Ho Emily S, Curtis Christine G, Clarke Howard M
Division of Plastic and Reconstructive Surgery and Department of Rehabilitation Services, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Rehabilitation Sciences Institute, Department of Physical Therapy and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
J Hand Surg Am. 2015 Jun;40(6):1177-83. doi: 10.1016/j.jhsa.2015.02.003. Epub 2015 Mar 25.
To determine the prevalence and characteristics of pain experienced by children who have had microsurgical reconstruction for obstetrical brachial plexus palsy (OBPP).
A prospective case series study was conducted of 65 children aged 6 to 18 years with a diagnosis of OBPP and who had microsurgery at less than 12 months of age with nerve grafting or transfer. A total of 28 patients (43%) had upper OBPP and 37 (57%) had total OBPP. We evaluated pain using the Faces Pain Scale-Revised and the Adolescent Pediatric Pain Tool. Sensory symptoms in the affected limb were also collected. Mean age was 11.0 ± 3.3 years.
We evaluated 65 children. The point prevalence of pain (pain at the time of assessment) was 25%. The reported lifetime prevalence of pain (experienced anytime during life) was 66%. A total of 71% reported that the affected extremity felt different at least once in their lifetime. Average intensity of those with pain (n = 43) was 40 ± 19 mm on a 100-mm visual analog scale. Seventy percent of children reported that symptoms occurred every day or at least once a week. Anatomical distribution of pain was throughout the affected upper extremity irrespective of the severity of injury, with the exception of children with upper plexus injuries who did not report pain in their hand. Words typically used to describe neuropathic or musculoskeletal symptoms were chosen by the children to represent their pain.
Children with OBPP who had microsurgical reconstruction commonly reported pain. These symptoms were typically frequent but were episodic and low in intensity. The descriptions of the type of pain include terms typical of both neuropathic and musculoskeletal origins.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
确定接受过产科臂丛神经麻痹（OBPP）显微外科重建手术的儿童疼痛的患病率及特征。
对65名年龄在6至18岁、诊断为OBPP且在12个月龄前接受过神经移植或移位显微手术的儿童进行了一项前瞻性病例系列研究。共有28例患者（43%）为上型OBPP，37例（57%）为全型OBPP。我们使用面部疼痛量表修订版和青少年儿童疼痛工具评估疼痛情况。还收集了患侧肢体的感觉症状。平均年龄为11.0±3.3岁。
我们评估了65名儿童。评估时疼痛的时点患病率为25%。报告的终生疼痛患病率（一生中任何时候经历过疼痛）为66%。共有71%的人报告患侧肢体在其一生中至少有一次感觉不同。疼痛患者（n = 43）在100毫米视觉模拟量表上的平均强度为40±19毫米。70%的儿童报告症状每天或至少每周出现一次。疼痛的解剖分布遍及整个患侧上肢，与损伤严重程度无关，但上丛损伤的儿童手部未报告疼痛。儿童选择通常用于描述神经性或肌肉骨骼症状的词汇来表示他们的疼痛。
接受显微外科重建手术的OBPP儿童普遍报告有疼痛。这些症状通常频繁出现，但为发作性且强度较低。疼痛类型的描述包括神经性和肌肉骨骼性起源的典型术语。
研究类型/证据水平：预后性IV级。
