神经松解加神经外膜内置管给药治疗灼性神经痛

目的　用神经手术及神经外膜内置管定期注入镇痛药物 ,以提高灼性神经痛的治疗效果。方法　对 12例周围神经损伤后发生灼性神经痛者 ,行神经束间松解术 ,并将硬膜外麻醉导管置于切开的神经外膜内 ,管口位于病变神经近端正常神经束间 ,管尾引出皮外 ,与皮肤固定后连接注射器。术后每隔4～ 6小时 ,从导管内推入布比卡因 ( 0 .5g L) 2～ 3ml。共 1周。结果　 11例术后随访 6个月～ 2年 ,未见复发。 1例失访。结论　本法治疗灼性神经痛是有效的 ,但其适应证及远期疗效有待进一步探索     

臂丛神经损伤灼性神经痛的治疗

报告２０８６例臂丛损伤中４８例伴有灼性神经痛（占２．３％），其中节前损伤２８例，节后损伤２２例（锁骨下动脉同时损伤、放射性损伤及枪弹性多见）。采用神经减压术，术后疼痛消失者占５０％，但无效者占３３％。神经缝合或移植术术后疼痛消失者占７５％，仅１例（１０％）无效。神经移位术术后疼痛消失者占４６％，无效者３４％。对顽固性的性痛（第一次手术无效者），采用神经根切断术，颈交感神经节切除，丘脑痛觉核立体定向毁损术，术后部分伤病例可缓解疼痛。     

神经束膜减压术治疗肘部尺神经灼性神经痛—例报告

神经束膜减压术治疗肘部尺神经灼性神经痛—例报告付万有，杨永宸，黄振起，杜宝在，刘彦荣，吕福润，白锋，刘经伦患者男，５５岁，工人。左肘部被砖砸伤，２周后出现左前臂尺侧及环、小指剧烈疼痛，夜不能寝。肢端畏热喜冷，伯阳光，喜阴天。白天加重，晚上略减轻，惧怕...     

带蒂肌膜瓣重建神经外膜的临床研究

目的　介绍对 18例 (2 2条 )周围神经显微松解、束间修复后神经外膜缺损 >5cm时用带蒂肌膜瓣重建神经外膜的手术方法。方法　周围神经SeddonⅡ类损伤 ,经 3～ 6个月保守治疗无效后 ,采用常规神经显微松解或神经束间修复 ,并确定神经干外膜的缺损范围后 ,选用邻近健康肌肉的肌外膜 ,形成带蒂肌膜瓣 ,包裹在外膜缺损段神经干上 ,用 9 0无损伤缝线将肌膜瓣两侧相互缝合呈管状 ,再将两端与神经外膜缝合。结果　术后随访 6个月～ 5.6年 (平均 3 2 .6个月 ) ,按 1954年英国医学研究所颁布的感觉、运动分级标准评定 ,优良率达到 77.3 %。结论　带蒂肌膜瓣重建神经外膜可改善损伤段神经血运 ,隔离神经束与周围瘢痕的粘连 ,提供了与神经外膜极为相似的神经生长所需理想的局部生理环境     

面神经瘫痪外科治疗301例回顾

１９８２年２月至１９９６年６月，共收治各类面瘫病人３０１例。其中采用神经、肌肉移植修复１５７例，筋膜悬吊１１９例，其他２５例。包括：①神经、肌肉移植，Ⅰ期带血管神经肌瓣移植，Ⅱ期带血管、神经肌肉移植；②损伤面神经修复，面神经残端肌肉内种植以及舌下—面神经吻接；③动力性或静力性筋膜悬吊；④其他：面部畸形整形及其他肌肉移植等。认为：早期损伤的面神经吻接，舌下—面神经吻接等是早期外伤性面瘫治疗的最佳选择。Ⅰ期节段性断层背阔肌肌瓣移植是晚期面瘫的最佳选择，６８例中６６例取得了术后动静态平衡。腹内斜肌肌瓣移植是有前途的术式，Ⅱ期胸小肌移植及筋膜悬吊仍是晚期面瘫治疗中可选择的术式。讨论了手术时机的选择和适应证，着重提出带有靶器官的神经移植的生长不是爬行生长，而是逐步的能量积累，由量变到质变的飞跃。     

