of Medicine, Washington, D.C.
Plast Reconstr Surg Glob Open. 2021 Feb 16;9(2):e3436. doi: 10.1097/GOX.0000000000003436. eCollection 2021 Feb.
Symptomatic neuromas can cause debilitating pain, significantly impairing patients' quality of life. There are numerous medical and surgical options for management. Targeted muscle reinnervation (TMR) is a nerve transfer procedure that is now commonly used to prevent or treat symptomatic neuromas or phantom limb pain in amputees. There are a few reports in the current literature about performing TMR in the nonamputee, but no cohort studies to date that report pain outcomes. This study evaluates TMR to treat symptomatic neuromas in nonamputee patients. This is a retrospective cohort study of all patients with symptomatic neuromas treated with TMR over a 1-year period from January 1,2019, to January 1, 2020, at MedStar Georgetown University Hospital. The neuromas are excised to healthy nerve fascicles, and a redundant donor motor fascicle is selected for nerve transfer. Patients were asked in clinic or via telephone about their preoperative and postoperative pain, function, and quality of life, and postoperative clinic notes were reviewed for complications and motor deficits. Fifteen patients were included in this study. Patients had symptomatic neuromas involving the upper extremity, lower extremity, and trunk. Pain frequency decreased from 6.7 times per week to 3.9 ( < 0.01) and from 9.1 times per day to 5.1 ( < 0.01). Pain severity decreased from an average of 7.9/10 to 4.3/10 ( < 0.01). Overall physical function increased from 3.7/10 to 5.8/10 ( = 0.01), and overall quality of life increased from 4.9/10 to 7.0/10 ( < 0.01). No patients had demonstrable weakness of the motor function of the donor nerve. Targeted muscle reinnervation is a viable surgical option for the treatment of symptomatic neuromas, particularly in those patients who have previously failed prior neuroma excisions.
有症状的神经瘤可导致使人衰弱的疼痛，严重损害患者的生活质量。治疗方法有多种医学和外科选择。靶向肌肉再支配术（TMR）是一种神经移植手术，目前常用于预防或治疗截肢患者的有症状神经瘤或幻肢痛。目前文献中有一些关于在非截肢患者中进行TMR的报道，但迄今为止尚无关于疼痛结果的队列研究。本研究评估TMR治疗非截肢患者有症状神经瘤的效果。这是一项回顾性队列研究，研究对象为2019年1月1日至2020年1月1日在MedStar乔治敦大学医院接受TMR治疗的所有有症状神经瘤患者。将神经瘤切除至健康的神经束，并选择一条多余的供体运动神经束进行神经移植。在诊所或通过电话询问患者术前和术后的疼痛、功能及生活质量，并查阅术后临床记录以了解并发症和运动功能缺陷情况。本研究纳入了15例患者。患者的有症状神经瘤累及上肢、下肢和躯干。疼痛频率从每周6.7次降至3.9次（<0.01），从每天9.1次降至5.1次（<0.01）。疼痛严重程度从平均7.9/10降至4.3/10（<0.01）。总体身体功能从3.7/10提高到5.8/10（=0.01），总体生活质量从4.9/10提高到7.0/10（<0.01）。没有患者出现供体神经运动功能的明显减弱。靶向肌肉再支配术是治疗有症状神经瘤的一种可行的手术选择，尤其是对于那些先前神经瘤切除失败的患者。
