Department of Plastic, Reconstructive and Hand surgery, Erasmus Medical Centre, Rotterdam, Netherlands.
Hand and Peripheral Nerve Surgery Service, Queen Elizabeth Hospital, Birmingham, UK.
J Plast Reconstr Aesthet Surg. 2022 Mar;75(3):948-959. doi: 10.1016/j.bjps.2021.11.076. Epub 2021 Dec 5.
Pain after amputation can be known as residual limb pain (RLP) or phantom limb pain (PLP); however, both can be disabling in daily life with reported incidences of 8% for finger amputations and up to 85% for major limb amputations. The current treatment is focused on reducing the pain after neuropathic pain occurs. However, surgical techniques to prevent neuropathic pain after amputation are available and effective, but they are underutilized. The purpose of the review is to investigate the effects of techniques during amputation to prevent neuropathic pain.
A systematic review was performed in multiple databases (Embase, Medline, Web of Science, Scopus, Cochrane, and Google Scholar) and following the PRISMA guidelines. Studies that reported surgical techniques to prevent neuropathic pain during limb amputation were included.
Of the 6188 selected studies, 13 eligible articles were selected. Five articles reported techniques for finger amputation: neurovascular island flap, centro-central union (CCU), and epineural ligatures, and flaps. For finger amputations, the use of prevention techniques resulted in a decrease of incidences from 8% to 0-3% with CCU being the most beneficial. For major limb amputations, the incidences for RLP were decreased to 0 to 55% with TMR and RPNI and compared to 64-91% for the control group. Eight articles reported techniques for amputations on major limbs: targeted muscle reinnervation (TMR), targeted nerve implantation, concomitant nerve coaptation, and regenerative peripheral nerve interface (RPNI).
Based on the current literature, we state that during finger and major limb amputation, the techniques to prevent neuropathic pain and PLP should be performed.
截肢后的疼痛可表现为残肢痛（RLP）或幻肢痛（PLP）；然而，这两种疼痛在日常生活中都可能导致残疾，报告的手指截肢发生率为 8%，而大肢体截肢的发生率高达 85%。目前的治疗方法主要集中在治疗神经病理性疼痛发生后的疼痛。然而，预防截肢后神经病理性疼痛的手术技术是可行且有效的，但却未得到充分利用。本综述的目的是调查预防截肢后神经病理性疼痛的技术效果。
在多个数据库（Embase、Medline、Web of Science、Scopus、Cochrane 和 Google Scholar）中进行了系统综述，并遵循 PRISMA 指南。纳入报告预防肢体截肢神经病理性疼痛手术技术的研究。
在 6188 项选定的研究中，有 13 项符合条件的文章被选中。有 5 篇文章报道了预防手指截肢神经病理性疼痛的技术：神经血管岛皮瓣、中央-中央联合（CCU）和神经外膜结扎，以及皮瓣。对于手指截肢，使用预防技术可将发病率从 8%降低至 0-3%，其中 CCU 最为有益。对于大肢体截肢，使用 TMR 和 RPNI 可将 RLP 的发生率降低至 0 至 55%，而对照组的发生率为 64-91%。有 8 篇文章报道了预防大肢体截肢神经病理性疼痛和 PLP 的技术：靶向肌肉神经再支配（TMR）、靶向神经植入、同时神经吻合和再生周围神经接口（RPNI）。
根据目前的文献，我们认为在手指和大肢体截肢时，应采用预防神经病理性疼痛和 PLP 的技术。
