Maguire Michael F, Latter Janet A, Mahajan Ravi, Beggs F David, Duffy John P
Department of Thoracic Surgery, Nottingham City Hospital Trust, Hucknall Road, Nottingham NG5 1PB, UK.
Eur J Cardiothorac Surg. 2006 Jun;29(6):873-9. doi: 10.1016/j.ejcts.2006.03.031. Epub 2006 May 3.
Our aim was to investigate the prevalence of intra-operative nerve damage and its association with chronic pain.
Our prospective study of 33 patients used nerve conduction studies to assess intercostal nerve function during elective thoracic surgical procedures. We used two methods to study nerve conduction: pre-operative magnetic stimulation (in 10 patients) and intra-operative nerve conduction studies (in all patients) We correlated these findings with specific intra-operative parameters, pain and psychological questionnaires pre-op and 3 month post-op and altered cutaneous sensation.
Magstim (magnetic stimulation) assessments were not reliable and were therefore abandoned. Intraoperative intercostal nerve studies revealed two distinct patterns of nerve injury and also that nerve injury was less in those cases where a rib was not resected. However, intercostal nerve damage detected at the time of operation is not associated with chronic pain or altered cutaneous sensation at 3 months post-op.
The study findings suggest that either the amount of intra-operative intercostal nerve damage is not indicative of long-term nerve damage or that there is a more significant cause for chronic pain other than intercostal nerve injury.
我们的目的是调查术中神经损伤的发生率及其与慢性疼痛的关联。
我们对33例患者进行了前瞻性研究，在择期胸外科手术过程中使用神经传导研究来评估肋间神经功能。我们采用两种方法研究神经传导：术前磁刺激（10例患者）和术中神经传导研究（所有患者）。我们将这些结果与特定的术中参数、术前和术后3个月的疼痛及心理问卷以及皮肤感觉改变进行关联。
磁刺激评估不可靠，因此被放弃。术中肋间神经研究揭示了两种不同的神经损伤模式，并且还发现未切除肋骨的病例中神经损伤较少。然而，术中检测到的肋间神经损伤与术后3个月的慢性疼痛或皮肤感觉改变无关。
研究结果表明，要么术中肋间神经损伤的程度不能指示长期神经损伤，要么除肋间神经损伤外存在更重要的慢性疼痛原因。
