痛性神经瘤33例治疗分析

Treatment of painful neuromas in 33 cases

目的 通过对痛性神经瘤不同的治疗比较,分析痛性神经瘤的疗效及预后.方法 对33例不同受伤机制而导致的39处痛性神经瘤,进行单纯神经瘤体高位切除（8例）,瘤体切除伴屈肌腱鞘植入（1例）、伴骨内植入（5例）、神经断端吻合（2例）、神经原位移植（10例）、皮瓣覆盖（7例）等进行不同手术的治疗比较.结果 术后随访2～30年,按患者疼痛的主观意见来改善评定：优11例,良20例,差2例,优良率93%.结论 不同的受伤机制导致不同部位形成的痛性神经瘤行不同的手术治疗,其疗效无明显差异,而与受伤机制、首次术后局部血运、是否感染、瘢痕增生情况、神经处理方式、患者心理状况等有明显差异.

Objective To compare the different treatment of cases with painful neuroma, to analyse the emcacy and prognosis of painful neuroma.Methods 33 cases of painful neuroma with 39 painful sites by different damage mechanism was treated repectively, 8 cases were on treated high cut of nerve tumor resection alone, 1 case was treated on tumor resection with flexor tendon sheath implantation, 5 cases were treated on tumor resection implanted with bone, 2 cases were treated on tumor resection with nerve stump anastomosis, 10 cases were treated on tumor resection with nerve graft in situ, 7 cases were treated on tumor resection with flap coverage,and so on.Their effects are all compared with each other.Results The follow-up ranged from 2 to 30 years, and improving pain assessment by the subjective views of patients：11 cases of superior degree, 20 cases of fine degree, 2 cases of poor degree, acceptance rate is 93%. Conclusion There is no significant difference with the effect of painful neuroma for different surgical treatment with different sites and damage mechanism. However, they have significant differences on the mechanism of injury, local blood supply after the first operation, infection or not, scar hyperplasia, neurological treatment and mental status of patients.