靶向肌肉神经移植和再生周围神经界面与标准管理在截肢治疗中的对比:系统回顾和荟萃分析

IF 0.7 4区 医学 Q4 SURGERY
Plastic surgery Pub Date : 2024-05-01 Epub Date: 2022-06-16 DOI:10.1177/22925503221107462
Morgan Yuan, Matteo Gallo, Lucas Gallo, Minh Hq Huynh, Mark McRae, Matthew C McRae, Achilleas Thoma, Christopher J Coroneos, Sophocles H Voineskos
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引用次数: 0

摘要

引言:疼痛性神经瘤是截肢术后常见的并发症,通常采用二次神经再支配治疗。手术再支配包括靶向肌肉再支配(TMR)和再生周围神经接口(RPNI),可以是原发性和继发性的。本综述的目的是评估截肢时原发性TMR/RPNI对术后神经瘤和疼痛的发生率和强度的影响。方法:本综述在PROSPERO(CRD42021264360)上预先登记。2021年6月对以下数据库进行了搜索:Medline、EMBASE和CENTRAL。使用clinicaltrials.gov搜索未发表的试验。包括所有用神经再支配策略(TMR,RPNI)评估截肢的随机和非随机研究。评估的结果包括疼痛神经瘤、幻肢疼痛(PLP)、残肢疼痛(RLP)的发生率,以及疼痛的严重程度,以及疼痛强度、行为和干扰(PROMIS)。结果:11项研究被纳入本系统综述,5项观察性研究被纳入定量综合。观察研究证据表明,TMR/RPNI可显著降低PLP和RLP的发病率、疼痛评分和PROMIS评分。神经瘤发生率的降低有利于原发性TMR/RPNI,但这并没有达到统计学意义(p = 0.07)。纳入的研究具有中度至临界的偏倚风险。结论:观察数据表明,原发性TMR/RPNI可降低PLP和RLP的发病率、疼痛评分和PROMIS评分。今后,有必要进行随机试验来评估这一研究问题,特别是提高证据的确定性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces Versus Standard Management in the Treatment of Limb Amputation: A Systematic Review and Meta-Analysis.

Introduction: Painful neuromas are a common postoperative complication of limb amputation often treated with secondary reinnervation. Surgical reinnervation include Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interface (RPNI), and can be primary and secondary. The aim of this review is to assess the effects of primary TMR/RPNI at the time of limb amputation on the incidence and intensity of post-operative neuroma and pain. Methods: This review was registered a priori on PROSPERO (CRD42021264360). A search of the following databases was performed in June 2021: Medline, EMBASE, and CENTRAL. Unpublished trials were searched using clinicaltrials.gov. All randomized and non-randomized studies assessing amputation with a reinnervation strategy (TMR, RPNI) were included. Outcomes evaluated included the incidences of painful neuroma, phantom limb pain (PLP), residual limb pain (RLP), as well as severity of pain, and Pain intensity, behavior, and interference (PROMIS). Results: Eleven studies were included in this systematic review, and five observational studies for quantitative synthesis. Observational study evidence suggests that TMR/RPNI results in a statistically significant reduction in incidence, pain scores and PROMIS scores of PLP and RLP. Decreased incidence of neuromas favored primary TMR/RPNI, but this did not achieve statistical significance (p = 0.07). Included studies had moderate to critical risk of bias. Conclusion: The observational data suggests that primary TMR/RPNI reduces incidence, pain scores and PROMIS scores of PLP and RLP. Going forward, randomized trials are warranted to evaluate this research question, particularly to improve the certainty of evidence.

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来源期刊
Plastic surgery
Plastic surgery Medicine-Surgery
CiteScore
1.70
自引率
0.00%
发文量
73
期刊介绍: Plastic Surgery (Chirurgie Plastique) is the official journal of the Canadian Society of Plastic Surgeons, the Canadian Society for Aesthetic Plastic Surgery, Group for the Advancement of Microsurgery, and the Canadian Society for Surgery of the Hand. It serves as a major venue for Canadian research, society guidelines, and continuing medical education.
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