Raj Corentin, Amouyel Thomas, Maynou Carlos, Chantelot Christophe, Saab Marc
Service d'orthopédie-traumatologie, CHU of Lille, 59000 Lille, France.
Service d'orthopédie-traumatologie, CHU of Lille, 59000 Lille, France.
Orthop Traumatol Surg Res. 2024 Jun;110(4):103839. doi: 10.1016/j.otsr.2024.103839. Epub 2024 Feb 13.
Neurologic complications after limb schwannoma resection are not unusual, but there is no consensus on risk factors for neurologic deficit or poor functional results. We therefore conducted a retrospective study, to screen for factors predicting, firstly, postoperative neurologic deficit and, secondly, poor functional results.
Certain pre- and intraoperative features predict risk of failure, poor results or aggravation.
A single-center retrospective study was conducted in the University Hospital of Lille, France, for the period January 2004 to March 2020, including 71 patients. Preoperative variables (gender, age, symptoms, progression, tumor location and size) and operative data (type of surgery) were collected as possible risk factors for postoperative sensory deficit (Weber) and/or motor deficit [Medical Research Council (MRC)] and poor functional result [Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH); Lower Extremity Functional Scale (LEFS) and douleur neuropathique (neuropathic pain) 4 (DN4)].
Results were assessed a mean 69.4±38.5 months' follow-up (range, 6-180 months). In total, 21 patients (29.6%) had deficits (21 sensory, 1 motor) preoperatively and 25 patients (35.2%) postoperatively (20 sensory, 9 motor) (p=0.689). Fourteen patients (19.7%) showed functional aggravation. Fascicular resection was associated with risk of postoperative deficit [OR = 4.65 (95% CI: 1.485-15.543); p=0.004] and functional deterioration [OR = 3.9 (95% CI: 1.143-13.311); p=0.042]. Thirteen patients (18.3%) showed no improvement on DN4. Preoperative pain was a factor for improvement on DN4 [OR = 3.667 (95% CI: 1.055-12.738); p=0.0409].
The study identified fascicular resection as a risk factor for postoperative deficit and functional deterioration after limb schwannoma resection. Patients with preoperative neuropathic pain showed alleviation. Resection should be precise, under magnification, avoiding fascicular resection. Preoperative patient information is essential.
IV; retrospective series.
肢体神经鞘瘤切除术后出现神经并发症并不罕见，但对于神经功能缺损或功能预后不良的危险因素尚无共识。因此，我们进行了一项回顾性研究，以筛选预测术后神经功能缺损及功能预后不良的因素。
某些术前和术中特征可预测手术失败、预后不良或病情加重的风险。
在法国里尔大学医院进行了一项单中心回顾性研究，研究时间为2004年1月至2020年3月，共纳入71例患者。收集术前变量（性别、年龄、症状、病情进展、肿瘤位置和大小）和手术数据（手术类型），作为术后感觉功能缺损（韦伯分级）和/或运动功能缺损[医学研究委员会（MRC）分级]以及功能预后不良[手臂、肩部和手部快速残疾评定量表（QuickDASH）；下肢功能量表（LEFS）和神经病理性疼痛4级（DN4）]的可能危险因素。
平均随访69.4±38.5个月（范围6 - 180个月）后评估结果。共有21例患者（29.6%）术前存在功能缺损（21例感觉功能缺损，1例运动功能缺损），25例患者（35.2%）术后存在功能缺损（20例感觉功能缺损，9例运动功能缺损）（p = 0.689）。14例患者（19.7%）出现功能恶化。束状切除与术后功能缺损风险相关[比值比（OR）= 4.65（95%置信区间：1.485 - 15.543）；p = 0.004]以及功能恶化相关[OR = 3.9（95%置信区间：1.1清3 - 13.311）；p = 0.042]。13例患者（18.3%）DN4评分无改善。术前疼痛是DN4评分改善的一个因素[OR = 3.667（95%置信区间：1.055清2.738）；p = 0.0409]。
该研究确定束状切除是肢体神经鞘瘤切除术后出现术后功能缺损和功能恶化的危险因素。术前患有神经病理性疼痛的患者症状有所缓解。手术应在放大条件下精确操作，避免束状切除。术前向患者提供信息至关重要。
IV级；回顾性系列研究。
