背景:创伤后三叉神经病变(PTN)可对患者的健康产生实质性影响。然而,神经性症状及其对心理社会功能的影响之间的关系仍然存在争议。这项研究的目的是评估PTN中神经感觉功能的客观和主观评估之间的关联,并使用基线测量来预测神经感觉结果。
方法:这项前瞻性观察性队列研究包括口腔颌面外科诊断为PTN的患者,鲁汶大学医院,比利时,2018年4月至2020年5月。在随访期间,多次同时记录标准化的客观和主观神经感觉检查。进行相关分析和主成分分析,并建立了神经感觉恢复的预测模型。
结果:生活质量与受影响的皮刀百分比(ρ=-0.35)显着相关(P<0.05),刷中风异常性疼痛的存在(ρ=-0.24),功能增益感觉表型(ρ=-0.41),医学研究理事会量表(ρ=0.36),和桑德兰分类(ρ=-0.21)。生活质量与方向性判别无显著相关性(P>0.05)。刺激定位,两点歧视,或感官功能丧失。预测模型显示6个月后神经感觉恢复的阴性预测值为87%。
结论:我们发现主观幸福感与刷式中风异常性疼痛存在很强的相关性,热和/或机械感觉过高,和神经病变区域的大小。这些结果表明,阳性症状主导了对情感的影响。在没有阳性症状或较大的神经病区的情况下报告主观幸福感差的患者中,对心理社会触发因素的额外关注可能会提高治疗效果.该预测模型可能有助于建立对神经感觉恢复可能性的现实期望,但仍有待在未来的研究中验证。
BACKGROUND: Post-traumatic trigeminal neuropathy (PTN) can have a substantial effect on patient well-being. However, the relation between the neuropathic symptoms and their effect on psychosocial functioning remains a matter of debate. The purpose of this study was to evaluate the association between objective and subjective assessments of neurosensory function in PTN and predict neurosensory outcome using baseline measurements.
METHODS: This prospective observational cohort study included patients diagnosed with PTN at the Department of Oral and Maxillofacial Surgery, University Hospital Leuven, Belgium, between April 2018 and May 2020. Standardized objective and subjective neurosensory examinations were recorded simultaneously on multiple occasions during the follow-up period. Correlation analyses and principal component analysis were conducted, and a prediction model of neurosensory recovery was developed.
RESULTS: Quality of life correlated significantly (P < 0.05) with percentage of affected dermatome (ρ = - 0.35), the presence of brush stroke allodynia (ρ = - 0.24), gain-of-function sensory phenotype (ρ = - 0.41), Medical Research Council Scale (ρ = 0.36), and Sunderland classification (ρ = - 0.21). Quality of life was not significantly correlated (P > 0.05) with directional discrimination, stimulus localization, two-point discrimination, or sensory loss-of-function. The prediction model showed a negative predictive value for neurosensory recovery after 6 months of 87%.
CONCLUSIONS: We found a strong correlation of subjective well-being with the presence of brush stroke allodynia, thermal and/or mechanical hyperesthesia, and the size of the neuropathic area. These results suggest that positive symptoms dominate the effect on affect. In patients reporting poor subjective well-being in the absence of positive symptoms or a large neuropathic area, additional attention towards psychosocial triggers might enhance treatment outcome. The prediction model could contribute to establishing realistic expectations about the likelihood of neurosensory recovery but remains to be validated in future studies.