神经端侧缝合治疗手指顽固性残端痛性神经瘤

Treatment of refractory stump pain caused by neuroma by end-to-side neurorrlmphy

目的介绍一种治疗顽固性残端痛性神经瘤的手术方法。方法2006年1月至2010年6月，采用神经端侧缝合的方法治疗手指顽固性残端痛性神经瘤共5例6指，术中彻底切除残端神经瘤直至正常神经组织。其中3例将修整后的神经残端直接与邻指正常指神经作端侧缝合；2例（3指）行腓肠神经移植修复，一端与修整后的神经残端作端端缝合，另一端与邻指指神经作端侧缝合。结果术后经过12～63个月的随访，3例残端神经痛完全消失，2年后未复发；1例随访12个月，疼痛无复发；1例环、小指残端痛，术前已有过4次手术，本次术后环指疼痛消失，小指仍有疼痛，术后1个月小指再次行神经松解，随访63个月小指自发性疼痛减轻，但仍有触痛，环指疼痛消失。参照Burchiel的疗效评定标准，优良率为83．3％（5／6）。结论神经端侧缝合的方法可有效治疗残端痛性神经瘤。

Objective To introduce a new method to treat refractory stump pain caused by neuroma. Methods From January 2006 to June 2010, 6 fingers in 5 patients with refractory stump pain caused by neuroma were treated by end-to-side neurorrbaphy. The surgical technique included neurolysis, neumma resection and end-to-side neuron-haphy. The nerve stump was sutured to the uninjured nerve of the neighboring finger directly in an end-to-side fashion in 3 eases. In the other 3 fingers of 2 cases a sural nerve graft was used, while one end of the graft was attached to the nerve stump by end-to-end neurorrhaphy and the other end was sutured to the digital nerve of the neighboring finger by end-to-side neurorrhaphy. Results Postoperative follow-up interval ranged from 12 to 63 months. Three patients experienced complete pain relief. There was no recurrence 2 years postoperatively. One patient was follow-up for 12 months when no reeurrence of stump pain was observed. Another patient who suffered from stump pain of ring and little fingers experienced full pain relief in the ring finger and partial pain relief in the little finger. Neurolysis in the little finger was carried out 1 month after the neumrrhaphy procedure. At 63 months follow-up spontaneous pain had been relieved but there was still tenderness in the little finger. According to Burehiel＇ s evaluation criteria, the overall effective rate was 83.3% （5/6）. Conclusion Refractory stump pain caused by neuroma can be effectively treated by end-to-side neurorrhaphy.