脊髓背根入髓区显微外科毁损术治疗臂丛神经损伤后疼痛

Microsurgical lesioning in dorsal root entry zone for pain due to brachial plexus injury

目的探讨脊髓背根入髓区显微外科毁损术对臂丛神经损伤后慢性神经源性疼痛的疗效和安全性。方法回顾性分析行脊髓背根入髓区显微外科毁损术治疗的36例臂丛神经损伤后疼痛患者的临床资料,对所有患者进行术前和术后疼痛视觉模拟评分(visual analysis scale,VAS)。以术后疼痛缓解>75%为疗效优秀,50%-75%为良好,<50%为差。结果术后2周,86.1%疗效优秀,2.8%疗效良好,11.1%疗效差;随访1-5年,69.4%疗效优秀,13.9%疗效良好,16.7%疗效差。术后并发症为一过性同侧下肢无力和轻度深感觉障碍。结论脊髓背根入髓区显微外科毁损术对臂丛神经损伤后慢性神经源性疼痛疗效满意,并发症少。

Objective To study the curative effect and safety of microsurgical lesioning in dorsal root entry zone（DREZ） for chronic neuropathic pain due to brachial plexus injury.Methods Clinical data about 36 patients with chronic neuropathic pain due to brachial plexus injury after microsurgical lesioning in DREZ were retrospectively analyzed.Their pain was scored according to the visual analog scale（VAS） before and after operation.Excellent,good and poor curative effect was considered,respectively,when the pain relief was 〉75%,50%-75%,and 〈50%.Results The excellent,good and poor curative effect was 86.1%,2.8% and 11.1%,respectively,2 weeks after operation.The patients were followed up for 1-5 years,during which the excellent,good and poor curative effect was 69.4%,13.9% and 16.7%,respectively.The postoperative complications were transient homolateral lower extremity muscle weakness and mild deep sensory disturbance.Conclusion The curative effect of microsurgical lesioning in the DREZ for chronic neuropathic pain due to brachial plexus injury is satisfactory with few complications.