Lee Jennifer C, Kubiak Carrie A, Best Christine S W, Hamill Jennifer B, Ki Jamie, Kim Hyungjin Myra, Roth Randy S, Kozlow Jeffrey H, Tinney Melissa J, Geisser Michael E, Cederna Paul S, Kemp Stephen W P, Kung Theodore A
From the Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI.
Consulting for Statistics, Computing & Analytics Research, University of Michigan, Ann Arbor, MI.
Ann Surg Open. 2025 Jan 7;6(1):e535. doi: 10.1097/AS9.0000000000000535. eCollection 2025 Mar.
The objective was to assess the postsurgical outcomes of regenerative peripheral nerve interface (RPNI) surgery in a prospective cohort of major lower extremity amputation patients with chronic postamputation pain.
Chronic pain in lower limb amputation patients is commonly the result of neuroma formation after traumatic peripheral nerve injury. By implanting more proximal transected nerve ends into autologous free muscle grafts, RPNI surgery can treat postamputation pain by diminishing the development of neuromas. RPNI surgery in prior retrospective studies has been shown to mitigate postamputation pain.
Twenty-two lower limb amputation patients with established chronic postamputation pain were recruited from 2 studies in this prospective study. All patients underwent RPNI surgery to treat identified symptomatic neuromas within the residual limb. Patient-reported outcome instruments were administered preoperatively and postoperatively at 1 week, 4 months, and 12 months to examine residual limb pain (McGill Pain Questionnaire, PROMIS Pain Intensity, and PROMIS Pain Interference), phantom limb pain (modified PROMIS Pain Intensity and Phantom Limb sensation questionnaire), psychosocial status (PHQ-9, GAD-7, and PCS), and functional (OPUS) outcomes.
RPNI surgery significantly improved residual limb pain. While phantom limb sensation improved significantly, phantom limb pain demonstrated a modest decrease. Psychosocial outcomes also improved significantly after RPNI surgery. Prosthetic use slightly increased, and patients did not experience loss of function.
RPNI surgery leverages the processes of reinnervation to successfully treat residual limb pain and improve psychosocial outcomes in patients with chronic postamputation pain. Phantom limb pain may be more difficult to treat in chronic pain patients who have central sensitization at the time of surgery.
本研究旨在评估再生周围神经接口（RPNI）手术在一组患有慢性截肢后疼痛的下肢大截肢患者前瞻性队列中的术后效果。
下肢截肢患者的慢性疼痛通常是创伤性周围神经损伤后神经瘤形成的结果。通过将更近端的横断神经末端植入自体游离肌肉移植物中，RPNI手术可通过减少神经瘤的形成来治疗截肢后疼痛。先前的回顾性研究表明，RPNI手术可减轻截肢后疼痛。
在这项前瞻性研究中，从2项研究中招募了22例患有慢性截肢后疼痛的下肢截肢患者。所有患者均接受RPNI手术，以治疗残肢内已确定的有症状神经瘤。在术前以及术后1周、4个月和12个月使用患者报告结局工具，以检查残肢疼痛（麦吉尔疼痛问卷、PROMIS疼痛强度和PROMIS疼痛干扰）、幻肢痛（改良的PROMIS疼痛强度和幻肢感觉问卷）、心理社会状态（PHQ-9、GAD-7和PCS）以及功能（OPUS）结局。
RPNI手术显著改善了残肢疼痛。虽然幻肢感觉显著改善，但幻肢痛有适度减轻。RPNI手术后心理社会结局也显著改善。假肢使用略有增加，且患者未出现功能丧失。
RPNI手术利用神经再支配过程成功治疗残肢疼痛，并改善慢性截肢后疼痛患者的心理社会结局。对于手术时存在中枢敏化的慢性疼痛患者，幻肢痛可能更难治疗。
