神经疏导与重建神经连续性预防及治疗神经瘤性残端痛  

Prevention and treatment of stump pain caused by neuroma by nerve re-direction and reconstruction of nerve continuity

作　　者：尹维田[1] 李庆霖[1] 张君[1] 魏壮[1] 

机构地区：[1]吉林大学中日联谊医院手外科 ,长春130031

出　　处：《中华手外科杂志》2007年第1期19-21,共3页Chinese Journal of Hand Surgery

摘　　要：目的 探讨从预防神经瘤形成入手来治疗手及肢体神经瘤性残端痛。方法 分别采用SD大鼠30只及Wister大鼠30只，进行神经肌腱缝合及神经骨骼肌桥接。术后16周进行大体解剖学观察及组织学检测。在临床上对残指（肢）神经瘤性残端痛进行神经肌腱缝合50例，神经肌肉桥接3例，静脉桥接77例，神经原位移植73例，神经断端直接缝合32例。结果 动物实验：组织学检测结果，实验组无神经瘤形成，再生神经在肌纤维间或肌腱纤维间排列有序；对照组均有神经瘤形成。临床235例结果，优206例，良14例，可15例，优良率超过90％。结论 神经瘤性残端痛因残端神经失去了正常的连续性形成神经瘤而引起疼痛。采用神经疏导及重建神经连续性的方法，从预防神经瘤形成入手；从病因学及临床结果分析，合理有效、值得推广应用。Objective To investigate the options for preventing formation of traumatic neuroma and treatment of stump pain caused by neuroma. Methods Sciatic nerves of 30 Sprague-Dawley rats and 30 Wister rats were sutured to the tendon and skeletal muscle respectively. Gross anatomy and histological observation were carried out 16 weeks postoperatively. Clinically, 50 cases of stump neuromas were bridged by nerve-tendon coaptation, 3 cases by nerve-muscle suture, 77 cases by nerve-vein bridge, and 32 cases by nerve-nerve coaptation. Results There was no neuroma formation in the experimental groups. Regenerating nerve fibers aligned orderly among tendon and muscle fibers. Of the 231 cases treated clinically, 202 were graded to have excellent results, 14 cases as good, and 15 cases as fair. The overall excellent and good rote was 93%. Conclusion Traumatic neuroma forms when the nerve loses normal continuity and can cause stump pain. Creating an outlet for the nerve or restoring its continuity can prevent neuroma formation and thus treat stump patn.

关 键 词：周围神经 治疗结果 残端痛 神经疏导 

分 类 号：R686[医药卫生—骨科学]