超声引导下残端神经瘤毁损治疗截肢后疼痛回顾性分析  

Retrospective analysis of ultrasound-guided stump neuroma neurolysis in the treatment of postamputation neuropathic pain

作　　者：李晨 浦少锋[1] 吴军珍[1] 吕莹莹[1] 杜冬萍[1] LI Chen;PU Shaofeng;WU Junzhen;LV Yingying;DU Dongping(Department of Pain Management,Shanghai Sixth People's Hospital,Shanghai 200233,China)

机构地区：[1]上海市第六人民医院疼痛科,上海200233

出　　处：《中国疼痛医学杂志》2022年第1期36-43,共8页Chinese Journal of Pain Medicine

摘　　要：目的:截肢后疼痛是截肢术后病人常见的神经病理性疼痛,包括残肢痛、幻肢痛和幻肢觉。残端神经瘤形成是引起疼痛的重要外周发病机制,针对痛性神经瘤进行毁损治疗简单易行。旨在研究超声引导下残端神经瘤毁损治疗截肢后神经病理性疼痛病人的短期与长期疗效。方法:回顾分析2016年6月至2019年10月在上海市第六人民医院疼痛科就诊的截肢后残肢痛和/或幻肢痛的病人共53例,其中36例病人最终纳入分析。治疗前记录病人的年龄、性别、截肢位置、病程、残肢痛的疼痛数字评分法(numerical rating scale,NRS)评分、是否伴有幻肢痛。在末次治疗后随访至12个月,记录末次治疗后2周、6月和12月后残肢痛的NRS评分、残肢爆发痛发作次数、幻肢痛的变化,并观察治疗的并发症。结果:共36例病人,治疗后残肢痛NRS评分和幻肢痛均较治疗前缓解,爆发痛的发作次数降低。在术后2周时有效率86.1%,术后6月和12月时有效率均为77.8%。所有病人均无并发症发生。结论:对截肢后疼痛的病人,可以用超声技术寻找是否有残端神经瘤;射频消融和无水乙醇注射毁损痛性神经瘤能有效缓解截肢病人的残端疼痛和幻肢痛(随访12个月),且操作简单、安全、无辐射,适合临床应用。Objective:Post amputation pain is a common neuropathic pain in patients after amputation,including residual limb pain,phantom limb pain and phantom limb sensation.The formation of stump neuroma is an important peripheral pathogenesis.It is simple and feasible to treat painful neuroma.The purpose of this study was to investigate the short-term and long-term efficacy of ultrasound-guided stump neuroma neurolysis in the treatment of postamputation pain.Methods:A total of 53 patients with post amputation residual limb pain and/or phantom limb pain treated in the department of pain management,Shanghai Sixth People's Hospital from June 2016 to October 2019 were retrospectively analyzed,and 36 patients were finally included in the analysis.Before treatment,the patients'age,gender,amputation site,duration of disease,NRS score of stump pain with or without phantom limb pain were recorded.The patients were followed up for 12 months after the last treatment.The NRS score of stump pain,the number of attacks of stump pain,the changes of phantom limb pain and the complications were recorded 2 weeks,6 months and 12 months after the last treatment.Results:A total of 36 patients were selected for analysis.After treatment,the NRS score and phantom limb pain were relieved,and the frequency of outbreak pain was reduced.The effective rate was 86.1%at 2 weeks,77.8%at 6 and 12 months after operation.No complications occurred in all patients.Conclusion:For patients with postamputation pain,ultrasonic technique can be used to find out whether there is residual neuroma.Radiofrequency ablation and anhydrous alcohol injection are effective methods for the treatment of postamputation pain.It can effectively relieve the pain of the amputation patients and phantom limb pain(followed up for 12 months),and it is simple,safe and free of radiation,therefore it is very suitable for clinical application.

关 键 词：截肢后疼痛 神经瘤 射频消融 无水乙醇 超声 镇痛 

分 类 号：R445.1[医药卫生—影像医学与核医学] R687.5[医药卫生—诊断学]