Guo Tian-Zhi, Offley Sarah C, Boyd Erin A, Jacobs Christopher R, Kingery Wade S
Physical Medicine and Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA.
Pain. 2004 Mar;108(1-2):95-107. doi: 10.1016/j.pain.2003.12.010.
Wrist and ankle fractures are the most frequent causes of complex regional pain syndrome (CRPS type I). The current study examined the temporal development of vascular, nociceptive and bony changes after distal tibial fracture in rats and compared these changes to those observed after cast immobilization in intact normal rats. After baseline testing the right distal tibial was fractured and the hindlimb casted. A control group was simply casted without fracturing the tibia. After 4 weeks the casts were removed and the rats retested. Subsequent testing was performed at 6, 8, 10, 16, and 20 weeks after onset of treatment. Distal tibial fracture or cast immobilization alone generated chronic hindlimb warmth, edema, spontaneous protein extravasation, allodynia, and periarticular osteoporosis, changes resembling those observed in CRPS. Hindlimb warmth and allodynia resolved much more quickly after cast immobilization than after fracture. Previously we observed that the substance P receptor (NK(1)) antagonist LY303870 reversed vascular and nociceptive changes in a sciatic section rat model of CRPS type II. Postulating that facilitated substance P signaling may also contribute to the vascular and nociceptive abnormalities observed after tibial fracture or cast immobilization, we attempted to reverse these changes with LY303870. Hindpaw warmth, spontaneous extravasation, edema, and allodynia were inhibited by LY303870. Collectively, these data support the hypotheses that the distal tibial fracture model simulates CRPS, immobilization alone can generate a syndrome resembling CRPS, and substance P signaling contributes to the vascular and nociceptive changes observed in these models.
手腕和脚踝骨折是复杂性区域疼痛综合征(I型CRPS)最常见的病因。本研究检测了大鼠胫骨干骺端骨折后血管、伤害性感受和骨质变化的时间发展过程,并将这些变化与完整正常大鼠石膏固定后观察到的变化进行比较。在基线测试后,将右侧胫骨干骺端骨折并对后肢进行石膏固定。对照组仅进行石膏固定,不造成胫骨骨折。4周后拆除石膏并对大鼠重新进行测试。在治疗开始后的6、8、10、16和20周进行后续测试。单纯胫骨干骺端骨折或石膏固定均可导致后肢慢性温热、水肿、自发性蛋白外渗、痛觉过敏和关节周围骨质疏松,这些变化与CRPS中观察到的变化相似。与骨折后相比,石膏固定后后肢温热和痛觉过敏的消退要快得多。此前我们观察到,P物质受体(NK(1))拮抗剂LY303870可逆转II型CRPS坐骨神经切断大鼠模型中的血管和伤害性感受变化。假设P物质信号传导增强也可能导致胫骨干骺端骨折或石膏固定后观察到的血管和伤害性感受异常,我们试图用LY303870逆转这些变化。LY303870可抑制后爪温热、自发性外渗、水肿和痛觉过敏。总体而言,这些数据支持以下假设:胫骨干骺端骨折模型模拟CRPS,单纯固定可产生类似CRPS的综合征,且P物质信号传导导致了这些模型中观察到的血管和伤害性感受变化。