手指顽固性残端痛

正顽固性残端神经痛(亦称灼性神经痛)是一种临床综合征~([1])。手指由于外伤或一些疾病截指后,两侧神经的近断端会形成神经瘤,但并不是所有的神经瘤都会产生疼痛,文献报道约10%患者引起顽固性残端神经痛~([2])。手指顽固性神经痛一旦发生,治疗比较困难,术后复发率高,给患者带来极大的痛苦。为进一步提高对该疾病认识并更好地进行治疗,现就     

肌外膜转位重建神经外膜的实验研究

目的观察带蒂肌外膜瓣转位重建神经外膜后的组织学改变及其对损伤段神经再生的作用。方法将60只SD大鼠,按手术先后随机平分为实验组和对照组。建立一侧坐骨神经挤压伤(6mm长)模型。伤后3周行神经松解术,2组均切除损伤处神经外膜1cm。实验组用带蒂肌膜瓣转位重建损伤段的神经外膜,对照组用周围正常的软组织覆盖神经损伤段。于术后42d进行大体、电生理、组织学观察和形态学分析。结果实验组重建的神经外膜表面光滑,与周围无明显粘连,神经外膜与肌膜缝合口愈合良好,外膜下血管及再生有髓神经纤维数目增加,直径增粗,运动神经传导速度(MNCV)平均达62.50m/s。对照组损伤段神经与周围组织粘连明显,MNCV均值为34.48m/s。结论肌外膜瓣重建神经外膜后其组织学改变与神经外膜极为相似,为临床应用提供了实验室依据。     

面神经瘫痪外科治疗301例回顾

1982年2月至1996年6月,共收治各类面瘫病人301例。其中采用神经、肌肉移植修复157例,筋膜悬吊119例,其他25例。包括:①神经、肌肉移植。Ⅰ期带血管神经肌瓣移植,Ⅱ期带血管、神经肌肉移植;②损伤面神经修复,面神经残端肌肉内种植以及舌下一面神经吻接;③动力性或静力性筋膜悬吊;④其他:面部畸形整形及其他肌肉移植等。认为:早期损伤的面神经吻接,舌下一面神经吻接等是早期外伤性面瘫治疗的最佳选择。Ⅰ期节段性断层背阔肌肌瓣移植是晚期面瘫的最佳选择,68例中66例取得了术后动静态平衡。腹内斜肌肌瓣移植是有前途的术式,Ⅱ期胸小肌移植及筋膜悬吊仍是晚期面瘫治疗中可选择的术式。讨论了手术时机的选择和适应证,着重提出带有靶器官的神经移植的生长不是爬行生长,而是逐步的能量积累,由量变到质变的飞跃。     

束间松解加束膜减压治疗灼性神经痛

灼性神经痛的治疗方法仍在探索之中，我院1992年4月至2003年6月采用束间松解加束膜减压治疗8例，收效良好，报道如下。     

周围神经端侧缝合后侧支神经再生的研究进展

周围神经端侧缝合术式可以追溯到本世纪初。１９０３年Ｂａｌｌａｎｃｅ等~［１］第一次报告此术式，把面神经远端缝合到副神经侧方治疗面瘫。但直到１９９２年Ｖｉｔｅｒｂｏ等~［２，３］就端侧缝合发表一系列实验和临床研究文献后，它才因其较好的临床应用前景而被重视，并很快在世界范围内引起反响。周围神经端侧缝合术是将损伤神经远断端缝合到相邻神经侧方，或将一段神经用端侧缝合方式桥接于正常神经和失功能神经之间。术后正常的供体神经能够作为动力神经，以侧支发芽（ｃｏｌｌａｔｅｒａｌｓｐｒｏｕｔｉｎｇ）的神经再生方式通过…     

