Haninec Pavel, Kaiser Radek, Mencl Libor, Waldauf Petr
Department of Neurosurgery, Third Faculty of Medicine, Charles University, Hospital Kralovske Vinohrady, Srobarova 50 100 34, Prague, Czech Republic.
Department of Anesthesiology and Critical Care Medicine, Third Faculty of Medicine, Charles University, Hospital Kralovske Vinohrady, Prague, Czech Republic.
BMC Neurol. 2014 Dec 9;14:225. doi: 10.1186/s12883-014-0225-9.
Despite high success rate of DREZ lesioning in the treatment of intractable central pain, there is still a significant incidence of patients without satisfactory post-operative effect. The aim of the study was to evaluate the long-term effect of DREZ lesioning using both a subjective assessment using a visual analog scale (VAS) to quantify residual pain and an assessment using the screening tool (painDETECT Questionnaire, PD-Q).
DREZ lesioning was performed in 52 patients from a total 441 cases with brachial plexus injury (11.8%) during a 17-year period (1995-2011). The effect of surgery was retrospectively assessed in 48 patients.
A decrease in pre-operative pain by more than 75% (Group I) was achieved in 70.8% of patients and another 20.8% reported significant improvement (Group II). The surgery was unsucessful in 8.4% (Group III). We found a significant correlation between 'improvement' groups from both methods of assessments. Patients from Group I usually complained of residual nociceptive pain according to PD-Q, patients from Group II typically had pain of unclear origin, and all cases those in Group III suffered from neuropathic pain, Cramer's V = .66, P < .001. Overall, 66.7% of patients had resolved neuropathic pain, 20.8% patients had more serious complaints and may also suffer from residual neuropathic pain, while 12.5% had unresolved neuropathic pain.
DREZ lesioning is a safe and effective method with success rates of about 90%. PD-Q scores correspond to subjective satisfaction with the surgery and it seems to be a suitable screening tool for finding patients with residual neuropathic pain after surgery.
尽管脊髓背根入髓区（DREZ）毁损术治疗顽固性中枢性疼痛的成功率很高，但仍有相当一部分患者术后效果不理想。本研究旨在通过视觉模拟量表（VAS）进行主观评估以量化残余疼痛，并使用筛查工具（疼痛DETECT问卷，PD-Q）进行评估，从而评价DREZ毁损术的长期效果。
在17年期间（1995 - 2011年），对441例臂丛神经损伤患者中的52例（11.8%）实施了DREZ毁损术。对48例患者的手术效果进行了回顾性评估。
70.8%的患者术前疼痛减轻超过75%（I组），另有20.8%的患者报告有显著改善（II组）。手术失败率为8.4%（III组）。我们发现两种评估方法的“改善”组之间存在显著相关性。根据PD-Q，I组患者通常抱怨有残余伤害性疼痛，II组患者典型地有不明来源的疼痛，而III组所有病例都患有神经性疼痛，克莱默V值 = 0.66，P < 0.001。总体而言，66.7%的患者神经性疼痛得到缓解，20.8%的患者有更严重的主诉且可能也患有残余神经性疼痛，而12.5%的患者神经性疼痛未得到缓解。
DREZ毁损术是一种安全有效的方法，成功率约为90%。PD-Q评分与对手术的主观满意度相对应，它似乎是一种适合筛查术后有残余神经性疼痛患者的工具。
