矫形器和运动训练对青少年特发性脊柱侧凸的效果比较

目的探讨矫形器和运动训练治疗青少年特发性脊柱侧凸(AIS)的疗效以及两种治疗方法对患者心理状况和生活质量的影响。方法 2017年7月至2018年2月,选取10～16岁、Cobb角25°～40°的特发性脊柱侧凸患者55例,分为运动训练组(n=25)和矫形器组(n=30),并进行对应治疗。分别记录患者治疗前、治疗3个月、治疗6个月后的Cobb角、躯干位移(TS)、顶椎旋转度(AVR)和顶椎偏离中线距离(AVT),并于治疗前和治疗6个月后采用国际脊柱侧凸研究学会22项问卷(SRS-22)对生活质量和心理状态进行评定。结果治疗后,运动训练组SRS-22中功能/活动度、疼痛、自我形象/外观和治疗满意度评分均优于矫形器组(t2.137, P 0.05)。治疗3个月及治疗6个月后,两组Cobb角均显著小于治疗前(t 4.461, P 0.001);治疗6个月后,矫形器组Cobb角小于运动训练组(t=2.548, P 0.05)。治疗3个月后及治疗6个月后,两组TS、AVR和AVT均优于治疗前(t 2.338, P 0.05);治疗6个月后,矫形器组TS、AVR、AVT均优于运动训练组(t 2.259, P 0.05)。结论单独的运动训练对Cobb角为25°～40°的AIS患者有较好的疗效,且在心理状况和生活质量方面的改善优于矫形器治疗,但是在脊柱侧凸畸形的改善方面不如矫形器治疗。     

扩大色努矫形器释放空间在脊柱侧凸矫形治疗中的意义

摘要 目的：研究扩大色努矫形器凹侧的释放空间,引导生长、呼吸、运动对治疗青少年脊柱侧凸的意义。 方法：对168例Risser征0度—Ⅲ度特发性脊柱侧凸患儿,通过设置扩大色努矫形器凹侧的释放空间,引导生长,呼吸,运动进行治疗随访,观察并比较患儿治疗前后Cobb角、顶椎偏离中线距离（AVT）、顶椎旋转度(AVR)、躯干位移(TS)并分别计算矫正率。同时检测肺活量（VC）、第1秒钟用力呼气容积(FEV1)、用力肺活量 (FVC)、第一秒用力呼气容积占用力肺活量的百分比（FEV1/FVC）、残气量(RV)、肺总量(TLC)等指标并分别分析计算正常率。从而分析并评价扩大色努矫形器凹侧释放空间的疗效。 结果：治疗前,脊柱侧凸的Cobb角为（36.7±11.3）°,经扩大凹侧释放空间的色努矫形器治疗并配合运动、呼吸疗法,连续平均随访2年后Cobb角为（20.4±8.3）°,脊柱侧凸的Cobb角减少了16°—35°,治疗前、后比较差异具有显著意义（P<0.01）,矫正率为44.4%。治疗后,顶椎偏离中线距离、顶椎旋转度、躯干位移与治疗前比较,均有显著改善（P<0.01）;患者使用扩大释放空间矫形器前、6个月、1年、2年后肺功能各项指标（包括VC、FEV1、FVC、FEV1/FVC、RV、TLC）的正常率与使用未扩大释放空间的侧弯矫形器前、6个月、1年、2年后相比,差异均有显著意义（P<0.05）。除3例患者加重、7例患者改行手术治疗外,其他158例患者侧弯畸形均有显著改善,肺功能各项指标也有一定改善。 结论：通过设置压力垫、扩大凹侧释放空间,矫形器完全可以降低凸起,使凸起部位向释放空间转移,释放空间位置必须与压力垫相对应,释放空间的面积必须10倍于压力垫面积使压力垫发挥矫正作用。     

夜用式脊柱侧凸矫形器治疗脊柱单侧弯的临床疗效观察

目的：探讨分析夜用式脊柱侧凸矫形器对青少年特发性脊柱单侧弯的疗效。方法：脊柱单侧凸患者40例,分为观察组22例和对照组18例。观察组在睡觉时佩戴夜用式脊柱侧凸矫形器8-10h ,对照组佩戴传统色努式脊柱侧凸矫形器≥20h。观察2组患者治疗前后的Cobb角,顶椎偏离中线距离（AVT）、躯干位移（TS）和肺活量（VC）的改善。结果：治疗3个月后,2组患者的Cobb角度、AVT及TS距离均明显低于治疗前（P＜0．01）,且观察组更低于对照组（P＜0．01）;2组治疗后VC含量均明显高于治疗前,且观察组更高于对照组（P＜0．01）。结论：夜用式脊柱侧凸矫形器适合青少年C型侧凸治疗,其矫正效果明显优于传统的脊柱侧凸矫形器,值得临床推广应用。     

