Hunter J P, Katz J, Davis K D
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
Neuroscience. 2008 Oct 28;156(4):939-49. doi: 10.1016/j.neuroscience.2008.07.053. Epub 2008 Aug 3.
Amputees may experience stump pain (SP), phantom limb (PL) sensations, pain, and/or a general awareness of the missing limb. The mechanisms underlying these perceptions could involve nervous system neuroplasticity and be reflected in altered sensory function of the residual limb. Since little is known about the progression of post-amputation sensory phenomena over time, we longitudinally evaluated the stability of, and relationships among: 1) subjective reports of PL sensations, pain, awareness, and SP, 2) stump tactile and tactile spatial acuity thresholds, and 3) use of a functional vs. a cosmetic prosthesis in 11 otherwise healthy individuals with recent unilateral, traumatic upper-extremity amputation. Subjects were evaluated within 6 months and at 1-3 years after amputation. Processing of tactile sensory information from the stump remained stable over the study time period. PL awareness was frequent, stable over time, intense, and occurred with or without PL sensations. Functional prosthetic use correlated with stable vividness of PL awareness whereas subjects who used a cosmetic prosthesis had less vivid PL awareness at follow-up. Initial SP correlated with follow-up SP, the initial PL pain correlated with follow-up PL pain but neither initial nor follow-up SP appear to be related to follow-up PL pain after accounting for initial PL pain intensity. Neither limb temperature nor prosthesis-use correlated with the initial vs. follow-up change in PL pain intensity. These data provide evidence that PL pain described 1-3 years after an amputation is not related in any simple way to peripheral sensory function, SP, or limb temperature; and PL awareness but not PL pain may be influenced by the frequent use of a functional prosthesis.
截肢者可能会经历残肢疼痛（SP）、幻肢（PL）感觉、疼痛和/或对缺失肢体的总体感知。这些感知背后的机制可能涉及神经系统的神经可塑性，并反映在残肢感觉功能的改变上。由于对截肢后感觉现象随时间的进展了解甚少，我们纵向评估了以下方面的稳定性及其之间的关系：1）幻肢感觉、疼痛、感知和残肢疼痛的主观报告；2）残肢触觉和触觉空间敏锐度阈值；3）11名近期单侧上肢外伤性截肢的健康个体使用功能性假肢与美容假肢的情况。在截肢后6个月内及1 - 3年对受试者进行评估。在研究时间段内，来自残肢的触觉感觉信息处理保持稳定。幻肢感知频繁出现，随时间稳定，强烈，且无论有无幻肢感觉都会发生。功能性假肢的使用与幻肢感知的稳定生动程度相关，而使用美容假肢的受试者在随访时幻肢感知较不生动。初始残肢疼痛与随访时的残肢疼痛相关，初始幻肢疼痛与随访时的幻肢疼痛相关，但在考虑初始幻肢疼痛强度后，初始和随访的残肢疼痛似乎均与随访时的幻肢疼痛无关。肢体温度和假肢使用均与幻肢疼痛强度的初始与随访变化无关。这些数据表明，截肢后1 - 3年出现的幻肢疼痛与周围感觉功能、残肢疼痛或肢体温度没有任何简单的关联；频繁使用功能性假肢可能会影响幻肢感知，但不会影响幻肢疼痛。