Causalgia: a wartime experience--report of twenty treated cases

During the 10-year period from 1975 to 1985 20 patients suffering from causalgia were treated. There were 15 men and five women. Ages ranged from 17 to 45 years (mean, 23). All were war casualties injured by high-velocity missiles. The median nerve was involved in eight cases, ulnar nerve in six, brachial plexus in four, sciatic nerve in four, radial nerve in three, and there were multiple nerve injuries in five cases. The diagnosis of causalgia was based on the characteristic clinical picture and was confirmed by sympathetic blocks. All patients were treated by sympathectomy and all had complete dramatic relief in the immediate postoperative period. Followup ranged from 4 months to 10 years (mean, 5.3 yr).     

Sympathectomy for causalgia: experience with military injuries

BACKGROUND: Causalgia is a rare disease in civilian practice, and most reports regarding causalgia in the literature are from major extended wars. To increase awareness of this syndrome, our wartime experience with this disease is presented. METHODS: The charts of patients with causalgia referred to two university hospitals for treatment from 1985 to 1989 were retrospectively studied. Characteristics of the cause, clinical manifestations, and the response to therapy were evaluated. RESULTS: Among 1,564 patients with peripheral nerve injuries, there were 54 cases (3.4%) of causalgia. All of the patients, except five, were injured in battle by high-velocity bullets or missiles. Upper extremities were involved in 28 patients (52 %) and lower extremities in 26 patients (48%). The most common presenting symptoms were as follows: burning pain, 100%; wet extremity, 100%; cold extremity, 93%; sensitivity to cold, 89%; paresthesia, 78%; and color changes in the extremities, 55%. In 48 patients (89%), pain was relieved by sympathetic block (3 patients had permanent cure). Six patients had no response to the blocks (11%). Of 45 patients who had temporary relief, all underwent sympathectomy. All of these patients had complete relief of symptoms in the immediate postoperative period and for follow-up from 1 to 6 years. CONCLUSION: Causalgia is essentially a war casualty disease. The condition is associated with burning pain, hyperesthesia, and symptoms of sympathetic overactivity. Sympathectomy is effective and the treatment of choice, particularly for patients who respond temporarily to sympathetic blocks.     

Lower Extremity Complex Regional Pain Syndrome: Long-term Outcome after Surgical Treatment of Peripheral Pain Generators

We undertook a retrospective study to evaluate the hypothesis that complex regional pain syndrome (CRPS) I, known as the “new” reflex sympathetic dystrophy, persists because of undiagnosed injured joint afferents, cutaneous neuromas, or nerve compressions, and is, therefore, a misdiagnosed form of CRPS II, which is known as the “new” causalgia. We used a research protocol, with institutional review board approval, to review medical records for the purpose of identifying 30 patients with lower extremity reflex sympathetic dystrophy, based on their history, physical examination, neurosensory testing, and response to peripheral nerve blocks, who were treated surgically at the level of the peripheral nerve. In this report, we describe long-term outcomes in 13 of these patients who were followed up for a minimum of 24 months (mean, 47.8 months; range, 25-90 months). Based primarily on the results of physical examination and the response to peripheral nerve blocks, surgery included a combination of joint denervation, neuroma resection plus muscle implantation, and neurolysis. Outcomes were measured in terms of decreased pain medication usage and recovery of function, and the results were excellent in 7 (55%), good in 4 (30%), and poor (failure) in 2 (15%) of the patients. Based on these results, we concluded that most patients referred with a diagnosis of CRPS I have continuing pain input from injured joint or cutaneous afferents, and chronic nerve compression, which is indistinguishable from CRPS II, and amenable to successful treatment by means of an appropriate peripheral nerve surgical strategy.     