色努式脊柱侧弯矫形器佩戴时间与效果的对比分析

目的探讨比较色努式脊柱侧弯矫形器佩戴时间及功能锻炼对矫正治疗效果的影响。方法将2004年7月-20011年7月收治的126例脊柱侧弯患者,按自愿选择分为试验组和对照组,试验组佩戴色努式脊柱侧弯矫形器18～20h,功能锻炼〉90min;对照组佩戴侧弯矫形器23h,功能锻炼30～60min。对比两组患者治疗前后的Cobb角、顶椎偏离中线距离（AVT）、顶椎旋转度（AVR）、躯干位移（Ts）、脊柱柔韧性及肺功能指标的改善。结果经X线检查测定,治疗后两组患者的Cobb角、AVT、AVR、TS均低于治疗前（P〈0．01）,且试验组明显低于对照组（P〈0．01）。肺功能指标：试验组治疗后肺活量（VC）、第1秒钟用力呼气容积（FEV1）、用力肺活量（FVC）、肺总量（TLC）,等均高于治疗前,残气量（RV）低于治疗前（P〈O．01）,对照组治疗后VC、FEV1、FVC、TLC均低于治疗前,RV高于治疗前（P〈0．01）,且试验组优于对照组（P〈0．01）。功能位Cobb角：两组患者的功能位主弯Cobb角、代偿弯Cobb角均低于治疗前（P〈0．01）,且试验组明显低于对照组（P〈0．01）。结论色努式脊柱侧弯矫形器每天佩戴18～20h,并结合适当的体操疗法,呼吸、肌力训练及麦肯基力学疗法,可使肺功能、腰背部肌力、脊柱柔韧性、身体的协调性、以及平衡能力得到改善,从而达到脊柱侧弯治疗的较好效果。     

Rodin 4D技术与传统石膏技术制作青少年特发性脊柱侧凸矫形器的临床疗效观察

目的:观察Rodin 4D技术制作青少年特发性脊柱侧凸(AIS)矫形器与传统石膏技术制作AIS矫形器的疗效差异。方法:对2014年1月至2017年1月上海市残联康复中心与苏州市残联康复服务训练中心收治的青少年特发性脊柱侧凸患者30例,主弯角度(25°Cobb40°),年龄10—16岁,进行佩戴AIS矫形器干预。上海市残联康复中心收治AIS患者20例,其中,通过Rodin 4D技术制作矫形器10例(本地Rodin 4D组),传统石膏技术制作矫形器10例(石膏组);苏州市残联康复服务训练中心收治AIS患者10例,通过Rodin 4D脊柱扫描远程网络传输技术,将10例AIS患者评估数据网络传输至上海市残联康复中心,由上海市残联康复中心负责矫形器制作(远程Rodin 4D组)。所有AIS患者每日佩戴矫形器时间为20—22h,总计佩戴时间为1年,并对其干预前后进行Cobb角测量,观察疗效差异。结果:3组AIS患者矫形器干预前后Cobb角度均有改善,治疗前后差异有显著性意义(P0.05);本地Rodin 4D组与远程Rodin 4D组治疗后Cobb角度差异无显著性意义(P0.05);本地及远程Rodin 4D组与石膏组治疗前后Cobb角度差异有显著性意义(P0.05)。结论:应用Rodin 4D技术制作AIS矫形器疗效优于传统石膏技术,可推广应用Rodin 4D远程制作AIS矫形器模式。     

中文版SRS-22问卷评估青少年特发性脊柱侧凸患者生活质量的研究

目的研究未经治疗的青少年特发性脊柱侧凸（AIS）患者的健康相关的生活质量。 方法对62例未经治疗的女性AIS患者采用中文版脊柱侧凸研究学会患者问卷表（SRS-22）进行问卷评估。根据Cobb角大小分为轻度脊柱侧凸组14例（Cobb角＜30°）、中度脊柱侧凸组42例（Cobb角30°~50°）、重度脊柱侧凸组6例（Cobb角＞50°）。 结果重度脊柱侧凸组自我形象维度得分均低于轻度脊柱侧凸组和中度脊柱侧凸组,差异有统计学意义（P＜0.05）。3组功能活动、疼痛、心理健康三个维度的得分差异均无统计学意义（P&rt;0.05）。 结论中文版SRS-22问卷可提供AIS患者与健康相关的生活质量信息。Cobb角＞50°的AIS患者自我形象维度得分较低。     

