Rath S A, Braun V, Soliman N, Antoniadis G, Richter H P
Department of Neurosurgery, University of Ulm, Günzburg, Federal Republic of Germany.
Acta Neurochir (Wien). 1996;138(4):364-9. doi: 10.1007/BF01420297.
The results of 58 dorsal root entry zone (DREZ) thermocoagulation procedures in 51 patients are reported. The postoperative analgesic effect was judged by the patients as being good (more than 75% pain reduction), fair (25-75% pain reduction) or poor (less than 25% pain reduction). Of the 14 patients who underwent surgery for pain due to cervical root avulsion, 10 (77%) had permanently good (8) or fair (2) pain relief after a mean follow up period of 76 months, another 2 (15%) experienced recurrence to the preoperative level (initially 1 good, 1 fair) after more than 2 and 4 years, respectively. Twenty two paraplegics were operated upon, 3 of whom twice, for intractable pain. After a mean observation time of 54 months, continuing pain relief was reported by 12 (55%) patients (11 good, 1 fair), and one (initially fair) had recurrent pain after 8 months. All 3 (early) re-operations remain successful for an average period of 75 months. Poor results were seen especially in cases of associated spinal cord cysts (5 out of 7), despite combined drainage, and in patients with diffuse pain distribution (5 out of 6). Continuous marked improvement for longer periods (mean follow up: 52 months) after DREZ lesions was reported only by 2 out of 10 patients with postherpetic neuralgia (12 procedures) and by 1 out of 5 with painful states due to radiation-induced brachial plexopathy (2), previous surgery (2) and malignant tumour infiltration of the brachial plexus (1). Three patients died postoperatively due to acute cardiac failure (2) and pulmonary embolism (1). Major complications, especially permanent gait disturbances were observed in 6 patients (12%) following primary procedures and in 2 out of 7 patients after re-operations, most of them suffering from postherpetic neuralgia. Minor neurological deficits were noted in 9 cases (18%). DREZ lesions revealed to be an effective procedure in patients with pain related to root avulsion and paraplegia. In contrast, it seems to be less successful for painful states due to other plexus lesions or postherpetic neuralgia.
报告了51例患者接受58次背根入髓区（DREZ）热凝手术的结果。术后镇痛效果由患者判定为良好（疼痛减轻超过75%）、尚可（疼痛减轻25%-75%）或较差（疼痛减轻少于25%）。在14例因颈神经根撕脱伤而接受疼痛手术的患者中，10例（77%）在平均76个月的随访期后获得了永久性良好（8例）或尚可（2例）的疼痛缓解，另外2例（15%）分别在2年多和4年多后疼痛复发至术前水平（最初1例良好，1例尚可）。22例截瘫患者因顽固性疼痛接受了手术，其中3例接受了两次手术。平均观察54个月后，12例（55%）患者（11例良好，1例尚可）报告持续疼痛缓解，1例（最初尚可）在8个月后疼痛复发。所有3例（早期）再次手术平均75个月内仍成功。尤其是伴有脊髓囊肿的病例（7例中的5例），尽管进行了联合引流，以及疼痛分布弥漫的患者（6例中的5例），效果较差。仅10例带状疱疹后神经痛患者（12次手术）中的2例以及5例因放射性臂丛神经病变（2例）、既往手术（2例）和臂丛神经恶性肿瘤浸润（1例）导致疼痛状态的患者中的1例，在DREZ损伤后较长时间（平均随访：52个月）持续有明显改善。3例患者术后因急性心力衰竭（2例）和肺栓塞（1例）死亡。主要并发症，尤其是永久性步态障碍，在初次手术后6例患者（12%）中观察到，再次手术后7例患者中的2例观察到，其中大多数患有带状疱疹后神经痛。9例（18%）出现轻微神经功能缺损。DREZ损伤对与神经根撕脱伤和截瘫相关的疼痛患者是一种有效的手术方法。相比之下，对于其他臂丛神经病变或带状疱疹后神经痛导致的疼痛状态，似乎不太成功。
