摘要： 探讨不同术式治疗痛性指固有神经瘤疗效。共30 例患者（30 指）分别接受神经弓式双端侧神经吻合术（11 例）、神经移植端-端吻合术（10 例）或直接端-端吻合术（9 例）。参照Burchiel 等疗效评价标准，神经弓式双端侧神经吻合术组疗效达优9 例、良2 例，神经移植端-端吻合术组达优4 例、良3 例、可3 例，直接端-端吻合术组达优4 例、良4 例、可1 例，神经弓式双端侧神经吻合术疗效优于其他两种术式（Z = -1.927，P = 0.041）；测量3 种术式组患指两点分辨觉，分别为（5.01 ± 0.71）、（7.30 ± 1.21）和（6.10 ±1.10）mm，神经弓式双端侧神经吻合术低于其他两种术式（F = 3.144，P = 0.022）。提示神经弓式双端侧神经吻合术治疗痛性指固有神经瘤的效果优于神经移植或直接端-端吻合术，可有效治疗痛性指固有神经瘤，消除患指疼痛、恢复指腹触摸敏感性。

关键词: 神经瘤, 指损伤, 疼痛, 顽固性, 神经移位, 修复外科手术

Abstract: This paper aims to investigate the curative effect of different surgeries for painful digital proper neuroma. There were 30 patients with painful digital proper neuroma, among whom 11 patients underwent arched double end-to-side neuroanastomosis, 10 patients underwent nerve graft with end-to-end neuroanastomosis, while other 9 patients underwent directly end-to-end neuroanastomosis. The results showed that the two-point discrimination (2-PD) was (5.01 ± 0.71) mm in arched double end- to-side neuroanastomosis, which was significantly lower than that in nerve graft with end-to-end neuroanastomosis [(7.30 ± 1.21) mm] and directly end-to-end neuroanastomosis [(6.10 ± 1.10) mm; F = 3.144, P = 0.022]. According to Burchiel's efficacy, there were 9 excellent and 2 good fingers in arched double end-to-side neuroanastomosis; 4 excellent, 3 good and 3 fair fingers in nerve graft with end-to-end neuroanastomosis; 4 excellent, 4 good and one fair fingers in directly end-to-end neuroanastomosis. The efficacy of the first group was significantly better than those of the other 2 groups (Z = -1.927, P = 0.041). The arched nerves of double end-to-side neuroanastomosis is a valuable surgical method for painful digital proper neuroma, which can quickly restore the sensation of fingers, and have better outcome than the other two methods.

Key words: Neuroma, Finger injuries, Pain, intractable, Nerve transfer, Reconstructive surgical procedures