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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SPSSl6.0进行统计,组间比较采用)x~2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1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陛神经瘤,可以取得中期稳定的疗效。
Objective To investigate the mid-term clinical efficacy of microsurgical technique in the implantation of the stump bone in the stump of the stump. Methods Retrospective analysis of 37 patients with painful stump amputation after neurosurgical treatment of microsurgery. Among them, 19 cases underwent nerve endoscopic double bone hole implantation (intramedullary implantation group). During surgery, the sharp edge of the neuroma was severed severely until the nerve endings exposed the normal nerve fiber bundle. In the adjacent bone Quality drilling two holes with electric drill, the two bone holes with a curette Scratch, the free nerve trunk so that the nerve stump can be fully into the marrow cavity, so that the nerve ends through a bone hole, from another Bone hole out, with 8-0 non-invasive sutures and epicardial periosteal suture 4 to 6 needles can be sutured through the periosteum, closing the bone hole, to ensure that the nerve stump in the bone hyperplasia, to prevent the stump neuroma revealed . Another 18 patients underwent intramuscular instillation (intramuscular insertion), neuroma treatment and nerve free intraosseous implants. Muscle blind bags were formed along the muscle fibers in the surrounding muscle strips, feasible muscle fibers were sutured to form blind bags, Stump inserted into the muscle blind bag, the use of fiber surgical sutures and adductor fibers fixed 4 to 6-pin. Regular follow-up after surgery. Using SPSSl6.0 statistics, comparison between groups using) x ~ 2 test. P≤0.05 for the difference was statistically significant. Results The average follow-up of 30 patients was 25 (16 ~ 40) months. The excellent and good rates of early surgery (within 1 year after operation) were 93.75% and 92.86% The excellent and good rates of 3-year and 1-year surgery were 87.50% and 57.14%, respectively. There was no significant difference between the two groups in the rate of excellent and good and in the early and middle stages of bone implantation (P> 0.05) (P <0.05) .Conclusion The use of microsurgical techniques in the treatment of painful neuroma by double-ended osteosynthesis can achieve medium-term stable efficacy.