脊髓背根入髓区切开术治疗脊髓和马尾神经损伤后慢性疼痛

MICROSURGICAL DREZOTOMY FOR CHRONIC PAIN DUE TO SPINAL CORD AND CAUDA EQUINA INJURIES

目的：探讨脊髓背根入髓区（Dorsal root entry zone，DREZ）切开术在脊髓和马尾神经损伤后慢性疼痛中的临床应用。方法：脊髓和马尾神经损伤后慢性神经源性疼痛10例，年龄28～72岁，病程8月～28年。患者均有不同程度的双下肢截瘫，疼痛位于下肢感觉减退和缺失区，为烧灼样、压榨样、痉挛性疼痛，视觉模拟疼痛评分（VAS）8～10分。10例均行脊髓背根入髓区显微外科切开术，切开范围由患者疼痛范围决定。结果：随访4月～2年，4例疼痛消失，停用镇痛剂，生活质量改善；5例疼痛明显减轻，VAS2～4分，其中，3例停用镇痛剂，2例镇痛剂使用量明显下降，生活质量改善；1例疼痛无明显改善。结论：脊髓背根入髓区切开术对脊髓和马尾神经损伤后慢性疼痛疗效满意，可明显提高患者的生活质量。

Objective： To investigate the clinical use of microsurgical DREZotomy in chronic pain due to spinal cord and cauda equina injuries. Methods： There were 10 patients with chronic pain due to spinal cord and cauda equina injuries. The age was between 28 to 72 yrs. The course was between 8 months to 28 years. They all had complete or incomplete paraplegia. The distribution of pain was confined to hypoesthetic and anesthetic area. Pain was often described as severe burning, crushing or cramping in character. The Visual Analog Scale （VAS） was between 8 to 10. They all had microsurgieal DREZotomy. Results ： During 4 months to 2 years postoperative follow-up, four patients were free of pain with complete withdrawal of narcotics. Five patients had great pain relief whose VAS was from 2 to 4. Among them, 3 were free of narcotics, 2 reduced the dose of narcotics, one was inefficient. Conclusion： Microsurgical DREZotomy was effective in treating chronic pain due to spinal cord and cauda equina injuries.