From the Department of Plastic and Reconstructive Surgery.
Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital.
Plast Reconstr Surg. 2024 Apr 1;153(4):873-883. doi: 10.1097/PRS.0000000000010659. Epub 2023 May 18.
Although symptomatic neuroma formation has been described in other patient populations, these data have not been studied in patients undergoing resection of musculoskeletal tumors. This study aimed to characterize the incidence and risk factors of symptomatic neuroma formation following en bloc resection in this population.
The authors retrospectively reviewed adults undergoing en bloc resections for musculoskeletal tumors at a high-volume sarcoma center from 2014 to 2019. The authors included en bloc resections for an oncologic indication and excluded non-en bloc resections, primary amputations, and patients with insufficient follow-up. Data are provided as descriptive statistics, and multivariable regression modeling was performed.
The authors included 231 patients undergoing 331 en bloc resections (female, 46%; mean age, 52 years). Nerve transection was documented in 87 resections (26%). There were 81 symptomatic neuromas (25%) meeting criteria of Tinel sign or pain on examination and neuropathy in the distribution of suspected nerve injury. Factors associated with symptomatic neuroma formation included age 18 to 39 [adjusted OR (aOR), 3.6; 95% CI, 1.5 to 8.4; P < 0.01] and 40 to 64 (aOR, 2.2; 95% CI, 1.1 to 4.6; P = 0.04), multiple resections (aOR, 3.2; 95% CI, 1.7 to 5.9; P < 0.001), preoperative neuromodulator requirement (aOR, 2.7; 95% CI, 1.2 to 6.0; P = 0.01), and resection of fascia or muscle (aOR, 0.5; 95% CI, 0.3 to 1.0; P = 0.045).
The authors' results highlight the importance of adequate preoperative optimization of pain control and intraoperative prophylaxis for neuroma prevention following en bloc resection of tumors, particularly for younger patients with a recurrent tumor burden.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
虽然在其他患者群体中已经描述了有症状的神经瘤形成，但这些数据尚未在接受肌肉骨骼肿瘤切除术的患者中进行研究。本研究旨在描述该人群中整块切除术后有症状神经瘤形成的发生率和危险因素。
作者回顾性分析了 2014 年至 2019 年在一家高容量肉瘤中心接受整块切除术治疗的成年人的资料。作者纳入了因肿瘤原因而行整块切除术的患者，排除了非整块切除术、原发性截肢术和随访时间不足的患者。数据以描述性统计表示，并进行多变量回归建模。
作者纳入了 231 例接受 331 例整块切除术（女性占 46%，平均年龄为 52 岁）的患者。87 例（26%）记录有神经切断。81 例（25%）符合体检时出现 Tinel 征或疼痛以及可疑神经损伤分布处出现神经病变的有症状神经瘤标准。与有症状神经瘤形成相关的因素包括 18 岁至 39 岁（调整后的比值比[aOR]，3.6；95%置信区间[CI]，1.5 至 8.4；P < 0.01）和 40 岁至 64 岁（aOR，2.2；95% CI，1.1 至 4.6；P = 0.04）、多次切除（aOR，3.2；95% CI，1.7 至 5.9；P < 0.001）、术前神经调节剂需求（aOR，2.7；95% CI，1.2 至 6.0；P = 0.01）和筋膜或肌肉切除（aOR，0.5；95% CI，0.3 至 1.0；P = 0.045）。
作者的研究结果强调了在整块切除肿瘤后，充分优化疼痛控制的术前准备和术中预防神经瘤形成的重要性，特别是对于具有复发性肿瘤负担的年轻患者。
临床问题/证据水平：风险，III 级。
