Skov Simon Toftgaard, Bünger Cody, Li Haisheng, Vigh-Larsen Marianne, Rölfing Jan Duedal
Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Spine Deform. 2020 Aug;8(4):763-770. doi: 10.1007/s43390-020-00096-3. Epub 2020 Mar 13.
Descriptive case series.
The aim of the study is to investigate the pain associated with magnetically controlled growing rod (MCGR) lengthening procedures. MCGRs have gained popularity because they offer non-surgical lengthening procedures in early-onset scoliosis (EOS) instead of semi-annual open surgery elongations with traditional growing rods. Many aspects of MCGR treatment have been investigated, but pain in conjunction with distraction is only sparsely described in the literature.
Pain intensity was assessed in 25 EOS patients before, during and after MCGR lengthening procedures in an outpatient setup. They underwent at least two (range 2-16) lengthening procedures prior to this study. The pain intensity was estimated using patient-reported Faces Pain Scale (FPS-R), caregiver-reported pain numeric rating scale (NRS), and NRS and revised Face, Legs, Activity, Cry, Consolability scale (r-FLACC) by two medically trained observers. The inter-rater reliability and correlation between instruments were analyzed.
23 of 25 EOS patients (8- to 16-year old) with mixed etiology were able to self-report pain. The average pain intensity was mild: median 1 (range 0-6) on all four instruments on a 0-to-10 scale. Afterward, 22/25 patients (88%) were completely pain free and the remaining 3 patients had a pain score of 1. MCGR stalling (i.e. clunking) was encountered in 14/25 (56%) of the patients without impact on the pain intensity.
The average maximum pain intensities during the lengthening procedures were mild and pain ceased within few minutes. The inter-rater reliability was good to excellent for NRS and r-FLACC, and there were high correlations between all the four pain instruments, indicating high criterion validity.
Level IV, case series.
描述性病例系列研究。
本研究旨在调查与磁控生长棒（MCGR）延长手术相关的疼痛。MCGR因能为早发性脊柱侧弯（EOS）患者提供非手术延长手术，而非传统生长棒每半年进行一次的开放手术延长，从而受到欢迎。MCGR治疗的许多方面已得到研究，但文献中对与撑开相关的疼痛描述甚少。
在门诊环境中，对25例EOS患者在MCGR延长手术前、手术期间和手术后的疼痛强度进行评估。在本研究之前，他们至少接受了两次（范围为2 - 16次）延长手术。疼痛强度由患者报告的面部疼痛量表（FPS - R）、护理人员报告的疼痛数字评定量表（NRS）以及两名经过医学培训的观察者使用NRS和修订的面部、腿部、活动、哭泣、安慰量表（r - FLACC）进行评估。分析了评估者间信度以及各工具之间的相关性。
25例病因混合的EOS患者（8至16岁）中有23例能够自我报告疼痛。在0至10分的量表上，所有四种工具测得的平均疼痛强度均为轻度：中位数为1（范围为0 - 6）。之后，22/25例患者（88%）完全无痛，其余3例患者的疼痛评分为1。14/25例（56%）患者出现MCGR卡顿（即发出沉闷声），但对疼痛强度无影响。
延长手术期间的平均最大疼痛强度为轻度，且疼痛在几分钟内消失。NRS和r - FLACC的评估者间信度良好至优秀，且四种疼痛评估工具之间存在高度相关性，表明标准效度高。
IV级，病例系列研究。