Intrafascicular decompression in the treatment of causalgia with special reference to the mechanism

A new concept of the pathogenesis of causalgia is suggested in accordance with experimental and clinical work. Endoneural hypertension secondary to nerve trunk disruption is incriminated and intrafascicular decompression is used as the key therapeutic measure. In 14 patients with causalgia thus treated, all except 1 were cured. No symptomatic recurrence was noted in a 4- to 6-year follow-up study.     

Postoperative treatment of phantom pain and causalgias with calcitonin

Results of IV calcitonin treatment in patients suffering from postoperative phantom limb pain (n = 12) or causalgia following peripheral nerve lesions (n = 4) are reported. All patients were complained of severe pain after a traumatic event or amputation, with disturbed sleep in many cases. After only 1-2 infusions 10 patients with phantom limb pain (83%) were discharged from hospital pain-free. Pain was effectively reduced by up to 5 infusions in 2 patients (17%). A follow-up for maximally 24 months showed a recurrence of pain in only 4 patients with obvious stump problems or reamputations. Three patients with causalgia also profited from a remarkable but transitory pain reduction; in 1 patient therapy was ineffective. Recurrent pain due to causalgia could not be improved by repeated calcitonin infusion, although this was effective for phantom limb pain. The administration of calcitonin IV can be recommended as a valuable treatment for phantom limb pain and causalgias in the early postoperative period. Therapy was effective with negligible side-effects, and long-term follow-up revealed a long-lasting effect.     

Phenoxybenzamine in the treatment of causalgia. Report of 40 cases

Forty consecutive cases of causalgia treated during a 7-year period are presented. The patients ranged in age between 17 and 55 years, and all patients were males who received their nerve injuries from missile or shrapnel wounds. The greater occipital nerve was involved in two cases, median nerve in 10, sciatic nerve in 12, brachial plexus in seven, cauda equina in five, and multiple nerves in four cases. Each patient was treated with phenoxybenzamine, a postsynaptic alpha 1-blocker and presynaptic alpha 2-blocking agent. The drug was given orally in gradually increasing increments until a maximum daily dose of 40 to 120 mg was reached. Duration of treatment was usually 6 to 8 weeks. Total resolution of pain was achieved in all cases. The follow-up period ranged between 6 months and 6 years. Side effects of phenoxybenzamine were minimal and transient, consisting primarily of mild orthostatic hypotension and ejaculatory problems. We conclude that oral phenoxybenzamine is a simple, safe, and effective treatment of causalgia.     

Causalgia: a meta-analysis of the literature

BACKGROUND: Causalgia is not familiar to most physicians whose training and experience are limited to civilian practice. HYPOTHESIS: Through a thorough review of the literature, we attempted to determine the boundaries of causalgia and separate it from other sympathetically related disorders. DATA SOURCES: Database search for English-language articles in MEDLINE and Index Medicus up to the year 2000 as both keyword and subject under causalgia. STUDY SELECTION: References that described any new cases referred to as "causalgia" by their authors were included in a meta-analysis. DATA SYNTHESIS: One hundred ten articles contained a total of 1528 cases of causalgia. High-velocity missiles caused at least 77% of the injuries. In 72% and 90% of the cases reported, the time from injury to onset of pain was within 1 week and 1 month, respectively. Median nerve alone or in combination with other nerves (56%) and sciatic trunk injury (60%) were the most common nerves involved. In 92%, the nerve injury was incomplete. The most prominent clinical manifestations included burning pain in 86%, increased sweating in 73%, relief with application of cold in 62%, warmth in 50%, paresthesias in 96%, absence of anesthesia in 81%, and sensitivity to stimuli in 98%. Response to sympathetic blocks was observed in 88%. Finally, a total of 94% of the patients undergoing sympathectomy were cured. CONCLUSIONS: Cases of causalgia are easy to recognize and treat, with excellent results. Causalgia always follows a somatic nerve injury, usually partial, and is associated with near-constant, very severe pain distal to the injury in the extremity, varied in nature but characteristically with a predominantly burning quality. An effective anesthetic block of the appropriate part of the sympathetic chain frequently immediately relieves the pain. Most cases are cured by surgical sympathectomy.     

