Zollinger P E, Tuinebreijer W E, Kreis R W, Breederveld R S
Department of Orthopaedics, Leyenburg Hospital, The Hague, The Netherlands.
Lancet. 1999 Dec 11;354(9195):2025-8. doi: 10.1016/S0140-6736(99)03059-7.
The pathogenesis of reflex sympathetic dystrophy (RSD) is not clear, nor is there a definitive treatment for this syndrome. The morbidity, costs in health care, and loss of work time justify the search for a means to prevent post-traumatic dystrophy. Although the role of toxic oxygen radicals has not yet been clarified, we investigated vitamin C (ascorbic acid) as a prophylactic antioxidant drug.
123 adults with 127 conservatively treated wrist fractures were randomly allocated in a double-blind trial to take a capsule of 500 mg vitamin C or placebo daily for 50 days. Each participant's sex, age, side of fracture, dominance, fracture type, dislocation, reduction, and complaints with the plaster cast were recorded, and they were clinically scored for RSD. The follow-up lasted 1 year.
Eight patients were withdrawn after randomisation. 52 patients with 54 fractures (male 22%, female 78%; mean age 57 years) received vitamin C and 63 patients with 65 fractures (male 20%, female 80%; mean age 60 years) received placebo. RSD occurred in four (7%) wrists in the vitamin C group and 14 (22%) in the placebo group 15% (95% CI for differences 2-26). Other significant prognostic variables for the occurrence of RSD were complaints while wearing the cast (relative risk 0.17 [0.07-0.41]) and fracture type (0.37 [0.16-0.89]).
This prospective, double-blind study shows that vitamin C was associated with a lower risk of RSD after wrist fractures. Our hypothesis is that this beneficial effect of prophylaxis would be useful in other forms of trauma.
反射性交感神经营养不良（RSD）的发病机制尚不清楚，针对该综合征也没有确切的治疗方法。其发病率、医疗费用以及工作时间的损失促使人们寻找预防创伤后营养不良的方法。尽管有毒性氧自由基的作用尚未阐明，但我们研究了维生素C（抗坏血酸）作为预防性抗氧化药物的效果。
123名接受保守治疗的腕部骨折成人患者（共127处骨折）被随机分配到一项双盲试验中，每天服用500毫克维生素C胶囊或安慰剂，持续50天。记录每位参与者的性别、年龄、骨折部位、利手、骨折类型、脱位、复位情况以及石膏固定后的不适症状，并对他们进行RSD临床评分。随访持续1年。
随机分组后有8名患者退出。52名有54处骨折的患者（男性22%，女性78%；平均年龄57岁）接受了维生素C治疗，63名有65处骨折的患者（男性20%，女性80%；平均年龄60岁）接受了安慰剂治疗。维生素C组有4例（7%）腕部发生RSD，安慰剂组有14例（22%）（差异的95%CI为15%[2%-26%]）。发生RSD的其他重要预后变量是佩戴石膏时的不适症状（相对风险0.17[0.07 - 0.41]）和骨折类型（0.37[0.16 - 0.89]）。
这项前瞻性双盲研究表明，维生素C与腕部骨折后发生RSD的风险较低有关。我们的假设是，这种预防性的有益效果在其他形式的创伤中也会有用。
