Htut M, Misra P, Anand P, Birch R, Carlstedt T
The Royal National Orthopaedic Hospital, Stanmore, Hammersmith Hospital, London, and St Mary's Hospital, London, UK.
J Hand Surg Br. 2006 Dec;31(6):596-605. doi: 10.1016/j.jhsb.2006.04.027. Epub 2006 Jul 5.
Seventy-six patients with severe brachial plexus avulsion injuries were studied using pain questionnaires and quantitative sensory testing. There was significant correlation between pain intensity and the number of roots avulsed prior to surgery (P=0.0004) and surgical repairs were associated with pain relief. Sensory recovery to thermal stimuli was observed, mainly in the C5 dermatome. Allodynia to mechanical and thermal stimuli was observed in the border zone of affected and unaffected dermatomes in 18% of patients assessed early (<6 months) and 37% patients at later stages. Pain and sensations referred to the original source of afferents occurred at a later stage (>6 months) in 12% of patients and were related to nerve regeneration. By contrast, "wrong-way" referred sensations (e.g. down the affected arm while shaving or drinking cold fluids) were reported by 44% of patients and often occurred early, suggesting CNS plasticity. Understanding sensory mechanisms will help develop new treatments for severe brachial plexus injuries.
采用疼痛问卷和定量感觉测试对76例严重臂丛神经撕脱伤患者进行了研究。疼痛强度与手术前撕脱的神经根数量之间存在显著相关性（P = 0.0004），手术修复与疼痛缓解相关。观察到对热刺激的感觉恢复，主要在C5皮节。在早期（<6个月）评估的18%患者和后期37%患者中，在受影响和未受影响皮节的边界区域观察到对机械和热刺激的痛觉过敏。12%的患者在后期（>6个月）出现疼痛和牵涉到原始传入神经源的感觉，这与神经再生有关。相比之下，44%的患者报告有“错误方向”的牵涉感觉（例如剃须或喝冷饮时沿患侧手臂向下），且通常发生较早，提示中枢神经系统可塑性。了解感觉机制将有助于开发针对严重臂丛神经损伤的新治疗方法。
