脊髓背根入髓区毁损术治疗臂丛神经撕脱伤后疼痛

目的 探讨脊髓背根入髓区毁损术治疗臂丛神经撕脱伤后疼痛的疗效及安全性.方法 15例臂丛神经撕脱伤后疼痛患者接受脊髓背根入髓区毁损术治疗.分别于术后2周、6个月和1年采用视觉模拟评分（VAS）、汉密尔顿抑郁（HAMD）和焦虑评分（HAMA）来评估手术疗效.结果 手术早期,100%的患者疗效满意,经过1年的随访,疗效满意率逐渐下降.但是比较术后2周和术后6个月,以及比较术后2周和术后1年的VAS评分,结果 显示无统计学差异.并发症主要包括同侧下肢的轻度无力（3例）和同侧下肢深感觉障碍（3例）,在术后6个月都有不同程度的恢复.结论 脊髓背根入髓区毁损术是治疗臂丛神经撕脱伤后疼痛的一种安全、有效的措施.

Microsurgical lesions in the dorsal root entry zone for pain due to brachial plexus avulsion

Objective To analyze efficacy and safety of mierosurgical lesions in DREZ in patients with pain due to brachial plexus avulsion. Methods Fifteen patients with intractable deafferentation pain due to brachial plexus avulsion had microsurgical lesion in the dorsal root entry zone （DREZ）. The visual analog scale （VAS） , HAMD and HAMA was assessed at 2 week, 6 months and lyear after the surgery. Results The greatest pain relief （100%） was reported immediately after the DREZ procedure. Over the l-year follow-up period, the pain relief effect gradually decreased. There were no significant differences between the pain relief evaluated at 2 week and after 6 months and between the pain relief evaluated at 2 week and after 1 year. The major complications included motor weakness of the ipsilateral lower limb （n=3） and dysfunction of deep sensory of the ipsilateral lower limb （n= 3）. These complications can be improved 6 months after surgery. Conclusions Microsurgical lesions in the dorsal root entry zone can be performed to treat refractory pain due to brachial plexus avulsions. It is an effective and safe procedure.