Sterling Michele
Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia 4072, Australia.
Man Ther. 2004 May;9(2):60-70. doi: 10.1016/j.math.2004.01.006.
The development of chronic symptoms following whiplash injury is common and contributes substantially to costs associated with this condition. The currently used Quebec Task Force classification system of whiplash associated disorders is primarily based on the severity of signs and symptoms following injury and its usefulness has been questioned. Recent evidence is emerging that demonstrates differences in physical and psychological impairments between individuals who recover from the injury and those who develop persistent pain and disability. Motor dysfunction, local cervical mechanical hyperalgesia and psychological distress are present soon after injury in all whiplash injured persons irrespective of recovery. In contrast those individuals who develop persistent moderate/severe pain and disability show a more complex picture, characterized by additional impairments of widespread sensory hypersensitivity indicative of underlying disturbances in central pain processing as well as acute posttraumatic stress reaction, with these changes present from soon after injury. Based on this heterogeneity a new classification system is proposed that takes into account measurable disturbances in motor, sensory and psychological dysfunction. The implications for the management of this condition are discussed.
挥鞭样损伤后慢性症状的出现很常见，且在很大程度上增加了与此病症相关的成本。目前使用的魁北克工作小组关于挥鞭样相关疾病的分类系统主要基于损伤后体征和症状的严重程度，其效用受到了质疑。最近有证据表明，从损伤中恢复的个体与出现持续性疼痛和残疾的个体在身体和心理损伤方面存在差异。所有挥鞭样损伤患者在受伤后不久都会出现运动功能障碍、局部颈部机械性痛觉过敏和心理困扰，无论其是否恢复。相比之下，那些出现持续性中度/重度疼痛和残疾的个体情况更为复杂，其特征是存在广泛的感觉超敏反应，这表明中枢性疼痛处理存在潜在紊乱，以及急性创伤后应激反应，这些变化在受伤后不久就已出现。基于这种异质性，提出了一种新的分类系统，该系统考虑了运动、感觉和心理功能障碍中可测量的紊乱情况。文中还讨论了这一病症管理方面的影响。
