Международный неврологический журнал Том 20, №8 2024
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Нейропатичний постампутаційний біль кукси після бойової травми: доказовий огляд діагностики та ін’єкційних методів лікування
Авторы: B.V. Zadorozhna (1), A.I. Bohdan (2)
(1) - Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
(2) - Military Medical Clinical Center of the Western Region, Lviv, Ukraine
Рубрики: Неврология
Разделы: Справочник специалиста
Версия для печати
Резюме
Актуальність. Нищівний характер російсько-української війни призвів до значного зростання частки ампутацій кінцівок. Мета: проаналізувати доступну медичну літературу щодо нейропатичного постампутаційного болю кукси та ін’єкційних методів лікування. Матеріали та методи. Пошук первинної літератури проведений за допомогою електронних баз MEDLINE/Pubmed, Embase, Scopus. Доказовий огляд виконаний згідно з критичною оцінкою опублікованих статей, стандартів PRISMA та OCEBM. У фінальний аналіз увійшло 64 публікації. Результати. Визначено, що поширеність болю в куксі після бойових травматичних ампутацій вища (61 %), ніж внаслідок загальних захворювань або цивільних травм (22–27 %). Останні українські дані (63,6 %) відповідають цій сукупній поширеності. Прозапальні медіатори та симптомні невроми мають значний вплив на периферичні механізми постампутаційного невропатичного болю. З огляду на специфіку бойової травми необхідні подальші дослідження серед військовослужбовців. Ін’єкції спирту під ультразвуковим контролем та радіочастотна абляція невром мають порівнянні профілі ефективності в лікуванні нейропатичного постампутаційного болю кукси. Висновки. Уніфікований підхід до термінології та діагностики постампутаційного болю створює підґрунтя для високодоказових досліджень. Ін’єкційна терапія симптомних термінальних невром є перспективною, однак з огляду на недостатню кількість високоякісних досліджень серед гомогенних груп пацієнтів після ампутацій необхідний подальший аналіз ефективності різних фармакологічних агентів.
Background. The devastating nature of the russian-Ukrainian war has led to a dramatic increase in the incidence of limb amputations. The purpose was to analyze the available medical literature concerning neuropathic postamputation residual limb pain and injection therapy. Materials and methods. A comprehensive literature search of electronic databases MEDLINE/PubMed, Embase, and Scopus was conducted to identify primary studies. The evidence-based review was reported in accordance with the critical evaluation of published articles, PRISMA, and OCEBM. A total of 64 publications were included in the final quantitative analyses. Results. The estimated prevalence of residual limb pain after combat traumatic amputations is higher (61 %) than due to general diseases or civilian injuries (22–27 %). Recent Ukrainian data (63.6 %) correspond to this pooled combat-related residual limb pain prevalence. Pro-inflammatory mediators and symptomatic neuromas are determined to make significant contribution to the peripheral mechanisms of postamputation neuropathic pain. Given the distinct nature of combat trauma, further research of military populations is needed. Ultrasound-guided alcohol injections and radiofrequency ablation of neuromas have comparable efficacy profiles in the treatment for neuropathic residual limb pain. Conclusions. A standardized approach to the terminology and diagnosis of postamputation pain is essential for producing high-quality research. The injection therapy of symptomatic terminal neuromas is promising; however, given the insufficient number of high-quality studies including homogeneous groups of patients after amputations, further analysis of the pharmacological agent effectiveness is required.
Ключевые слова
постампутаційний біль; нейропатичний біль кукси; біль кукси; ін’єкційна терапія; симптомна неврома; бойова травма
postamputation pain; neuropathic residual limb pain; stump pain; injection therapy; symptomatic neuroma; combat trauma
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