Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Orthop Clin North Am. 2022 Apr;53(2):155-166. doi: 10.1016/j.ocl.2022.01.002. Epub 2022 Mar 8.
The effective management of peripheral nerves in amputation surgery is critical to optimizing patient outcomes. Nerve-related pain after amputation is common, maybe a source of dissatisfaction and functional impairment, and should be considered in all amputees presenting with pain and dysfunction. While traction neurectomy or transposition has long been the standard of care, both regenerative peripheral nerve interface (RPNI) and targeted muscle reinnervation (TMR) have emerged as promising techniques to improve neuroma-related and phantom pain. A multi-disciplinary and multi-modal approach is essential for the optimal management of amputees both acutely and in the delayed or chronic setting.
在截肢手术中有效管理周围神经对于优化患者的治疗效果至关重要。截肢后与神经相关的疼痛很常见，可能是导致患者不满和功能障碍的原因，对于所有出现疼痛和功能障碍的截肢患者，都应考虑这一因素。虽然牵拉神经切除术或神经转位术长期以来一直是标准的治疗方法，但再生周围神经界面（RPNI）和有针对性的肌肉神经再支配（TMR）已成为改善神经瘤相关疼痛和幻肢痛的有前途的技术。对于急性和延迟或慢性截肢患者，多学科和多模式的方法是最佳治疗方案的关键。
