Jain Sonu A, Nydick Jason, Leversedge Fraser, Power Dominic, Styron Joseph, Safa Bauback, Buncke Gregory
The Ohio State University Wexner Medical Center, Columbus, Ohio.
Florida Orthopaedic Institute, Tampa, Fla.
Plast Reconstr Surg Glob Open. 2021 Oct 4;9(10):e3832. doi: 10.1097/GOX.0000000000003832. eCollection 2021 Oct.
Neuromas causing sensory disturbance can substantially affect nerve function and quality of life. Historically, passive termination of the nerve end and proximal relocation to muscle or bone has been performed after neuroma resection, but this method does not allow for neurologic recovery or prevent recurrent neuromas. The use of processed nerve allografts (PNAs) for intercalary reconstruction of nerve defects following neuroma resection is reasonable for neuroma management, although reported outcomes are limited. The purpose of this study was to assess the outcomes of pain reduction and functional recovery following neuroma resection and intercalary nerve reconstruction using PNA.
Data on outcomes of PNA use for peripheral nerve reconstruction were collected from a multicenter registry study. The registry database was queried for upper extremity nerve reconstruction with PNA after resection of symptomatic neuroma. Patients completing both pain and quantitative sensory assessments were included in the analysis. Improvement in pain-related symptoms was determined via patient self-reported outcomes and/or the visual analog scale. Meaningful sensory recovery was defined as a score of at least S3 on the Medical Research Council Classification scale.
Twenty-five repairs involving 21 patients were included in this study. The median interval from injury to reconstruction was 386 days, and the average nerve defect length was 31 mm. Pain improved in 80% of repairs. Meaningful sensory recovery was achieved in 88% of repairs.
Neuroma resection and nerve reconstruction using PNA can reduce or eliminate chronic peripheral nerve pain and provide meaningful sensory recovery.
导致感觉障碍的神经瘤会严重影响神经功能和生活质量。从历史上看，神经瘤切除术后采用神经末端的被动终止以及近端重新定位到肌肉或骨骼的方法，但这种方法无法实现神经功能恢复或预防复发性神经瘤。尽管报道的结果有限，但使用处理过的同种异体神经移植物（PNA）进行神经瘤切除术后神经缺损的间置重建对于神经瘤的治疗是合理的。本研究的目的是评估使用PNA进行神经瘤切除和间置神经重建后疼痛减轻和功能恢复的结果。
从一项多中心注册研究中收集了使用PNA进行周围神经重建的结果数据。在有症状的神经瘤切除术后，查询注册数据库中使用PNA进行上肢神经重建的情况。完成疼痛和定量感觉评估的患者纳入分析。通过患者自我报告的结果和/或视觉模拟量表确定疼痛相关症状的改善情况。有意义的感觉恢复定义为医学研究委员会分类量表上至少为S3分。
本研究纳入了涉及21例患者的25例修复手术。从损伤到重建的中位间隔时间为386天，平均神经缺损长度为31毫米。80%的修复手术疼痛得到改善。88%的修复手术实现了有意义的感觉恢复。
使用PNA进行神经瘤切除和神经重建可以减轻或消除慢性周围神经疼痛，并提供有意义的感觉恢复。
