Suppr超能文献

桡侧感觉神经至骨间前神经移位治疗症状性神经瘤——临床结果及移位分类系统

Radial sensory nerve to anterior interosseous nerve transfer for symptomatic neuromas- clinical outcomes and a transfer classification system.

作者信息

Jeffs Alexander D, Fisher Margaret M, Wellborn Patricia K, Allen Andrew D, Lauck Bradley J, Baumann Charles A, Luther G Aman

机构信息

The University of North Carolina, Department of Orthopaedics, 130 Mason Farm Road, Chapel Hill, NC, 27514, United States of America.

The University of North Carolina, School of Medicine, 321 S. Columbia Street, Chapel Hill, NC, 27599, United States of America.

出版信息

J Orthop. 2025 Mar 15;70:20-24. doi: 10.1016/j.jor.2025.03.034. eCollection 2025 Dec.

Abstract

BACKGROUND

Radial sensory nerve (RSN) injuries occur during common surgical procedures or injuries to the wrist and often result in the formation of painful neuromas. Management strategies of primary repair or secondary reconstruction are limited by poor patient satisfaction. We present a targeted muscle reinnervation (TMR) technique, its clinical outcomes, and a novel classification system for the treatment of recalcitrant RSN neuromas with transfer of the RSN to the anterior interosseous nerve (AIN).

METHODS

Cadaveric specimens were used to devise a classification system for the transfer. RSN to AIN transfer was performed after simulated injury at three levels: proximal, at, and distal to the bifurcation. The transfer was performed in five patients with symptomatic recalcitrant RSN neuromas. Clinical and patient-reported outcomes were prospectively collected for one year.

RESULTS

A cadaveric classification system was devised to guide nerve transfer. Five patients underwent RSN to AIN transfer for symptomatic recalcitrant RSN neuromas. There was one Zone 1 injury, two Zone 2 injuries, and three Zone 3 injuries. The mean visual analog scale (VAS) pain score significantly improved by 6 ± 2 points. The mean Quick Disabilities of Arm, Shoulder, & Hand (DASH) scores significantly improved by 37 ± 11 points (p < 0.05). The wrist flexion/extension arc significantly improved by 30 ± 14°, and the radial/ulnar deviation arc significantly improved by 10 ± 3° (p < 0.05).

CONCLUSIONS

Our classification system can guide intraoperative decision-making for RSN to AIN transfer based on the zone of RSN injury. RSN to AIN transfer resulted in significant improvement in QuickDASH and VAS Pain scores that exceeded the established thresholds for substantial clinical benefit.

摘要

背景

桡侧感觉神经(RSN)损伤常见于普通外科手术或手腕受伤时,常导致疼痛性神经瘤形成。一期修复或二期重建的治疗策略因患者满意度低而受限。我们介绍一种靶向肌肉神经再支配(TMR)技术、其临床疗效以及一种新的分类系统,用于治疗难治性RSN神经瘤,即将RSN转移至骨间前神经(AIN)。

方法

使用尸体标本设计转移的分类系统。在模拟损伤后的三个水平(近端、分叉处、远端)进行RSN至AIN转移。对5例有症状的难治性RSN神经瘤患者进行了转移手术。前瞻性收集临床和患者报告的疗效数据,为期一年。

结果

设计了一种尸体分类系统以指导神经转移。5例有症状的难治性RSN神经瘤患者接受了RSN至AIN转移。有1例1区损伤、2例2区损伤和3例3区损伤。视觉模拟量表(VAS)疼痛评分平均显著改善6±2分。手臂、肩部和手部快速残疾(DASH)评分平均显著改善37±11分(p<0.05)。腕关节屈伸弧度平均显著改善30±14°,桡尺偏斜弧度平均显著改善10±3°(p<0.05)。

结论

我们的分类系统可根据RSN损伤区域指导RSN至AIN转移的术中决策。RSN至AIN转移使QuickDASH和VAS疼痛评分显著改善,超过了既定的显著临床获益阈值。

相似文献

2
Bioengineered nerve conduits and wraps for peripheral nerve repair of the upper limb.
Cochrane Database Syst Rev. 2022 Dec 7;12(12):CD012574. doi: 10.1002/14651858.CD012574.pub2.
4
A Small Number of Surgeons Perform the Large Majority of Uncommon Nerve Decompression Procedures.
Clin Orthop Relat Res. 2024 Dec 1;482(12):2182-2190. doi: 10.1097/CORR.0000000000003162. Epub 2024 Jun 21.
5
Comparing Open and Arthroscopic Grafting for Scaphoid Nonunion: Is There Truly a Noticeable Difference?
Clin Orthop Relat Res. 2024 Nov 1;482(11):2030-2038. doi: 10.1097/CORR.0000000000003145. Epub 2024 May 31.
6
Modified Partial Radial to Axillary Nerve Transfer.
JBJS Essent Surg Tech. 2025 Jun 25;15(2). doi: 10.2106/JBJS.ST.22.00026. eCollection 2025 Apr-Jun.
7
Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults.
Cochrane Database Syst Rev. 2017 Oct 9;10(10):CD012172. doi: 10.1002/14651858.CD012172.pub2.
8
Dexamethasone as an adjuvant to peripheral nerve block.
Cochrane Database Syst Rev. 2017 Nov 9;11(11):CD011770. doi: 10.1002/14651858.CD011770.pub2.

本文引用的文献

1
TMR for Peripheral Sensory Nerve Neuroma around the Wrist Utilizing the Distal Anterior Interosseous Nerve.
Plast Reconstr Surg Glob Open. 2024 Jan 19;12(1):e5531. doi: 10.1097/GOX.0000000000005531. eCollection 2024 Jan.
2
Anatomy of the Superficial Radial Nerve and Its Target Nerves for Targeted Muscle Reinnervation: An Anatomical Cadaver Study.
Plast Reconstr Surg. 2024 Jan 1;153(1):95e-100e. doi: 10.1097/PRS.0000000000010690. Epub 2023 May 16.
4
Anterior Interosseous Nerve to Ulnar Nerve Transfer: A Systematic Review.
JPRAS Open. 2022 Mar 11;32:195-210. doi: 10.1016/j.jpra.2022.02.007. eCollection 2022 Jun.
7
Targeted Muscle Reinnervation for Symptomatic Neuromas Utilizing the Terminal Anterior Interosseous Nerve.
Plast Reconstr Surg Glob Open. 2020 Jul 14;8(7):e2979. doi: 10.1097/GOX.0000000000002979. eCollection 2020 Jul.
8
Targeted Muscle Reinnervation for Prosthesis Optimization and Neuroma Management in the Setting of Transradial Amputation.
J Hand Surg Am. 2019 Jun;44(6):525.e1-525.e8. doi: 10.1016/j.jhsa.2018.11.019. Epub 2019 Feb 4.
9
Surgical Algorithm for Neuroma Management: A Changing Treatment Paradigm.
Plast Reconstr Surg Glob Open. 2018 Oct 16;6(10):e1952. doi: 10.1097/GOX.0000000000001952. eCollection 2018 Oct.
10
End-to-Side Nerve Repair: Current Concepts and Future Perspectives.
Ann Plast Surg. 2018 Dec;81(6):736-740. doi: 10.1097/SAP.0000000000001663.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验