Finsterbush A, Frankl U, Mann G, Lowe J
Department of Orthopaedic Surgery, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel.
Orthop Rev. 1991 Oct;20(10):877-85.
Eighteen patients with a diagnosis of reflex sympathetic dystrophy (RSD) affecting the knee were reviewed. Minor isolated injuries and operations about the knee triggered the original episode. The symptoms, regardless of location and mechanism of injury, occurred in the patellofemoral joint. Roentgenographic features of patchy demineralization and abnormal uptake on a 99mTc scan were typically located in the patella and corresponding femoral articular surface. At the initial stage of the syndrome, pain, hypersensitivity to touch, and inhibition of the quadriceps muscle were the most prominent features. In the later stages of the syndrome, functional instability due to quadriceps weakness created dependence on a knee brace or crutch support. Six patients whose RSD was initially misdiagnosed underwent numerous unsuccessful surgical procedures. In three of these patients, the knee was ultimately fused. All patients had an initial isolated knee injury (usually after minor trauma), and prolonged periods of immobilization and a cast, and 12 of the 18 patients were involved with workers' compensation. Early diagnosis and prompt treatment with an epidural block, followed by intensive physiotherapy, are recommended. A personal doctor/patient relationship that offers guidance and encouragement is key to successful management of this syndrome.
对18例诊断为累及膝关节的反射性交感神经营养不良（RSD）患者进行了回顾性研究。膝关节周围轻微的孤立性损伤和手术引发了最初的发病情况。无论损伤的部位和机制如何，症状均出现在髌股关节。X线片上的斑片状脱矿质和99mTc扫描上的异常摄取，典型地位于髌骨和相应的股骨关节面。在该综合征的初始阶段，疼痛、触觉过敏和股四头肌抑制是最突出的特征。在综合征的后期，由于股四头肌无力导致的功能不稳定使患者依赖膝关节支具或拐杖支撑。6例最初被误诊为RSD的患者接受了多次不成功的外科手术。其中3例患者最终进行了膝关节融合术。所有患者最初均有孤立的膝关节损伤（通常是轻微创伤后），并长期固定和使用石膏，18例患者中有12例涉及工伤赔偿。建议早期诊断并及时进行硬膜外阻滞治疗，随后进行强化物理治疗。提供指导和鼓励的私人医生/患者关系是成功管理该综合征的关键。
