Kumagai Y, Shimoji K, Honma T, Uchiyama S, Ishijima B, Hokari T, Fujioka H, Fukuda S, Ohama E
Department of Anesthesiology, Niigata University School of Medicine, Japan.
Acta Neurochir (Wien). 1992;115(3-4):71-8. doi: 10.1007/BF01406361.
Several clinical problems related to the dorsal root entry zone lesions (DREZLs) in 15 patients with chronic pain are presented and discussed in terms of ratings of pain relief following surgery, development of sensory or motor weakness and postmortem histologies. Subjective pain relief exceeding 70% was achieved at around 2 weeks after the operations in most patients (13/15), and then decreased in some to 30 from 70% in the follow-up observations. Our new "objective" pain relief score was tested in these patients. A significant positive correlation between subjective pain relief and our objective pain relief scale was found, but some discrepancies between them were also found during the follow-up. Sensory loss, motor weakness, paraesthesia and a new pain were found as complications in 12, 7, 4 and 6 patients, respectively. Postmortem histological findings of the spinal cord in two patients with systemic lupus erythematosus and uterine cancer, who received bilateral DREZLs twice and bilateral DREZLs plus commissural myelotomy, respectively, indicate that care should be taken to avoid extension of the coagulation beyond the dorsal horn.
本文介绍并讨论了15例慢性疼痛患者中与背根入髓区损伤（DREZLs）相关的几个临床问题，这些问题涉及术后疼痛缓解评分、感觉或运动功能障碍的发生情况以及尸检组织学检查结果。大多数患者（13/15）术后约2周主观疼痛缓解超过70%，但在随访观察中，部分患者的疼痛缓解率从70%降至30%。我们在这些患者中测试了新的“客观”疼痛缓解评分。结果发现主观疼痛缓解与我们的客观疼痛缓解量表之间存在显著正相关，但在随访期间也发现了两者之间的一些差异。分别有12例、7例、4例和6例患者出现感觉丧失、运动功能障碍、感觉异常和新发疼痛等并发症。对2例分别接受双侧DREZLs两次和双侧DREZLs加连合部脊髓切开术的系统性红斑狼疮和子宫癌患者的脊髓进行尸检组织学检查，结果表明应注意避免凝固范围超出背角。
