在全面战争中处理不同类型的截肢后残肢疼痛

MD Anastasiya Bohdan, I. Bohdan, Z. Plakhtyr
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摘要

背景。多达 50-80% 的军人患有截肢后疼痛。残肢疼痛会大大推迟假肢手术、康复和就业能力,对康复和军事任务的执行产生负面影响。本文旨在研究军人创伤性截肢后的残肢疼痛类型及其治疗方法的疗效。材料和方法。对 2022 年至 2024 年期间在全面战争中接受三级和四级军事医疗中心手术治疗的 231 名作战创伤截肢后残肢疼痛的军人进行随机横断面研究。研究结果36.36%的入组患者出现肢体残余疼痛,主要由异位骨化(30.74%)引起。41.13%的截肢者因神经瘤而出现神经性疼痛。22.51%的患者的疼痛综合征是由躯体原因和神经瘤共同造成的。作为躯体疼痛的一种,17.32%的患者出现假肢相关疼痛。该研究发现,与单纯神经瘤切除术组相比,利多卡因-酒精注射治疗疼痛神经瘤组患者在 6 个月随访时神经病理性疼痛的持续或复发率明显较低(Pα = 0.013)。在对 25 个末端神经瘤进行再生周围神经接口治疗后的 3 个月内,未观察到疼痛复发。结论对于残肢疼痛患者,重要的是假定其存在一种或两种疼痛类型:躯体疼痛和/或神经性疼痛。简单的神经瘤切除术会导致不理想的高再手术率--21.79 ± 4.86 %的持续性疼痛神经瘤。利多卡因-酒精注射在治疗末端神经瘤引起的神经痛方面足够简单有效(8.70 ± 3.26 %的再注射率)。再生外周神经接口在治疗和预防无症状神经瘤方面前景广阔。
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Management of different types of postamputation residual limb pain amid full scale war
Background. Up to 50–80 % of military service members suffer from postamputation pain. Residual limb pain significantly postpones prosthetic surgery, recovery, employability, negatively impacts rehabilitation and military duty performance. The purpose was to study residual limb pain types in military personnel after traumatic amputation and efficacy of methods for their treatment. Materials and methods. A randomized cross-sectional study was performed of 231 military service members with residual limb pain after combat traumatic amputation, who underwent surgical treatment in tertiary and quaternary level military medical center between 2022 and 2024 amid full-scale war. Results. Somatic residual limb pain was observed in 36.36 % of enrolled patients, which was mainly caused by heterotopic ossification (30.74 %). 41.13 % of amputees experienced neuropathic pain due to neuromas. Pain syndrome in 22.51 % of patients resulted from both somatic causes and neuromas. Prosthesis-associated pain as a type of somatic pain was observed in 17.32 % of individuals. This study found that the persistence or recurrence of neuropathic pain among patients from the group of lidocaine-alcohol injection for painful neuromas was significantly lower (Pα = 0.013) at 6-month follow-up compared to the simple neuroma resection group. During 3 months after regenerative peripheral nerve interface, which was performed for 25 terminal neuromas, no pain recurrence was observed. Conclusions. It is important to assume the presence of one or both pain types in a patient with residual limb pain: somatic and/or neuropathic. Simple neuroma resections lead to an undesirably high reoperation rate — 21.79 ± 4.86 % of persistent painful neuromas. Lidocaine-alcohol injections are sufficiently simple and effective (8.70 ± 3.26 % of reinjections) in the treatment of neuropathic pain caused by terminal neuromas. Regenerative peripheral nerve interface is promising in the treatment and prevention of symptomatic neuroma.
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