大腿切断5年後に断端神経腫を発症した1例

Amputation Neuroma at 5 Years after above Knee Amputation. Case Report

　症例は45歳の男性で，5年前に大腿切断を受け義足歩行を行っていた．特に誘因なく断端部の疼痛により義足歩行が不可能となった．臨床症状およびMR所見から断端神経腫と診断し，まずは保存的治療を行った．プレガバリンの内服が安静時痛に対して有効であったが，義足歩行は不可能であったため，断端神経腫切除術を施行した．断端神経腫は神経切断時の不適切な処理により発症すると考えられているが，その治療方法や発症予防法は確立されていない．今回われわれは神経結紮処理のみで断端神経腫を切除し良好な結果を得ることができた．

　A 45-year-old man was referred to our hospital because of amputation stump pain in his right lower limb.　He had undergone above-knee amputation five years before, and an artificial leg allowed him to go about his daily life unrestricted.　However, he had become unable to walk wearing his artificial leg because of sharp stump pain.　Based on the clinical findings and the MR findings we suspected that the cause of the intense pain was an amputation neuroma.　Pregabalin was very effective against the patient's pain at rest, but was not effective against a local pressure ache while walking on his artificial leg.　We excised the amputation neuroma surgically.　Amputation neuromas are thought to be caused by inappropriate processing of the neurectomy.　Various surgical procedures have been proposed for the prevention and treatment of amputation neuromas, but none has been widely accepted as a standard procedure.　We report a case of amputation neuroma that was cured by excision of the neuroma and ligation of the cut nerve.