Schürmann M, Gradl G, Zaspel J, Kayser M, Löhr P, Andress H J
Department of Surgery, Ludwig-Maximilians-University Munich, Klinikum Grosshadern, 81377 Munich, Germany.
Auton Neurosci. 2000 Dec 28;86(1-2):127-34. doi: 10.1016/S1566-0702(00)00250-2.
Complex regional pain syndrome type I (CRPS I) is a frequent complication after injuries of the upper limbs. The pathophysiology of this disease remains unclear, although disturbances of the sympathetic nervous system have been detected in several clinical studies, and sympathetic blocks resolve the symptoms in many of the cases. To investigate the meaning of sympathetic dysfunction at the beginning of the disease, 27 patients with distal radial fracture were examined prospectively during the course of the disease with regard to their clinical symptoms and their peripheral sympathetic nervous function. Sympathetic nervous function was examined by testing the vasoconstrictor response to sympathetic stimuli--recorded with laser Doppler fluxmetry--of the fingertips of both hands. Four patients developed CRPS I during the 12-week observation time and two patients presented an incomplete clinical CRPS I picture ('borderline patients'). The complaints of all patients (normal fracture patients, CRPS I patients, borderline patients) were similar during the first week after trauma with focus on pain, motoric disturbances and autonomic symptoms. After 1 or 2 weeks, a larger clinical difference developed between normal fracture patients and CRPS I or 'borderline patients'. In CRPS I patients and 'borderline patients', the sympathetic vasoconstrictor response was diminished or absent from the first posttraumatic day throughout the observation time, whereas the normal fracture patients revealed slightly impaired sympathetic nervous function on the first posttraumatic day and normal results during the rest of the observation time. With regard to the unaffected contralateral hand, CRPS I patients also showed impaired sympathetic nervous function. The results of the present study suggest that the disturbances in the sympathetic nervous system in CRPS I patients are systemic and not limited to the affected limb. Their occurrence before the clinical breakout of the disease may serve as a marker that might be useful for early therapy and lead to further understanding of the pathophysiology of CRPS I.
Ⅰ型复杂性区域疼痛综合征（CRPS I）是上肢损伤后常见的并发症。尽管多项临床研究已检测到交感神经系统紊乱，且交感神经阻滞在许多病例中可缓解症状，但该病的病理生理学仍不清楚。为了研究疾病初期交感神经功能障碍的意义，对27例桡骨远端骨折患者在病程中进行了前瞻性研究，观察其临床症状及外周交感神经功能。通过用激光多普勒血流仪记录双手指尖对交感神经刺激的血管收缩反应来检测交感神经功能。在12周的观察期内，4例患者发生了CRPS I，2例患者表现出不完全的临床CRPS I症状（“临界患者”）。所有患者（正常骨折患者、CRPS I患者、临界患者）在创伤后的第一周主诉相似，主要为疼痛、运动障碍和自主神经症状。1或2周后，正常骨折患者与CRPS I患者或“临界患者”之间出现了更大的临床差异。在CRPS I患者和“临界患者”中，从创伤后的第一天到整个观察期，交感神经血管收缩反应均减弱或消失，而正常骨折患者在创伤后的第一天交感神经功能略有受损，在其余观察期结果正常。对于未受影响的对侧手，CRPS I患者也表现出交感神经功能受损。本研究结果表明，CRPS I患者的交感神经系统紊乱是全身性的，不限于受影响的肢体。其在疾病临床发作前的出现可能作为一个标志物，有助于早期治疗，并进一步了解CRPS I的病理生理学。
