桡骨感觉神经向骨间前神经转移治疗症状性神经瘤的临床结果及转移分类系统

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-03-15 DOI:10.1016/j.jor.2025.03.034

Alexander D. Jeffs , Margaret M. Fisher , Patricia K. Wellborn , Andrew D. Allen , Bradley J. Lauck , Charles A. Baumann , G. Aman Luther

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引用次数: 0

摘要

桡感觉神经（RSN）损伤发生在常见的外科手术或手腕损伤中，通常导致疼痛性神经瘤的形成。由于患者满意度不高，初级修复或二次重建的管理策略受到限制。我们提出了一种靶向肌肉神经移植（TMR）技术，它的临床结果，以及一种新的分类系统，用于治疗顽固性RSN神经瘤，将RSN转移到前骨间神经（AIN）。方法采用普通标本，建立转移分类系统。在三个水平模拟损伤后进行RSN到AIN转移：近端、远端和远端分叉。在5例有症状的顽固性RSN神经瘤患者中进行了转移。临床和患者报告的结果被前瞻性地收集了一年。结果建立了一套指导神经移植的尸体分类系统。5例患者因症状性难治性RSN神经瘤接受了RSN到AIN的转移。有1例1区受伤，2例2区受伤，3例3区受伤。视觉模拟评分（VAS）疼痛评分平均提高6±2分。手臂、肩膀的快速残障手部（DASH）得分显著提高了37±11分(p <；0.05)。腕关节屈伸弧度显著改善30±14°，桡尺偏弧度显著改善10±3°(p <；0.05)。结论sour分类系统可指导术中根据RSN损伤区域进行RSN转移的决策。RSN到AIN的转移导致QuickDASH和VAS疼痛评分的显著改善，超过了临床获益的既定阈值。

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Radial sensory nerve to anterior interosseous nerve transfer for symptomatic neuromas- clinical outcomes and a transfer classification system

Background

Radial sensory nerve (RSN) injuries occur during common surgical procedures or injuries to the wrist and often result in the formation of painful neuromas. Management strategies of primary repair or secondary reconstruction are limited by poor patient satisfaction. We present a targeted muscle reinnervation (TMR) technique, its clinical outcomes, and a novel classification system for the treatment of recalcitrant RSN neuromas with transfer of the RSN to the anterior interosseous nerve (AIN).

Methods

Cadaveric specimens were used to devise a classification system for the transfer. RSN to AIN transfer was performed after simulated injury at three levels: proximal, at, and distal to the bifurcation. The transfer was performed in five patients with symptomatic recalcitrant RSN neuromas. Clinical and patient-reported outcomes were prospectively collected for one year.

Results

A cadaveric classification system was devised to guide nerve transfer. Five patients underwent RSN to AIN transfer for symptomatic recalcitrant RSN neuromas. There was one Zone 1 injury, two Zone 2 injuries, and three Zone 3 injuries. The mean visual analog scale (VAS) pain score significantly improved by 6 ± 2 points. The mean Quick Disabilities of Arm, Shoulder, & Hand (DASH) scores significantly improved by 37 ± 11 points (p < 0.05). The wrist flexion/extension arc significantly improved by 30 ± 14°, and the radial/ulnar deviation arc significantly improved by 10 ± 3° (p < 0.05).

Conclusions

Our classification system can guide intraoperative decision-making for RSN to AIN transfer based on the zone of RSN injury. RSN to AIN transfer resulted in significant improvement in QuickDASH and VAS Pain scores that exceeded the established thresholds for substantial clinical benefit.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.