A retrospective analysis of mid-term results of intraosseous nerve transposition with two osseous holes for painful neuromas

ZHU Hai-bo; XIONG Ge

doi:10.3969/j.issn.2095-252X.2014.03.010

Abstract：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.