Patterson Ryan W, Li Zhongyu, Smith Beth P, Smith Thomas L, Koman L Andrew
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
J Hand Surg Am. 2011 Sep;36(9):1553-62. doi: 10.1016/j.jhsa.2011.06.027.
The diagnosis and management of complex regional pain syndrome is often challenging. Early diagnosis and intervention improve outcomes in most patients; however, some patients will progress regardless of intervention. Multidisciplinary management facilitates care in complex cases. The onset of signs and symptoms may be obvious or insidious; temporal delay is a frequent occurrence. Difficulty sleeping, pain unresponsive to narcotics, swelling, stiffness, and hypersensitivity are harbingers of onset. Multimodal treatment with hand therapy, sympatholytic drugs, and stress loading may be augmented with anesthesia blocks. If the dystrophic symptoms are controllable by medications and a nociceptive focus or nerve derangement is correctable, surgery is an appropriate alternative. Chronic sequelae of contracture may also be addressed surgically in patients with controllable sympathetically maintained pain.
复杂区域疼痛综合征的诊断和管理通常具有挑战性。早期诊断和干预可改善大多数患者的预后；然而，一些患者无论是否接受干预都会病情进展。多学科管理有助于处理复杂病例。体征和症状的发作可能明显或隐匿；时间延迟很常见。睡眠困难、对麻醉药无反应的疼痛、肿胀、僵硬和超敏反应是发作的先兆。手部治疗、抗交感神经药物和压力负荷的多模式治疗可辅以麻醉阻滞。如果营养障碍症状可通过药物控制，且伤害性刺激源或神经紊乱可纠正，则手术是一种合适的选择。对于交感神经维持性疼痛可控的患者，挛缩的慢性后遗症也可通过手术治疗。
