Jiang Shuang, Zheng Ke, Wang Wei, Pei Yi, Qiu Enduo, Zhu Gang
Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
Department of Pain Medicine (Psychology Clinic), Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, 110042, People's Republic of China.
Neuropsychiatr Dis Treat. 2021 May 21;17:1579-1587. doi: 10.2147/NDT.S299771. eCollection 2021.
Phantom limb pain (PLP) was a common problem in malignant tumor amputees that can cause considerable suffering. The purposes of this study were to determine the incidence and factors associated with the occurrence of post-operation PLP, stump limb pain (SLP), and phantom limb sensations (PLS) in tumor amputees within the first month after surgery. Additionally, differences in phantom phenomena between upper and lower extremities were investigated.
In total, 162 amputees participated in this retrospective study who underwent malignant limb amputation between 2012 and 2019. Clinical characteristics were collected from medical records and reconfirmed by telephone interviews. A numerical rating scale (NRS) was used to quantitate phantom phenomena. We used analysis of variance and non-parametric statistics for categorical variables and ordinal variables separately.
In the first month after malignant amputation, the incidence of PLP was 54.3%, that of PLS was 65.4%, and that of SLP was 32.7%. The duration of preoperative pain and amputation level was significantly different for the incidence of acute PLP. Further subgroup analysis of amputation level showed that patients whose amputation level was below the wrist and ankle joints had a significantly reduced incidence of PLP (p<0.0083 in Bonferroni test). Binary logistics regression analysis determined that amputation level was the primary risk factor for the incidence of PLP. Factors related to the severity of postoperative PLP also included amputation level, preoperative pain, and amputation times. By comparing the differences between upper and lower limbs after amputation, we found that the incidence of PLS was higher after lower limb amputation, but there was no significant difference in the incidence of PLP and SLP. Preoperative experience of chemotherapy was not a risk factor for PLP.
Proximal amputation and long-term preoperative pain seemed to count more for PLP incidence. Further research may be required to individually determine factors associated with the occurrence and chronicity of phantom phenomena.
幻肢痛（PLP）是恶性肿瘤截肢患者中常见的问题，会导致相当大的痛苦。本研究的目的是确定肿瘤截肢患者术后第一个月内发生术后幻肢痛、残肢痛（SLP）和幻肢感觉（PLS）的发生率及相关因素。此外，还研究了上下肢幻肢现象的差异。
共有162名在2012年至2019年间接受恶性肢体截肢的患者参与了这项回顾性研究。从医疗记录中收集临床特征，并通过电话访谈再次确认。使用数字评分量表（NRS）对幻肢现象进行量化。我们分别对分类变量和有序变量使用方差分析和非参数统计。
在恶性截肢后的第一个月，幻肢痛的发生率为54.3%，幻肢感觉的发生率为65.4%，残肢痛的发生率为32.7%。术前疼痛持续时间和截肢水平对于急性幻肢痛的发生率有显著差异。截肢水平的进一步亚组分析表明，截肢水平在腕关节和踝关节以下的患者幻肢痛发生率显著降低（Bonferroni检验中p<0.0083）。二元逻辑回归分析确定截肢水平是幻肢痛发生率的主要危险因素。与术后幻肢痛严重程度相关的因素还包括截肢水平、术前疼痛和截肢次数。通过比较截肢后上下肢的差异，我们发现下肢截肢后幻肢感觉的发生率较高，但幻肢痛和残肢痛的发生率没有显著差异。术前化疗经历不是幻肢痛的危险因素。
近端截肢和长期术前疼痛似乎对幻肢痛的发生率影响更大。可能需要进一步研究以个别确定与幻肢现象的发生和慢性化相关的因素。
