评价镜像疗法预防膝下截肢术后幻肢痛的效果：一项随机临床试验。
Assessment of efficiency of mirror therapy in preventing phantom limb pain in patients undergoing below-knee amputation surgery-a randomized clinical trial.
机构信息
Department of Anaesthesiology and Critical Care, Second Floor, Institute Block, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
Department of Surgery, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India.
出版信息
J Anesth. 2023 Jun;37(3):387-393. doi: 10.1007/s00540-023-03173-9. Epub 2023 Feb 21.
PURPOSE AND OBJECTIVES
Phantom limb pain (PLP) is a major cause of physical limitation and disability accounting for about 85% of amputated patients. Mirror therapy is used as a therapeutic modality for patients with phantom limb pain. Primary objective was to study the incidence of PLP at 6 months following below-knee amputation between the mirror therapy group and control group.
METHODS
Patients posted for below-knee amputation surgery were randomized into two groups. Patients allocated to group M received mirror therapy in post-operative period. Two sessions of therapy were given per day for 7 days and each session lasted for 20 min. Patients who developed pain from the missing portion of the amputated limb were considered to have PLP. All patients were followed up for six months and the time of occurrence of PLP and intensity of the pain were recorded among other demographic factors.
RESULTS
A total of 120 patients completed the study after recruitment. The demographic parameters were comparable between the two groups. Overall incidence of phantom limb pain was significantly higher in the control group (Group C) when compared to the mirror therapy (Group M) group [Group M = 7 (11.7%) vs Group C = 17 (28.3%); p = 0.022]. Intensity of PLP measured on the Numerical Rating Scale (NRS) was significantly lower at 3 months in Group M compared to Group C among patients who developed PLP [NRS - median (Inter quartile range): Group M 5 (4,5) vs Group C 6 (5,6); p 0.001].
CONCLUSION
Mirror therapy reduced the incidence of phantom limb pain when administered pre-emptively in patients undergoing amputation surgeries. The severity of the pain was also found to be lower at 3 months in patients who received pre-emptive mirror therapy.
TRIAL REGISTRATION
This prospective study was registered in the clinical trial registry of India.
TRIAL REGISTRATION NUMBER
CTRI/2020/07/026488.
目的和目标
幻肢痛（PLP）是导致身体受限和残疾的主要原因，约占截肢患者的 85%。镜像疗法被用作治疗幻肢痛患者的一种治疗方式。主要目的是研究在膝下截肢后 6 个月内，镜像治疗组和对照组的幻肢痛发生率。
方法
将接受膝下截肢手术的患者随机分为两组。分配到 M 组的患者在术后接受镜像治疗。每天进行两次治疗，每次持续 20 分钟，共 7 天。被认为患有缺失肢体疼痛的患者被认为患有 PLP。所有患者均随访 6 个月，记录 PLP 的发生时间和疼痛强度以及其他人口统计学因素。
结果
招募后共有 120 名患者完成了研究。两组的人口统计学参数相似。与镜像治疗（M 组）组相比，对照组（C 组）的幻肢痛总体发生率明显更高[M 组 7（11.7%）vs C 组 17（28.3%）；p=0.022]。在发生 PLP 的患者中，M 组在 3 个月时的 NRS 测量的 PLP 强度明显低于 C 组[NRS-中位数（四分位距）：M 组 5（4，5）vs C 组 6（5，6）；p<0.001]。
结论
在接受截肢手术的患者中，预防性给予镜像治疗可降低幻肢痛的发生率。在接受预防性镜像治疗的患者中，3 个月时疼痛的严重程度也较低。
试验注册
这项前瞻性研究在印度临床试验注册处注册。
试验注册号
CTRI/2020/07/026488。
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