The outcome of percutaneous computed tomography-guided chemical lumbar sympathectomy for patients with causalgia after lumbar discectomy

BACKGROUND: Coldness, numbness, or causalgia usually affects the lower limbs in patients after back surgeries. The treatment of causalgia is still the source of continuing debate. We treated patients presenting with causalgia secondary to LD with CT-guided CLS and determined the therapeutic outcome at long-term follow-up. METHODS: From January 2002 to December 2002, a total of 15 patients (16 limbs) with causalgia after LD underwent the percutaneous CT-guided CLS. There were 7 male patients and 8 female patients, with an average age of 49.1 years. A total of 14 patients underwent unilateral procedures, and 1 patient underwent staged bilateral procedures. We followed up our patients for at least 24 months (24-36 months). RESULTS: There were 13 patients (14 limbs) diagnosed as Drucker stage I and 2 patients as stage II. There were 88% (14 limbs) that had an early satisfactory outcome after CLS and 75% (12 limbs) that had a late satisfactory outcome (more than 24 months after CLS). Stage I patients had more satisfying early and late outcome than stage II patients (P= .014 and P= .039, respectively). Female patients were more likely to have satisfactory late outcome than male patients (P= .034). There was no operative mortality. A patient had a complication of genitofemoral neuralgia, which had recovered in a month. CONCLUSIONS: We concluded that the percutaneous CT-guided CLS is an easy, safe, and reproducible technique, and it carries long-term benefit to patients with pain after LD presenting with causalgia, especially for patients with Drucker stage I and female patients.     

T2-ganglionectomy via limited costotransversectomy for minor causalgia

T2-ganglionectomy via limited costotransversectomy is a safe and effective method to produce sympathetic denervation of the upper extremity. It provides prompt and lasting relief of the complex array of symptoms associated with minor causalgia. Four patients with minor causalgia treated by this procedure are presented. All patients were seen by multiple physicians before a correct diagnosis was made. Pain and trophic changes resolved in all cases. No instances of Horner's syndrome or pneumothorax were encountered. Preoperative response to temporary stellate ganglion block is essential to both diagnosis and treatment. Consideration of early surgical intervention should be given in cases involving significant disability. A fundamental problem surrounding the appropriate management of minor causalgia has been and continues to be accurate recognition of the diagnosis.     

Successful vascular reconstruction. Determinants of disability

Improvements in limb salvage during the last decade are a reflection of advances in angiography, antibiotics and technique. We report a 100 per cent success rate with vascular repair and a 100 per cent disability outcome in extremity injuries. Ten male patients, with a mean age of 27.3 (range 18 to 41) years, sustained trauma to the extremity with vascular injury. The etiology of injury was gunshot wounds (5), blunt trauma (4), and stab wounds (1). Time from injury to vascular repair was a mean of 186 (range 60 to 360) min. Vessels injured included popliteal artery and vein (4), tibial artery and vein (2), subclavian artery and vein (2), and axillary artery (1). Six of the injuries were associated with fracture of the adjacent bone and treated with external skeletal fixation. All patients had an associated nerve injury. Five patients underwent fasciotomy; nine were treated with 500 ml Dextran-40 for 48 hr (each day for 2 days). All patients received cephalosporin antibiotics pre-, intra-, and post-operatively. All patients had successful vascular repair, as identified by Doppler ultrasound (10 patients) and intra-/post-operative arteriography (5 patients). The median follow-up period was 22 (range 18 to 30) months. There were no primary amputations (within 30 days); there were four late amputations (2, no function and foot ulcer; 2, causalgia). The five popliteal/tibial injuries had no dorsiflexion and foot drop, two had no function and leg ulcers; two patients had femoral and sciatic nerve injury at the thigh; and three patients had injuries to the brachial plexus.(ABSTRACT TRUNCATED AT 250 WORDS)