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经桡动脉心脏导管插入术后复杂性区域疼痛综合征

Complex regional pain syndrome after transradial cardiac catheterization.

作者信息

Lai Chih-Jou, Chou Chen-Liang, Liu Tcho-Jen, Chan Rai-Chi

机构信息

Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

出版信息

J Chin Med Assoc. 2006 Apr;69(4):179-83. doi: 10.1016/S1726-4901(09)70202-3.

Abstract

Complex regional pain syndrome (CRPS) is a disease with unclear pathophysiology. The condition is characterized by pain, soft tissue change, vasomotor change, and even psychosocial disturbance. It may affect the upper more than the lower extremities, and the distal more than the proximal. The trigger factors include carpal tunnel release, Dupuytren's repair, tendon release procedures, knee surgery, crush injury, ankle arthrodesis, amputation, and hip arthroplasty. Rarely, it has been associated with stroke, mastectomy, pregnancy, and osteogenesis imperfecta. Herein, we present a rare case of a patient who was diagnosed with CRPS after transradial cardiac catheterization. CRPS was first diagnosed due to hand swelling, allodynia, paresthesia, and the limited range of motion of interphalangeal, metacarpophalangeal, and wrist joints, with the preceding factor of transradial cardiac catheterization, and was then confirmed by a three-phase bone scan. After intensive physical therapy with hydrotherapy, manual soft tissue release, and occupational therapy for the hand function, there was much improvement in range of motion and hand function. There was no allodynia or painful sensation in the follow-up. After training, the functional status of this patient was adequate for daily activity.

摘要

复杂性区域疼痛综合征(CRPS)是一种病理生理学尚不清楚的疾病。该病症的特征为疼痛、软组织改变、血管舒缩变化,甚至心理社会障碍。它对上肢的影响可能大于下肢,对远端的影响大于近端。触发因素包括腕管松解术、掌腱膜修复术、肌腱松解术、膝关节手术、挤压伤、踝关节融合术、截肢术和髋关节置换术。极少数情况下,它与中风、乳房切除术、妊娠和成骨不全有关。在此,我们报告一例罕见病例,一名患者在经桡动脉心脏导管插入术后被诊断为CRPS。CRPS最初因手部肿胀、痛觉过敏、感觉异常以及指间关节、掌指关节和腕关节活动范围受限而被诊断,其先前因素为经桡动脉心脏导管插入术,随后经三相骨扫描得以确诊。在对手部功能进行水疗、手动软组织松解和职业治疗等强化物理治疗后,活动范围和手部功能有了很大改善。随访期间无痛觉过敏或疼痛感觉。经过训练,该患者的功能状态足以满足日常活动。

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