上肢周围神经损伤后的痛性神经瘤及其治疗

 外周神经损伤后,受损神经局部往往会出现神经纤维的异常生长增生,于损伤局部形成迂曲、错长,最终形成局部肿块,即所谓创伤性神经瘤,而其中约10％的创伤性神经瘤出现顽固的病理性疼痛。在手外科,创伤后痛性神经瘤是上肢外周神经损伤后常见的严重并发症之一,疗效尚不理想。经典手术治疗方法如神经残端转位至肌肉、残端缝合至小静脉及神经残端骨内包埋等往往疗效有限。近年来已尝试将自体脂肪移植、组织移植、电刺激及神经导管等新技术应用于创伤后痛性神经瘤的治疗。本文就上肢常见的痛性神经瘤的原因、诊断及治疗进展进行综述,为将来该领域的进一步研究提供参考。

Treatment of painful neuromas after peripheral neurotrauma in upper extremities

After traumatic injury of peripheral nerve,regenerating axons escape and proliferate into the surrounding epineurial tissue in a disorganized fashion,forming whorls,spirals,and convolutions,and finally leading to the so called traumatic neuroma.About 10% of traumatic neuromas are companied by intractable neuropathic pain.In handsurgery,post traumatic painful neuroma is known as a debilitating sequela of upper limb nerve injury and still remains a clinical challenge.Classical surgical interventions including nerve stump transposition to muscle,vein or bone provide limited efficacy.However,novel surgical techniques in recent years such as adipose autograft,tissue transfer,electrical stimulation,nerve guide tube,etc.have considerably enriched our armamentarium of neuroma treatment.In this article,we briefly review the common painful neuromas of upper extremity with special reference to new approaches emerging in recent years,which might lend support for future study in this area.