热塑矫形器及其材料在青少年特发性脊柱侧凸治疗中的应用

背景:矫形器治疗是目前公认的适于未发育成熟轻中度特发性脊柱侧凸患者惟一有效的非手术治疗方法.目的:回顾性分析热塑矫形器治疗青少年特发性脊柱侧凸临床疗效.方法:1997-04/2004-03在海南省人民医院康复医学部矫形科收治特发性脊柱侧凸患者113例.佩戴热塑矫形器(brace)从开始2.0-3.0 /d,逐渐增加22 h/d.复查时cobb's角减少大于30%,则佩戴时间减至20 h/d,Risser征Ⅳ度或月经初潮1年后佩戴时间减至4 h/d.同时每天完成1 h矫正体操,包括腰背肌锻练:5点式(即头、双肘及双足支撑)和3点式(即头、双足支撑)锻练.随访2年后复测cobb's角,监测cobb's角变化.结果与结论:全部病例随访2年,有效98例(86.7%);治疗无效15例(13.3%),出现脊柱侧凸进展加重.脊柱侧凸cobb's角在20°-30°者68例,有效63例(92.6%).31°-45°者45例,有效35例(77.8%).未发现材料方面的特殊不良反应.结果证明,热塑矫形器结合矫正体操综合治疗特发性脊柱侧凸疗效明显,可减少∞bb's角度,改善侧凸,防止或延缓特发性脊柱侧凸进展.     

热塑矫形支具治疗青少年特发性脊柱侧凸：疗效及材料和宿主反应随访

目的:回顾性分析支具矫正的青少年特发性脊柱侧凸适应证及临床效果。方法:对2003-01/2005-12在解放军第211医院骨科收治的106例未做过治疗的生长发育期青少年特发性脊柱侧凸患者,给予热塑矫形支具治疗。男21例,女85例;年龄8～19岁,平均(13.1±3.6)岁。单胸凸49例,双胸凸8例,胸和腰双凸37例,胸腰段或腰凸12例。原发Cobb角20°～42°,平均(±6.4)°。Risser征0度51例,Ⅰ度33例,Ⅱ度19例,Ⅲ度3例。支点29.5弯曲位时的矫正率≥50%的柔软性侧凸57例,<50%的僵硬性侧凸49例。每3～6个月复查1次,摄站立位全脊柱正侧位X射线片。结果:①全部病例随访24～72个月,平均36个月,79例(74.5%)治疗有效(原发性侧凸Cobb角增加≤5°,或是胸腰双主弯中继发侧凸超过原发侧凸≤5°),27例(25.5%)出现脊柱侧凸进展,治疗无效。②柔软性侧凸57例,支具矫正有效是48例;僵硬性侧凸49例,有效是37例,柔软性侧凸的矫正效果优于僵硬性侧凸。③脊柱侧凸Cobb角在20°°者63例,有效是54例,～2930～40°者43例,有效是25例,Cobb角20°°组的矫正效果优于Cobb角30°°组。③未出现特殊的材料和宿主的明显～29～40不良反应和负性事件,但腰、髋部骨密度明显下降。结论:①热塑矫形支具矫正青少年特发性脊柱侧凸能够取得良好疗效。②骨骼正处于生长发育期者,侧凸柔软性好者,Cobb角较小者,矫正效果好。③支点弯曲位时的矫正率可以预测支具矫正效果。④随访中发现应用支具后患者腰、髋部骨密度明显下降。     

3D打印脊柱侧凸矫形器的矫正效果

目的 观察3D打印脊柱侧凸矫形器的矫正期内矫正效果和短期矫正效果。方法 2021年7至12月，就诊于上海交通大学附属第九人民医院的青少年特发性脊柱侧凸患者36例，穿戴矫形器前及穿戴后即刻摄脊柱全长X线片；每日穿戴矫形器20 h以上，6个月后随访拍摄X线片；计算Cobb角。穿戴矫形器前后采用脊柱侧凸研究会22项问卷简体中文版(SRS-22)进行评估。结果 穿戴矫形器前，患者平均Cobb角(22.10±6.29)°；穿戴后即刻Cobb角(7.85±10.90)°(t=4.775, P <0.01);6个月后，Cobb角(14.33±0.74)°，仍明显低于穿戴前(t=4.189, P <0.01)。穿戴6个月后，SRS-22功能状况维度评分明显增加(Z=-2.676, P <0.01)。穿戴后即刻Cobb角与6个月后Cobb角呈正相关(r=0.826,P <0.05)。结论 穿戴3D打印脊柱侧凸矫形器矫正期内和短期矫正效果均较好。     

青少年特发性脊柱侧凸患者术后疼痛评估与控制的研究进展

正按照国际脊柱侧凸研究学会(Scoliosis Research Society,SRS)的定义,脊柱侧凸是指全脊柱X线冠状面Cobb角10°~[1]。青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)是儿童10岁至骨骼发育成熟期间不明原因的脊柱侧凸,是小儿最常见的骨骼肌肉畸形之一,占整个脊柱侧凸的80%~[2]。手术为该病的主要治疗方法,AIS矫形手术创伤大,疼痛为术后最为常见的问题。术后疼痛不仅影响患者术后呼吸功能、胃肠道功能、睡眠质     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.