Blumberg H, Griesser H J, Hornyak M
Neurologische Klinik und Poliklinik, Universität Freiburg.
Unfallchirurgie. 1990 Apr;16(2):95-106. doi: 10.1007/BF02588024.
Reflex sympathetic dystrophy can be elicited by various factors (e. g. trauma, herpes zoster, myocardial infarction). Independent of kind and site of a lesion, symptoms occur most often in the whole distal part of the affected extremity. There in most cases, a triad of autonomic, motor and sensory disturbances can be found clinically. For early diagnosis--beside clinical investigation--a comparative measurement of skin temperatures on both sides of finger or toe tips, respectively, is recommended. Hereby the clinical finding of a warmer or colder extremity can be proved, which supplies evidence of a disturbed skin blood flow. In case, the above mentioned triad and a disturbance of skin circulation is found, diagnosis of sympathetic reflex dystrophy can be made with great certainty. With regard to the underlying pathophysiology, symptoms can be explained at this time satisfactory only by the assumption of a vicious circle. Starting from a painful event (e.g. trauma, mark in a plaster cast, nerve lesion or myocardial infarction) a functional disturbance of the sympathetic nervous system is initiated. This results in a disturbance of the circulation in all of the affected tissues (skin, muscle, bone and joint), which finally gives rise to an abnormal excitation of afferent receptors, particularly of nociceptors. This excitation maintains the disturbance of the sympathetic nervous system at central nervous level (vicious circle). The most relevant pathomechanism in this process seems to be the occurrence of an imbalance between the activity of sympathetic vasoconstrictor neurons supplying arteries and those, supplying veins. A sympatholytic therapy, if applied in time, is able to cut off the vicious circle, which may lead to a restitutio ad integrum. Further investigations will show to what extent psychological factors are involved in developing the central nervous disturbance of the sympathetic nervous system and may also show if in addition the motor system is affected.
反射性交感神经营养不良可由多种因素引发（如创伤、带状疱疹、心肌梗死）。无论病变的类型和部位如何，症状最常出现在受累肢体的整个远端部位。在大多数情况下，临床上可发现自主神经、运动和感觉障碍三联征。对于早期诊断——除临床检查外——建议分别对比测量双侧指尖或趾尖的皮肤温度。由此可证实肢体一侧较热或较冷的临床发现，这为皮肤血流紊乱提供了证据。如果发现上述三联征及皮肤循环障碍，则可高度确定地诊断为交感反射性营养不良。关于潜在的病理生理学，目前只能通过恶性循环的假设来令人满意地解释症状。从一个疼痛事件（如创伤、石膏固定中的压痕、神经损伤或心肌梗死）开始，引发交感神经系统的功能障碍。这导致所有受累组织（皮肤、肌肉、骨骼和关节）的循环紊乱，最终引起传入感受器，尤其是伤害感受器的异常兴奋。这种兴奋在中枢神经水平维持交感神经系统的紊乱（恶性循环）。这一过程中最相关的病理机制似乎是供应动脉的交感缩血管神经元与供应静脉的交感缩血管神经元活动之间出现失衡。如果及时应用交感神经阻滞疗法，能够切断恶性循环，这可能导致完全恢复。进一步的研究将表明心理因素在交感神经系统中枢神经紊乱的发展过程中涉及的程度，也可能表明运动系统是否也受到影响。
