de Lange J W D, Duraku L S, Power D M, Rajaratnam V, van der Oest M J W, Selles R W, Huygen F J P M, Hundepool C A, Zuidam J M
Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.
Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands.
J Plast Reconstr Aesthet Surg. 2022 Sep;75(9):3242-3249. doi: 10.1016/j.bjps.2022.06.033. Epub 2022 Jun 20.
Post-traumatic neuropathic pain is a major factor affecting the quality of life after finger trauma and is reported with considerable variance in the literature. This can partially be attributed to the different methods of determining neuropathic pain. The Douleur Neuropathique 4 (DN4) has been validated to be a reliable and non-invasive tool to assess the presence of neuropathic pain. This study investigated the prevalence of neuropathic pain after finger amputation or digital nerve repair using the DN4 questionnaire.
Patients with finger amputation or digital nerve repair were identified between 2011 and 2018 at our institution. After a minimal follow-up of 12 months, the short form DN4 (S-DN4) was used to assess neuropathic pain.
A total of 120 patients were included: 50 patients with 91 digital amputations and 70 patients with 87 fingers with digital nerve repair. In the amputation group, 32% of the patients had pain, and 18% had neuropathic pain. In the digital nerve repair group, 38% of the patients had pain, and 14% had neuropathic pain. Secondly, of patient-, trauma-, and treatment-specific factors, only the time between trauma and surgery had a significant negative influence on the prevalence of neuropathic pain in patients with digital nerve repair.
This study shows that persistent pain and neuropathic pain are common after finger trauma with nerve damage. One of the significant prognostic factors in developing neuropathic pain is treatment delay between trauma and time of digital nerve repair, which is of major clinical relevance for surgical planning of these injuries.
创伤后神经性疼痛是影响手指创伤后生活质量的主要因素，文献报道的发生率差异很大。这部分可归因于确定神经性疼痛的不同方法。神经病理性疼痛4（DN4）已被验证是一种评估神经性疼痛存在的可靠且非侵入性的工具。本研究使用DN4问卷调查了手指截肢或指神经修复后神经性疼痛的患病率。
2011年至2018年在本机构确定了手指截肢或指神经修复的患者。在至少随访12个月后，使用简版DN4（S-DN4）评估神经性疼痛。
共纳入120例患者：50例患者进行了91次手指截肢，70例患者的87根手指进行了指神经修复。在截肢组中，32%的患者有疼痛，18%的患者有神经性疼痛。在指神经修复组中，38%的患者有疼痛，14%的患者有神经性疼痛。其次，在患者、创伤和治疗特定因素中，只有创伤与手术之间的时间对指神经修复患者神经性疼痛的患病率有显著负面影响。
本研究表明，手指创伤伴神经损伤后持续性疼痛和神经性疼痛很常见。发生神经性疼痛的一个重要预后因素是创伤与指神经修复时间之间的治疗延迟，这对这些损伤的手术规划具有重要的临床意义。
