Université de Lyon, Lyon, France.
Foot Ankle Surg. 2009;15(4):179-82. doi: 10.1016/j.fas.2009.02.002. Epub 2009 Apr 5.
The public health cost impact of complex regional pain syndrome type I (CRPS I) is considerable in both emergency and scheduled orthopaedic surgery. We proposed to assess the effectiveness of vitamin C in prevention of CRPS I in foot and ankle surgery.
We carried out a "before-after" quasi-experimental study comparing two chronologically successive groups without (Group I: July 2002-June 2003) and with (Group II: July 2003-June 2004) preventive 1g daily vitamin C treatment. All patients having surgery on the foot or ankle were enrolled, with the exception of diabetic foot cases. Several factors were analysed: sex, age, type of pathology, history of CRPS I, psychological context, tourniquet time, and cast immobilisation time.
420 feet (392 patients) were included in the study: 185 in Group I, 235 in Group II. CRPS I occurred in 18 cases in Group I (9.6%) and 4 cases in Group II (1.7%) (p<10(-4)), with history of CRPS I as a significantly correlated factor (relative risk=10.4). The psychological context (anxio-depressive state) showed a (sub-significant) tendency to increase the risk of CRPS I (relative risk=2.6).
Vitamin C has been shown to be effective in preventing CRPS I secondary to wrist fracture, but few data are available with respect to foot and ankle cases. The present study demonstrates the effectiveness of vitamin C in preventing CRPS I of the foot and ankle-a frequent complication in our control group (9.6%). The authors recommend preventive management by vitamin C.
复杂性区域疼痛综合征 I 型（CRPS I）在急诊和择期骨科手术中对公众健康的成本影响相当大。我们提出评估维生素 C 在预防足部和踝关节手术后 CRPS I 中的有效性。
我们进行了一项“前后”准实验研究，比较了两组无（I 组：2002 年 7 月至 2003 年 6 月）和有（II 组：2003 年 7 月至 2004 年 6 月）预防性每日 1g 维生素 C 治疗的连续两组患者。所有接受足部或踝关节手术的患者均被纳入研究，除外糖尿病足病例。分析了几个因素：性别、年龄、病理类型、CRPS I 病史、心理状态、止血带时间和石膏固定时间。
共有 420 只脚（392 名患者）纳入研究：I 组 185 例，II 组 235 例。I 组 18 例（9.6%）和 II 组 4 例（1.7%）发生 CRPS I（p<10(-4)），CRPS I 病史是显著相关因素（相对风险=10.4）。心理状态（焦虑抑郁状态）显示出增加 CRPS I 风险的趋势（相对风险=2.6）。
维生素 C 已被证明可有效预防腕部骨折引起的 CRPS I，但关于足部和踝关节病例的数据较少。本研究证明了维生素 C 在预防我们对照组中常见的足部和踝关节 CRPS I（9.6%）中的有效性。作者建议采用维生素 C 进行预防性管理。
