A Novel Technique Restores Function while Eliminating Intractable Neuropathic Pain in a 71-Year-Old Diabetic Patient under Challenging Injury Conditions

W. Micheo, C. Foy, D. Kuffler
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Abstract

Abstract Background  The extent of functional recovery induced in healthy patients by sensory nerve grafts, the clinical “gold standard” technique for repairing peripheral nerves with a gap, is significantly limited by increasing gap length, time between trauma and repair, and patient age. When the values of any two, or all three, variables increase simultaneously, there is little to no recovery. For diabetic patients, even under the best of conditions and without any large variables, the extent of axon regeneration and functional recovery is significantly less, but generally none. Therefore, novel techniques are required that enhance recovery in diabetic patients. Methods  A 12-cm long median nerve gap in the wrist/palm of a 71-year-old male long-term diabetic patient was bridged 1.3 years post nerve injury with a sural nerve graft within a platelet-rich plasma-filled collagen tube. Results  By 2 months post-repair, the patient's level 6 chronic neuropathic pain was permanently eliminated. By 6.75 months, the palm had recovered good sensitivity to stimuli of all sensory modalities, including 4.56 g pressure and less than 15 mm two-point discrimination. Each finger had good motor function of M3–5, with partial to complete sensitivity to stimuli of all sensory modalities and an overall recovery of S3. Conclusion  This technique permanently eliminates severe chronic neuropathic pain while simultaneously inducing good motor and sensory recovery in a long-term diabetic patient, under conditions where recovery is rarely, if ever, seen, even in non-diabetic patients. This technique holds great promise of restoring function to diabetic patients, for whom it is otherwise not possible.
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一项新技术在挑战性损伤条件下恢复功能同时消除71岁糖尿病患者的顽固性神经病疼痛
摘要背景感觉神经移植是修复周围神经缺损的临床“金标准”技术,但由于缺损长度、创伤与修复之间的时间以及患者年龄的增加,其功能恢复程度明显受到限制。当任何两个或所有三个变量的值同时增加时,几乎没有恢复。对于糖尿病患者,即使在最好的条件下,没有任何大的变量,轴突再生和功能恢复的程度也明显少,但一般没有。因此,需要新的技术来促进糖尿病患者的康复。方法对71岁男性长期糖尿病患者,在神经损伤后1.3年,采用富血小板血浆填充的胶原管内腓肠神经移植修复腕/掌正中神经缺损。结果修复后2个月,患者6级慢性神经性疼痛永久消除。到6.75个月时,手掌恢复了对所有感觉形式刺激的良好敏感性,包括4.56 g压力和小于15 mm两点辨别。各指M3-5运动功能良好,对所有感觉刺激均部分或完全敏感,S3功能全面恢复。结论:该技术可以永久消除严重的慢性神经性疼痛,同时在长期糖尿病患者中诱导良好的运动和感觉恢复,即使在非糖尿病患者中也很少看到恢复。这项技术对恢复糖尿病患者的功能有很大的希望,否则对他们来说是不可能的。
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审稿时长
14 weeks
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