小口径人工神经鞘管预防手部指神经挤压伤后神经病理性痛的临床疗效观察  

The clinical effect of the application of small diameter artificial nerve conduit on preventing neuropathic pain after crush injury of the digital nerve

作　　者：张文志[1] 赵睿[1] 臧成五[1] 张建磊[1] 马继[1] 陈永祥[1] 孟泽祖[1] 丛锐[1] 

机构地区：[1]第四军医大学西京医院手外科,西安710032

出　　处：《中华手外科杂志》2017年第1期44-46,共3页Chinese Journal of Hand Surgery

摘　　要：目的观察应用小口径人工神经鞘管预防及减少指神经挤压伤后神经病理性痛发生的临床效果。方法自2015年1月至2016年6月，我们对37例50根指神经挤压伤患者进行随机分组，人工神经鞘管组及对照组分别纳入19例和18例，受累指神经数量均为25根。两组均由同一术者进行创面清创、指神经探查修复术。术后2周、6周、3个月及6个月进行随访，使用视觉模拟评分法（visual analogue scale，VAS）对受损神经支配区域的疼痛程度进行评分，并进行统计学分析。结果人工神经鞘管组中有2例患者2根受损指神经支配区域术后出现神经病理性痛症状，疼痛高峰均在术后2周出现，术后6周症状明显减轻。对照组中有5例患者8根受损指神经支配区域出现神经病理性痛症状，疼痛高峰出现在术后2-6周，术后3个月症状明显减轻。人工神经鞘管组较对照组患者术后出现神经病理性痛的病例数显著减少，疼痛程度显著降低，疼痛持续时间显著缩短（P〈0．05）。结论小口径人工神经鞘管能够有效保护手部挤压伤患者受损的指固有神经及指总神经，预防神经病理性痛的发生。Objective To observe the clinica effect of the application of small diameter artificial nerve conduit on preventing and reducing the occurrence of neuropathic pain after crush injury of the digital nerve. Methods Front January 2015 to June 2016, 37 patients （50 digits） diagnosed with crush injury of the digital nerve were randomly divided into artificial nerve group and control group. There were 19 patients （25 digits） in the experimental group and 18 patients （25 digits） in the control group. Both groups underwent surgical debridement and digital nerve repair by the same surgeon, and were followed up and evaluated at 2 weeks, 6 weeks, 3 months and 6 months after the surgery. Every patient was assessed with visual analogue scale （VAS） for the degree of neuropathic pain. Results In the artificial nerve experimental group, there were 2 patients （2 digits） with neuropathic pain symptoms at the peak 2 weeks after the operation which significantly relieved at 6 weeks. In the control group, there were 5 patients （8 digits） of neuropathic pain symptoms at the peak from 2 to 6 weeks which significantly relieved within 3 months after the operation. Statistics analysis indicated that patients in the artificial nerve group had less neuropathic pain than the control group. The degree of pain was relieved and the duration was shortened significantly. Conclusion The small diameter artificial nerve conduit can effectively protect the digital nerve subjected to crush injury, prevent adhesion of the impaired nerve and its surrounding tissue, reduce compression of the scar tissue, and relieve the degree of pain and decrease the incidence of neuropathic pain.

关 键 词：手损伤 治疗结果 人工神经鞘管 神经病理性痛 

分 类 号：R688[医药卫生—骨科学]