School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK.
Christ's College, St. Andrew's Street, Cambridge, CB2 3BU, UK.
Eur J Orthop Surg Traumatol. 2023 May;33(4):1299-1306. doi: 10.1007/s00590-022-03281-4. Epub 2022 May 25.
A major cause of morbidity in lower limb amputees is phantom limb pain (PLP) and residual limb pain (RLP). This study aimed to determine whether a variation of the surgical technique of inserting nerve endings into adjacent muscle bellies at the time of lower limb amputation can decrease the incidence and severity of PLP and RLP.
Data were retrospectively collected from January 2015 to January 2021, including eight patients that underwent nerve insertion (NI) and 36 that received standard treatment. Primary outcomes included the 11-point Numerical Rating Scale (NRS) for pain severity, and Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity, behaviour, and interference. Secondary outcome included Neuro-QoL Lower Extremity Function assessing mobility. Cumulative scores were transformed to standardised t scores.
Across all primary and secondary outcomes, NI patients had lower PLP and RLP. Mean 'worst pain' score was 3.5 out of 10 for PLP in the NI cohort, compared to 4.89 in the control cohort (p = 0.298), and 2.6 out of 10 for RLP in the NI cohort, compared to 4.44 in the control cohort (p = 0.035). Mean 'best pain' and 'current pain' scores were also superior in the NI cohort for PLP (p = 0.003, p = 0.022), and RLP (p = 0.018, p = 0.134). Mean PROMIS t scores were lower for the NI cohort for RLP (40.1 vs 49.4 for pain intensity; p = 0.014, 44.4 vs 48.2 for pain interference; p = 0.085, 42.5 vs 49.9 for pain behaviour; p = 0.025). Mean PROMIS t scores were also lower for the NI cohort for PLP (42.5 vs 52.7 for pain intensity; p = 0.018); 45.0 vs 51.5 for pain interference; p = 0.015, 46.3 vs 51.1 for pain behaviour; p = 0.569). Mean Neuro-QoL t score was lower in NI cohort (45.4 vs 41.9; p = 0.03).
Surgical insertion of nerve endings into adjacent muscle bellies during lower limb amputation is a simple yet effective way of minimising PLP and RLP, improving patients' subsequent quality of life. Additional comparisons with targeted muscle reinnervation should be performed to determine the optimal treatment option.
下肢截肢患者的主要致残原因是幻肢痛（PLP）和残肢痛（RLP）。本研究旨在确定在下肢截肢时将神经末梢插入相邻的肌腹中的手术技术的变化是否可以降低 PLP 和 RLP 的发生率和严重程度。
数据回顾性收集于 2015 年 1 月至 2021 年 1 月，包括 8 例接受神经插入（NI）的患者和 36 例接受标准治疗的患者。主要结局包括 11 点数字评定量表（NRS）评估疼痛严重程度，以及患者报告的结局测量信息系统（PROMIS）疼痛强度、行为和干扰。次要结局包括神经质量 - 下肢功能评估移动能力。累积评分转换为标准化 t 评分。
在所有主要和次要结局中，NI 患者的 PLP 和 RLP 发生率较低。NI 组的 PLP 中“最痛”评分平均为 3.5 分，而对照组为 4.89 分（p=0.298），NI 组的 RLP 中“最痛”评分平均为 2.6 分，而对照组为 4.44 分（p=0.035）。NI 组的“最佳疼痛”和“当前疼痛”评分在 PLP（p=0.003，p=0.022）和 RLP（p=0.018，p=0.134）方面也更优。NI 组的 PROMIS t 评分在 RLP 方面也较低（疼痛强度为 40.1 分，49.4 分；p=0.014，疼痛干扰为 44.4 分，48.2 分；p=0.085，疼痛行为为 42.5 分，49.9 分；p=0.025）。NI 组的 PROMIS t 评分在 PLP 方面也较低（疼痛强度为 42.5 分，52.7 分；p=0.018）；疼痛干扰为 45.0 分，51.5 分；p=0.015，疼痛行为为 46.3 分，51.1 分；p=0.569）。NI 组的神经质量 t 评分较低（45.4 分，41.9 分；p=0.03）。
在下肢截肢时将神经末梢插入相邻的肌腹中是一种简单而有效的方法，可以最大限度地减少 PLP 和 RLP，提高患者的后续生活质量。应与靶向肌肉再神经支配进行进一步比较，以确定最佳治疗方案。
