选择性下肢截肢的预防性再生周围神经界面

Prilozi Pub Date : 2022-03-01 DOI:10.2478/prilozi-2022-0004
S. Pejkova, Bisera Nikolovska, Blagoja Srbov, Sofija Tusheva, Tomislav Jovanoski, Katerina Jovanovska, Gordana Georgieva
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引用次数: 4

摘要

再生周围神经界面(RPNI)是一种治疗截肢后神经瘤和幻肢痛的较新的手术技术。本研究评估了预防性RPNI在控制截肢后疼痛和神经瘤形成方面的疗效,并与未行此手术的截肢患者进行了比较。我们纳入了2019年7月至2020年12月期间因严重软组织感染而接受膝上截肢(AKA)或膝下截肢(BKA)的28例患者。所有患者均为胰岛素依赖型糖尿病。患者分为两组,14例为原发性RPNI, 14例为非原发性RPNI。在规定的随访期内,我们分析了人口统计学数据、截肢程度、rpni数量、手术时间、术后并发症和功能结局。患者平均年龄为68.6岁(49-85岁),男性19例(67.9%),女性9例(32.1%)。本研究进行了11例(39.3%)AKA和17例(60.7%)BKA。总共进行了37次rpni。平均随访时间为49周。RPNI患者的PROMIS t评分下降了15.9分。VAS评分显示,在RPNI组中,所有14名患者均无疼痛,而非RPNI组中,11名(78.6%)患者称其疼痛严重。RPNI患者使用假体的比例明显高于RPNI患者(p < 0.005)。数据显示RPNIs截肢后疼痛显著减少,患者满意度高。这项技术的目的是在截肢时进行RPNI手术,以防止神经瘤的形成。RPNI手术不会引起并发症或明显延长手术时间,应进一步作为一种外科技术加以开发。
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Prophylactic Regenerative Peripheral Nerve Interfaces in Elective Lower Limb Amputations
Abstract Regenerative peripheral nerve interface (RPNI) is a relatively new surgical technique to manage neuromas and phantom pain after limb amputation. This study evaluates prophylactic RPNI efficacy in managing post-amputation pain and neuroma formation in amputees compared with patients in which lower limb amputation was performed without this procedure. We included 28 patients who underwent above the knee amputation (AKA) or below the knee amputation (BKA) for severe soft tissue infection from July 2019 till December 2020. All patients had insulin-dependent diabetes. The patients were divided into two groups, 14 patients with primary RPNI and 14 patients without. We analyzed the demographic data, level of amputation, number of RPNIs, operative time, postoperative complications and functional outcome on the defined follow up period. The mean patient age was 68.6 years (range 49–85), 19 (67.9 %) male and 9 (32.1 %) female patients. In this study 11 (39.3 %) AKA and 17 (60.7 %) BKA were performed. Overall, 37 RPNIs were made. The mean follow-up period was 49 weeks. PROMIS T-score decreased by 15.9 points in favor for the patients with RPNI. The VAS score showed that, in the RPNI group, all 14 patients were without pain compared to the group of patients without RPNI, where the 11 (78.6 %) patients described their pain as severe. Patients with RPNI used prosthesis significantly more (p < 0.005). Data showed significant reduction in pain and high patient satisfaction after amputation with RPNIs. This technique is oriented as to prevent neuroma formation with RPNI surgery, performed at the time of amputation. RPNI surgery did not provoke complications or significant lengthening of operative time and it should be furthermore exploited as a surgical technique.
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