Smith J, Thompson J M
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1995 Apr;70(4):357-64. doi: 10.4065/70.4.357.
To determine the frequency of phantom limb pain in pediatric patients with cancer-related amputations and the relationship between phantom limb pain and chemotherapy (CHRx).
We retrospectively reviewed the medical records of all pediatric patients who underwent major limb amputations between 5 and 17 years of age during the period from Oct. 1, 1983, to Oct. 1, 1993, and were treated at the Mayo Clinic.
One investigator reviewed 293 medical records and selected cases on the basis of specific inclusion and exclusion criteria. The study group consisted of 75 patients (67 with cancer-related and 8 with trauma-associated amputations). All reports of phantom limb pain and its temporal relationship to administration of CHRx were recorded. Data were analyzed by use of descriptive statistics.
Phantom limb pain was reported in 48% of patients with cancer-related amputations in comparison with 12% of patients with trauma-associated amputations. Among patients with cancer, phantom limb pain was experienced by 74% who were exposed to CHRx before or at the time of amputation, 44% who received CHRx after amputation, and 12% who never received CHRx. Patients with trauma-related amputations and those who did not receive CHRx reported phantom limb pain at similar intervals after amputation (a mean of 6 days). In comparison, 76% of patients with cancer and a history of exposure to CHRx reported phantom limb pain within 72 hours after amputation. Three of four patients who first received CHRx after amputation reported phantom limb pain on the day CHRx was begun (a mean of 12.3 days after amputation).
Our observations suggest that (1) phantom limb pain occurs more often in pediatric amputees with cancer than in those with trauma and (2) the hypothesis that CHRx may be a risk factor in the development of phantom limb pain in pediatric amputees should be investigated further.
确定癌症相关截肢的儿科患者幻肢痛的发生率以及幻肢痛与化疗（CHRx）之间的关系。
我们回顾性分析了1983年10月1日至1993年10月1日期间在梅奥诊所接受治疗的所有5至17岁接受大肢体截肢的儿科患者的病历。
一名研究人员查阅了293份病历，并根据特定的纳入和排除标准选择病例。研究组由75名患者组成（67例癌症相关截肢和8例创伤相关截肢）。记录所有幻肢痛报告及其与CHRx给药的时间关系。使用描述性统计分析数据。
癌症相关截肢患者中有48%报告有幻肢痛，而创伤相关截肢患者中这一比例为12%。在癌症患者中，截肢前或截肢时接受CHRx的患者中有74%经历了幻肢痛，截肢后接受CHRx的患者中有44%，从未接受CHRx的患者中有12%。创伤相关截肢患者和未接受CHRx的患者在截肢后报告幻肢痛的间隔时间相似（平均6天）。相比之下，有癌症且有CHRx暴露史的患者中有76%在截肢后72小时内报告有幻肢痛。四名截肢后首次接受CHRx的患者中有三名在开始CHRx当天报告有幻肢痛（截肢后平均12.3天）。
我们的观察结果表明：（1）癌症相关截肢的儿科患者比创伤相关截肢患者更常出现幻肢痛；（2）CHRx可能是儿科截肢患者幻肢痛发生的危险因素这一假设应进一步研究。
