痛性神经瘤

痛性神经瘤是周围神经损伤或截肢术后常见并发症,其顽固性疼痛及术后高复发率给病人带来极大痛苦。神经瘤致痛与神经生长因子及酪氨酸激酶B(TrkB)受体作用、外周及中枢致敏、大麻素CB2受体、α-平滑肌肌动蛋白(α-SMA)、神经瘤纤维结构改变等有关。其早期干预治疗包括镜子理论应用、超声引导局部注射、阿霉素应用等,以及手术神经疏导及重建神经连续性、血管化筋膜皮瓣治疗等。该文就痛性神经瘤形成、相关致痛理论及其防治作一综述。     

痛性神经瘤

痛性神经瘤是周围神经损伤或截肢术后常见并发症,其顽固性疼痛及术后高复发率给病人带来极大痛苦。神经瘤致痛与神经生长因子及酪氨酸激酶B（TrkB）受体作用、外周及中枢致敏、大麻素CB2受体、α-平滑肌肌动蛋白（α-SMA）、神经瘤纤维结构改变等有关。其早期干预治疗包括镜子理论应用、超声引导局部注射、阿霉素应用等,以及手术神经疏导及重建神经连续性、血管化筋膜皮瓣治疗等。该文就痛性神经瘤形成、相关致痛理论及其防治作一综述。     

重建神经连续性治疗神经瘤性残端痛

重建神经连续性治疗神经瘤性残端痛尹维田张君崔树森朱清远残指（肢）端痛在临床上比较常见，其原因大部分是由残端神经瘤引起的。这种疼痛常呈持续性，稍有触碰，疼痛非常敏感，且伴有自主神经功能紊乱症状，严重影响患者的生活及工作。有关神经瘤性残端痛的治疗方法，国...     

中枢端对中枢端神经吻合治疗痛性指神经瘤

中枢端对中枢端神经吻合治疗痛性指神经瘤王大伟，陈传庆，刘闽生，杨晓飞，范保兴截指术后疼痛性指神经瘤较多见，无论采取重新安置神经未端，还是单纯切除神经瘤的方法，其术后复发率很高￣（１）。１９８１年Ｓａｍｉｉ￣（２）首次采用中枢端对中枢端吻合（Ｃｅｎｔｒ...     

外伤性神经瘤切除静脉桥接治疗神经瘤性残端痛

目的探讨外伤性神经瘤切除静脉桥接治疗神经瘤性残端痛的临床疗效.方法对56例外伤性神经瘤患者采用神经瘤切除静脉桥接手术.结果56例均获随访,时间3～18个月.参照尹维田等标准评定疗效：优45例,良7例,可4例,优良率为92．8％。结论采用静脉桥接治疗神经瘤性残端痛,可恢复神经连续性,预防神经瘤的再形成,临床效果确切.     

椎管内神经鞘瘤体位性根痛分析

神经鞘瘤在椎管肿瘤中占有一定比例,往往因压迫脊髓及神经根而出现根性疼痛,而腰骶部椎管内神经鞘瘤常以根性疼痛为首发症状。我们在治疗中发现根性疼痛与体位有关,分析如下：１临床资料我院自１９９３年３月～１９９６年５月共收治８例腰椎管内神经鞘瘤,其中男性５例...     

跖跗关节骨性结构的解剖及临床意义

目的通过对跖跗关节骨性结构的观察、测量,探讨跖跗关节骨性结构稳定的解剖学基础,及其活动度的临床意义。并为临床跖跗关节损伤的治疗提供理论依据。方法对12个成人足标本进行解剖、测量。测量第1—5跖跗关节面横径、纵径及深度;分别测量榫孔内、外侧缘的深度。结果（1）榫卯样结构内侧径（10．02±1．22）mm,外侧径（9．92±1．17）mm;（2）跖跗关节面的关节面深度：第1跖骨（0．98±0．15）mm,第2跖骨（0．02±0．02）mm,第3跖骨（0．01±0．01）mm,第4跖骨（1．32±0．15）mm,第5跖骨（1．46±0．17）mm;（3）跖跗关节远侧端关节面横径、纵径：第1跖骨关节面横径（17．25±1．01）mm,纵径（28．64±1．75）mm;第2跖骨关节面横径（15．24±1．13）mm,纵径（20．46±2．31）mm;第3跖骨关节面横径（13．30＋2．27）inln,纵径（19．12v1．57）mm;第4跖骨关节面横径（11．80±1．23）mm,纵径（17．17＋1．84）mm;第5跖骨关节面横径（18．66±2．80）mm,纵径（is．80±2．66）mm;（4）跖跗关节近侧端关节面横径、纵径：内侧楔骨关节面横径（15．9±1．52）mm,纵径（26．02±3．23）mm;中间楔骨关节面横径（13．07±1．25）mm,纵径（21．09±1．12）mm;外侧楔骨关节面横径（14．18±1．45）mm,纵径（20．15±1．95）mm;骰骨关节面横径（24．95±2．83）mm,纵径f17．72±1．37）mm。结论（1）跖跗关节的榫卯样结构,尤其是榫孔内、外侧缘的深度,是跖跗关节稳定的关键因素：（2）跖跗关节的关节面深度很浅,接近于平面关节,仅第4,5跖跗关节在矢状面和水平面有一定的活动度．手术治疗一期尽可能保留此关节。     

