CAJ | 학술논문

目的：探讨应用显微外科技术行残端神经瘤神经断端双骨孔骨内置入的中期临床疗效。方法回顾性分析37例截肢术后痛性残端神经瘤患者显微外科治疗的疗效。其中19例行神经断端双骨孔骨内置入(骨内置入组)，术中用锐利的刀片将神经瘤近端锐性切断直至神经断端外露正常的神经纤维束为止，在邻近的骨质用电钻钻两个骨洞，两个骨洞之间用刮匙刮通，游离神经主干使其神经残端能充分放入骨髓腔内，使神经断端从一个骨洞穿入，从另一个骨洞穿出，用8-0无创伤缝线缝合神经外膜与骨膜固定4～6针，可缝合穿出部位骨膜，闭合骨洞，保证神经残端在骨内增生，避免残端神经瘤外露。另外18例行肌内置入(肌内置入组)，神经瘤处理及神经游离同骨内置入组，在周围邻近肌肉顺着肌肉纤维剥离形成肌肉盲袋，可行肌肉纤维缝合形成盲袋，将神经断端置入肌肉盲袋内，利用纤维外科技术缝合神经外膜与肌纤维固定4～6针。术后定期随访。采用 SPSS16.0进行统计，组间比较采用χ2检验。P≤0.05为差异有统计学意义。结果30例平均随访25(16～40)个月；骨内置入组及肌内置入组术后的早期(术后1年内)手术优良率分别为93.75%和92.86%，中期(术后1～3年)手术优良率分别为87.50%和57.14%。两组的优良率比较以及骨内置入组早、中期的优良率比较差异均无统计学意义( P＞0.05)，肌肉内置入组早期与中期的优良率比较差异有统计学意义( P＜0.05)。结论利用显微外科技术行神经断端双骨孔骨内置入治疗痛性神经瘤，可以取得中期稳定的疗效。
목적：탐토응용현미외과기술행잔단신경류신경단단쌍골공골내치입적중기림상료효。방법회고성분석37례절지술후통성잔단신경류환자현미외과치료적료효。기중19례행신경단단쌍골공골내치입(골내치입조)，술중용예리적도편장신경류근단예성절단직지신경단단외로정상적신경섬유속위지，재린근적골질용전찬찬량개골동，량개골동지간용괄시괄통，유리신경주간사기신경잔단능충분방입골수강내，사신경단단종일개골동천입，종령일개골동천출，용8-0무창상봉선봉합신경외막여골막고정4～6침，가봉합천출부위골막，폐합골동，보증신경잔단재골내증생，피면잔단신경류외로。령외18례행기내치입(기내치입조)，신경류처리급신경유리동골내치입조，재주위린근기육순착기육섬유박리형성기육맹대，가행기육섬유봉합형성맹대，장신경단단치입기육맹대내，이용섬유외과기술봉합신경외막여기섬유고정4～6침。술후정기수방。채용 SPSS16.0진행통계，조간비교채용χ2검험。P≤0.05위차이유통계학의의。결과30례평균수방25(16～40)개월；골내치입조급기내치입조술후적조기(술후1년내)수술우량솔분별위93.75%화92.86%，중기(술후1～3년)수술우량솔분별위87.50%화57.14%。량조적우량솔비교이급골내치입조조、중기적우량솔비교차이균무통계학의의( P＞0.05)，기육내치입조조기여중기적우량솔비교차이유통계학의의( P＜0.05)。결론이용현미외과기술행신경단단쌍골공골내치입치료통성신경류，가이취득중기은정적료효。
Objective To explore the mid-term results of intraosseous nerve transposition with 2 osseous holes for painful neuromas by microsurgery. Methods The microsurgery results of 37 patients with painful neuromas who underwent amputation were analyzed retrospectively. The intraosseous nerve transposition with 2 osseous holes was performed in 19 cases, while muscle implantation in 18 cases. In the intraosseous nerve transposition operation, the proximal nerve stump was cut by a sharp blade until the normal nerve ifber bundle was exposed. And 2 holes were drilled by an electrodrill on the bone just besides the nerve stump, between which a curet was used. The nerve trunk was freed, so that all the nerve stump was in the marrow cavity. Then the nerve stump was put into 1 osseous hole and taken out from the other hole. The 8-0 atraumatic suture needle was used to suture the epineurium with the periosteum in 4-6 stitches at the ifrst hole. And the periosteum was closed at the second hole, so that the nerve end was buried inside the bone. In the muscle implantation operation, the processing and freeing of neuromas were similar to that in the intraosseous nerve transposition operation. In the adjacent muscles, the nerve was cut along the muscle ifber and buried into the muscle besides the stump. The epineurium was sutured with the muscle in 4-6 stitches by microsurgery. The patients were followed up regularly. The data were analyzed with Statistical Product and Service Solutions ( SPSS ) 16.0. Theχ2 test was used to compare the results between the 2 different groups. P≤0.05 meant the differences were statistically significant. Results 30 patients were followed up for an average period of 25 months ( range; 16-40 months ). The early excellent and good rates of the 2 operations were 93.75%and 92.86%respectively within 1 year after the operation, while the mid-term excellent and good rates were 87.50%and 57.14%respectively at 1-3 years after the operation. The differences between the 2 groups were not statistically signiifcant ( P>0.05 ). The differences in the excellent and good rate between the early and mid-term results in the muscle implantation group were statistically signiifcant ( P<0.05 ), while that in the intraosseous nerve transposition group were not statistically signiifcant ( P>0.05 ). Conclusions The intraosseous nerve transposition with 2 osseous holes by microsurgery is an effective method in treatment of painful neuromas, with stable mid-term results.