临床实践指南:治疗周围神经损伤。

IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Leila Harhaus, Nora F Dengler, Karsten Schwerdtfeger, Annette Stolle
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引用次数: 0

摘要

背景:神经损伤往往愈合不全,导致终生功能障碍,并给医疗系统带来高昂的费用。更新后的德国临床实践指南旨在促进对神经损伤的早期识别,并及时启动适当的治疗,以达到最佳的功能恢复效果:方法:这些建议是在对文献进行系统检索后得出的所有证据进行评估的基础上,并参考了多专业指导小组的专业知识:结果:只有少数出版物包含高质量的证据。与前一版本相比,这一版本的指南对战争损伤、先天性损伤、磁共振神经成像和特定治疗方法进行了更详细的讨论。至于不同的神经替代方法,自体移植与使用导管和管道的比较显示,这两种方法在 mBMRC 量表上没有显著差异,而自体移植在两点判别上的优势很小。至于在神经重建不可行或不可能成功的情况下使用神经转移术,在肘关节屈曲方面,神经转移术的效果略好于近端重建,但差异未达到统计学意义(mBMRC ≥ 3:RR 1.16,95% 置信区间 [1.02; 1.32])。在减少残肢痛(MD 2.0 +/- 2.8)和幻肢痛(MD 3.4 +/- 4.03)方面,使用靶向肌肉神经再支配治疗神经瘤优于传统方法:结论:延迟或不当治疗周围神经病变可导致严重损伤。结论:延迟或不当治疗周围神经病变可导致严重的损伤,及时诊断、根据指南采用适当的治疗方法以及专家之间的跨学科合作对于优化治疗效果至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Practice Guideline: The Treatment of Peripheral Nerve Injuries.

Background: Nerve lesions often heal incompletely, leading to lifelong functional impairment and high costs for the health care system. The updated German clinical practice guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function.

Methods: The recommendations are based on an assessment of all the evidence revealed by a systematic search of the literature, as well as on the expertise of the multiprofessional guideline group.

Results: Only a few publications contain high-quality evidence. This version of the guideline contains a more detailed discussion of war injuries, iatrogenic injuries, MR neurography, and specific treatments than the previous version. As for the different methods of nerve replacement, a comparison of autologous transplantation versus the use of conduits and tubes revealed no significant difference between these two methods on the mBMRC scale, and minimal superiority of autologous transplantation with respect to two-point discrimination. As for the use of nerve transfers when nerve reconstruction is not feasible or unlikely to succeed, nerve transfer yielded slightly better results than proximal reconstruction for elbow flexion, but the difference did not reach statistical significance (mBMRC ≥ 3: RR 1.16, 95% confidence interval [1.02; 1.32]). The treatment of neuromas with targeted muscle reinnervation was superior to the classic approach in decreasing both stump pain (MD 2.0 +/- 2.8) and phantom limb pain (MD 3.4 +/- 4.03).

Conclusion: The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome.

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来源期刊
Deutsches Arzteblatt international
Deutsches Arzteblatt international 医学-医学:内科
CiteScore
4.10
自引率
5.20%
发文量
306
审稿时长
4-8 weeks
期刊介绍: Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence. The journal aims to provide valuable medical information to its international readership and offers insights into the German medical landscape. Since its launch in January 2008, Deutsches Ärzteblatt International has been recognized and included in several prestigious databases, which helps to ensure its content is accessible and credible to the global medical community. These databases include: Carelit CINAHL (Cumulative Index to Nursing and Allied Health Literature) Compendex DOAJ (Directory of Open Access Journals) EMBASE (Excerpta Medica database) EMNursing GEOBASE (Geoscience & Environmental Data) HINARI (Health InterNetwork Access to Research Initiative) Index Copernicus Medline (MEDLARS Online) Medpilot PsycINFO (Psychological Information Database) Science Citation Index Expanded Scopus By being indexed in these databases, Deutsches Ärzteblatt International's articles are made available to researchers, clinicians, and healthcare professionals worldwide, contributing to the global exchange of medical knowledge and research.
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