Treatment of painful neuromas

The management of symptomatic neuromas is an unsolved problem. This article attempts to review the various management regimens that have been proposed in the past and their success rate. The authors propose an algorithm for the management of symptomatic neuromas based upon this information.     

Treatment of painful peripheral neuromas by vein implantation

Firstly, we designed a vein-implantation model using the rat femoral nerve and vein to study the morphometric changes in nerve endings inserted into venous lumina. By 4 weeks, nerve fibers had extended from the nerve stump into the lumen of the vein and along the endothelium of the vein. After 8 weeks, the lengths and number of nerve fibres extending into the vein lumen began to decrease. At 12 weeks, the nerve ending had developed a hemispherical shape. In none of the experiments was a neuroma formed. Secondly, we treated ten neuromas in ten patients by the vein-implantation method. We obtained excellent results in seven patients.     

Treatment of painful neuromas: a case report

The authors report a 15-year history of management of multiple recurrent neuromas in a patient with an amputated arm. Various surgical modalities were employed, including burying the nerve ends in muscle and bone. In addition, they also treated successfully one of the neuromas in this patient by capping the transected nerve with an extended autologous vein graft. This application of the extended autologous venous nerve conduit may be a novel alternative in the treatment of this challenging problem.     

Colonoscopy — how difficult,how painful?

Colonoscopy is sometimes painful for the patient and often difficult for the endoscopist, but it is hard to predict how difficult or painful the examination will be. The purpose of this study was to identify factors that influence difficulty and pain during colonoscopy.Some 1,284 consecutive patients undergoing office colonoscopy by three endoscopists were prospectively studied. A standard questionnaire was completed by the nursing staff, who assessed the degree of difficulty and pain associated with each exam on a four-point scale.There were 682 men and 551 women (sex not recorded in 51). There was no pain in 27%, mild pain in 39%, moderate pain in 25%, and severe pain in 9%. There was no difficulty in 25%, mild difficulty in 33%, moderate difficulty in 28%, and severe difficulty in 14%. Colonoscopy was significantly easier (P<0.001, chi square) and less painful (P<0.001, chi square) in patients after sigmoidectomy. It was more painful after hysterectomy (P<0.05, chi square) and more difficult and painful in women than in men (P<0.01, chi square). There were significant differences between endoscopists in the assessment of pain associated with colonoscopy.Most colonoscopies are associated with little or no pain (66%) and are easy or only mildly difficult to perform (58%). Patients who have had sigmoid resection are especially easy and painless to examine while women, especially after hysterectomy, are at higher risk of having a painful experience. Colonoscopy technique can influence the amount of pain experienced by the patient.     

Arthroscopic removal of painful Bristow hardware

Complications of metallic hardware about the shoulder have been well documented in the literature. This case report presents a recreational athlete who presented to our office with a painful shoulder 4 years after a Bristow procedure. Radiographic imaging confirmed contact of the humeral head on the Bristow screw. In these unusual situations, arthroscopic evaluation, as this case suggests, should be considered. The patient's hardware was removed arthroscopically, obviating an open procedure and hospitalization.     

Management of painful neuromas in the hand.

A new treatment for painful neuromas in the hand was used on thirtty-three patients. Fifteen of them were partial amputees and the others had unrepairable lesions. The treatment was transfer of the stumps to an unscarred site where the neuroma would not be under pressure when the hand was used. Excellent results were achieved in 82 per cent of patients.     

Arthroscopic findings in patients with painful wrist ganglia

The aetiology of painful dorsal wrist ganglia remains obscure. In a prospective study we investigated the link between a painful dorsal wrist ganglion and wrist joint abnormality with wrist arthroscopy before excision of the ganglion. Of 16 wrists arthroscoped 12 were abnormal, 10 had an abnormal scapholunate joint, and two had abnormal lunatetriquetral joints. We think that painful dorsal wrist ganglia, like popliteal cysts in the knee, are markers of underlying joint abnormalities. Surgeons who treat painful ganglia should be aware of a possible underlying cause so that they can target treatment more accurately, particularly in recurrent cases and those patients with persistent wrist pain after excision of the ganglion.