Idler R S
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, USA.
Orthop Clin North Am. 1996 Apr;27(2):409-16.
Persistent symptoms following surgical release for entrapment neuropathy are a source of great frustration for both the surgeon and patient. Fundamentals of management require review of the patient's history and examination in an attempt to confirm the initial diagnosis and to rule out elements of the differential diagnosis. Persistent symptomatology may be a reflection of an incorrect diagnosis or double crush syndrome. If the initial diagnosis can be reconfirmed, then it is reasonable to reinstitute conservative management and to objectively re-evaluate the entrapment neuropathy by electrodiagnostic testing. This electrodiagnostic testing must be comprehensive in order to evaluate all potential entrapment neuropathies within the differential diagnosis. Individuals who demonstrate a transient response to conservative management or evidence of further deterioration on electrodiagnostic testing may be considered candidates for revision surgery. These individuals may be found to have had an incomplete release, error of technique, or iatrogenic compression. Persistence of symptoms on the basis of end-stage disease must be recognized to avoid further surgery that is unlikely to be of benefit to the patient. If surgical intervention is chosen, the procedure must address issues of residual compression, preservation of nerve vascularity, prevention of neurodesis, and protective padding in the presence of nerve hypersensitivity.
因卡压性神经病接受手术松解后仍存在症状，这让外科医生和患者都极为沮丧。管理的基本原则要求回顾患者病史并进行检查，以尝试确认初始诊断并排除鉴别诊断的因素。持续的症状可能反映诊断错误或双重压迫综合征。如果能再次确认初始诊断，那么重新采用保守治疗并通过电诊断测试客观地重新评估卡压性神经病是合理的。这种电诊断测试必须全面，以便评估鉴别诊断范围内所有潜在的卡压性神经病。对保守治疗有短暂反应或电诊断测试显示进一步恶化迹象的个体，可被视为翻修手术的候选人。这些个体可能存在松解不完全、技术失误或医源性压迫。必须认识到基于终末期疾病导致的症状持续存在，以避免进行对患者不太可能有益的进一步手术。如果选择手术干预，该手术必须解决残留压迫、保留神经血管、预防神经固定以及在存在神经超敏反应时进行保护性衬垫等问题。
