Langeveld Mirte, Hundepool Caroline A, Duraku Liron S, Power Dominic M, Rajaratnam Vaikunthan, Zuidam J Michiel
From the Department of Plastic, Reconstructive Surgery, and Handsurgery, Erasmus Medical Center; Hand and Peripheral Nerve Surgery Service, Queen Elizabeth Hospital; and Department of Trauma and Orthopaedics, Khoo Teck Puat Hospital.
Plast Reconstr Surg. 2022 Oct 1;150(4):823e-834e. doi: 10.1097/PRS.0000000000009545. Epub 2022 Jul 27.
Despite many treatment options available, no consensus on the optimal surgical management of symptomatic peripheral nerve neuroma has been reached. The aim of this systematic review and meta-analysis was to evaluate the effectiveness of different surgical techniques for treating painful neuromas and to help guide surgeons in electing optimal treatment.
Four databases (Embase, MEDLINE, Web of Science, and Cochrane Central) were searched. Studies that reported either numerical (visual analogue scale/numeric rating scale) or nonnumeric postoperative pain scores after surgical treatment of peripheral neuroma were identified.
Thirty-two articles met the eligibility criteria and were analyzed for qualitative review. Thirty studies were included in qualitative analysis, for a total of 1150 neuromas. Surgical treatment of peripheral neuroma achieved good postoperative results in 70 percent of treated neuromas (95 percent CI, 64 to 77 percent). Proportions between techniques ranged between 60 and 92 percent. In a post hoc analysis, targeted muscle reinnervation (82 percent; 95 percent CI, 73 to 92 percent) performed significantly better than neurectomy ( p = 0.024).
The choice of surgical management in treating symptomatic peripheral neuroma is challenging, yet surgical intervention achieves significant pain relief in the majority of cases. Targeted muscle reinnervation is promising for the management of painful neuromas.
尽管有多种治疗选择，但对于有症状的周围神经神经瘤的最佳手术管理尚未达成共识。本系统评价和荟萃分析的目的是评估不同手术技术治疗疼痛性神经瘤的有效性，并帮助指导外科医生选择最佳治疗方法。
检索了四个数据库（Embase、MEDLINE、科学网和Cochrane中心）。纳入报告周围神经瘤手术治疗后数字（视觉模拟量表/数字评定量表）或非数字术后疼痛评分的研究。
32篇文章符合纳入标准并进行定性分析。30项研究纳入定性分析，共1150例神经瘤。周围神经瘤手术治疗后70%的神经瘤取得了良好的术后效果（95%可信区间，64%至77%）。不同技术之间的比例在60%至92%之间。在事后分析中，靶向肌肉再支配术（82%；95%可信区间，73%至92%）的效果明显优于神经切除术（p = 0.024）。
治疗有症状的周围神经瘤时手术管理的选择具有挑战性，但手术干预在大多数情况下能显著缓解疼痛。靶向肌肉再支配术在疼痛性神经瘤的治疗中很有前景。
