【晨读】脊髓电刺激（三）
英语晨读 ·
山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。
本次文献选自ROCK AK , Truong H , Park YL, et al. Spinal Cord Stimulation[J]. Neurosurg Clin N Am, 2019, 30(2):169-194.本次学习由谢珺田副主任医师主讲。
Complex Regional Pain Syndrome
Table 3 summarizes studies related to SCS treatment of CRPS. CRPS is a form of chronic pain, usually affecting a single limb, which typically arises after sustaining injury or having surgery. Patients with CRPS experience extreme burning pain with greater sensitivity to acute pain. According to the Budapest classification, patients with CRPS exhibit lower thresholds for pain perception in response to hot and / or cold stimuli.Diagnostic criteria include: hyperesthesia,allodynia,temperature asymmetry, skin color changes, edema, decreased range of motion, and trophic changes.
复杂性局部疼痛综合征
表 3 总结了与SCS治疗CRPS相关的临床研究。CRPS是一种慢性疼痛疾病，通常涉及单一肢体，且通常发生在持续受伤或手术后。CRPS患者往往主诉严重的灼烧样疼痛，并对急性疼痛刺激更为敏感。根据Budapest分类，CRPS患者对热刺激和/或冷刺激的痛觉阈值降低。其它诊断依据包括：感觉过度、触诱发痛、体表温度不对称、肤色改变、水肿、活动范围受限和营养改变。
After early case series showed positive benefits of SCS for CRPS,28 Kemler and colleagues 29 provided level I evidence on the topic with a well-designed singlecenter RCT comparing SCS plus physical therapy (PT) with PT alone for patients with CRPS who were unresponsive to at least 6 months of conventional treatment. At 6-month follow-up, SCS was successful in 56% of patients, with a 3.6-point improvement in VAS and improvement in QoL.
在早期病例报道表明SCS对CRPS症状改善有益之后，Kemler及同事通过设计完善的单中心RCT提供了I级证据，将至少6个月常规治疗无效的CRPS患者，随机分为SCS加物理治疗（PT）和单独接受PT治疗两组。在第6个月随访中，接受SCS治疗患者有效率为56%，VAS降低了3.6分（11点Likert 评分），生活质量评分（QoL）明显改善。
The benefits were sustained at 2 years with an average VAS improvement of three points compared with no change in the group receiving PT alone. Furthermore, 63% of the SCS group reported “much improvement” as compared with only 6% within the group with PT alone. Complications were reported in 38% of patients, which included lead and generator pocket revision, lead replacement, generator replacement, and explantation. 30 Despite the risk of complications, 95% of patients stated they would repeat the procedure again for the same outcome when asked at 5-year follow-up.
与单独接受PT组相比，这些改善持续至2年随访时点，VAS平均降低3分。此外，63%的SCS组患者报告“有很大改善”，而单独PT组只有6%。38%的患者报告有并发症，包括导线梳理和刺激器囊袋翻修、导线替换、刺激器替换和植皮手术。尽管存在上述并发症的风险，但95%的患者在5年随访时表示，为达到同样的效果，他们愿意再次接受此种手术。