双侧痛性指固有神经瘤手术新方法——神经弓式双端侧吻合

A New Method of Arched Nerves of Double end-to-side Neuroanastomosis for Repairing Refractory Pain Caused by Double Digital Neuroma

目的：探讨一种治疗双侧痛性指固有神经瘤的手术新方法。方法：双侧痛性指固有神经瘤30例患者,11例采用神经移植神经弓式的双端侧吻合,10例采用神经移植端-端吻合,9例采用直接端-端吻合。结果：术后随访24.5～52个月,平均38个月。双端侧吻合组指感觉测定为S（4.35±1.98）级,高于另2组（P=0.027）;两点分辨觉为（5.0±0.7）mm,小于另2组（P=0.022）;3组Burchiel疗效差异有统计学意义（Z=-1.733,P=0.020）。结论：神经移植双端侧神经吻合的方法可有效治疗双侧痛性指固有神经瘤,消除患指疼痛、恢复指腹触摸灵敏性。

Objective To introduce a new method in treating refractory pain caused by double digital neuroma. Methods Thirty patients with bilateral acute proper digital nerve injuries were admitted. Eleven patients underwent double end-to-side neuroanastomosis, 10 patients underwent nerve graft with end-to-end neuroanastomosis, while other 9 patients underwent directly end-to-end neuroanastomosis. Results All 30 patients were successfully followed up for 24.5 to 52 months, with an average of 38.2 months. In double end-to-side neuroanastomosis group, the average result of sensation measurement was S（4.35±1.98） which was significantly higher than those of the other 2 groups（P=0.027）; the average result of two point discrimination was （5.0 ± 0.7） mm which was significantly lower than those of the other 2 groups（P=0.022）. According to Burchiels evaluation criteria, there were differences in results of pain relief in the 3 groups（Z=-1.733P=0.020）. Conclusion Refractory pain caused by double digital neuroma can be effectively treated by double end-to-side neuroanastomosis, which can eliminate painness and restore sensation of wounded fingers.