Phimolsarnti Rapin, Waikakul Saranatra
Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10110, Thailand.
Eur J Orthop Surg Traumatol. 2015 Jul;25 Suppl 1:S225-31. doi: 10.1007/s00590-014-1533-x. Epub 2014 Sep 9.
This study was carried out to discover the prevalence, characteristics and severity of neuropathic pain after wide resection of chordoma of the sacrum by the use of posterior approach. Patients who had chordoma of their sacrums and underwent wide resection via posterior approach, during 1990-2002, were followed up as a prospective cohort. Pain assessment was carried out in terms of onset, characteristics, intensity (numerical rating scale), response to pain medication and associated symptoms. The correlation between patients' biographic data, preoperative neuropathic pain, type and levels of surgery and pain were analyzed. There were 21 patients; 14 male and 7 female patients. Their ages ranged between 29 and 75 years. Subtotal sacrectomy was carried out in 9 patients and total sacrectomy was carried out in 12 patients. All patients survived the operation. Neuropathic pain was found in 11 patients (52.4%). Male patients and presentation of preoperative neuropathic pain were significantly related to postoperative neuropathic pain. The other factors were not related to the postoperative pain. Recurrent of severe pain with different characteristics after the operation might indicate tumor recurrent. Early detection of the pain and proper treatment could minimize pain intensity and improved pain management satisfaction.
本研究旨在通过后侧入路广泛切除骶骨脊索瘤后，发现神经性疼痛的患病率、特征和严重程度。对1990年至2002年间患有骶骨脊索瘤并通过后侧入路进行广泛切除的患者作为前瞻性队列进行随访。从疼痛的发作、特征、强度（数字评分量表）、对止痛药物的反应以及相关症状等方面进行疼痛评估。分析了患者的传记资料、术前神经性疼痛、手术类型和水平与疼痛之间的相关性。共有21例患者，其中男性14例，女性7例。年龄在29岁至75岁之间。9例行次全骶骨切除术，12例行全骶骨切除术。所有患者术后均存活。11例患者（52.4%）出现神经性疼痛。男性患者和术前神经性疼痛的表现与术后神经性疼痛显著相关。其他因素与术后疼痛无关。术后出现具有不同特征的严重疼痛复发可能提示肿瘤复发。早期发现疼痛并进行适当治疗可将疼痛强度降至最低，并提高疼痛管理满意度。
