Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands Department of Anesthesiology and Pain Management, Erasmus MC, Rotterdam, The Netherlands Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Pain. 2012 Jun;153(6):1187-1192. doi: 10.1016/j.pain.2012.01.026. Epub 2012 Mar 3.
Limited data are available on the incidence of complex regional pain syndrome type 1 (CRPS1) and on demographic and medical risk factors for the development of CRPS1. The objective of this study was to investigate the incidence of CRPS1 in patients with a fracture using 3 sets of diagnostic criteria and to evaluate the association between demographic/medical factors and the development of CRPS1 diagnosed with the Harden and Bruehl criteria. A prospective multicenter cohort study of 596 patients (ages 18 years and older) with a single fracture of the wrist, scaphoid, ankle, or metatarsal V, recruited patients from the emergency rooms of 3 Dutch hospitals. Of the 596 participants, 42 (7.0%) were diagnosed with CRPS1 according to the Harden and Bruehl criteria, 289 (48.5%) according to the International Association for the Study of Pain criteria, and 127 (21.3%) according to the criteria of Veldman. An analysis of the medical and demographic differences revealed that patients in whom CRPS1 later developed more often had intra-articular fractures, fracture dislocations, rheumatoid arthritis, or musculoskeletal comorbidities. An ankle fracture, dislocation, and an intra-articular fracture contributed significantly to the prediction of the development of CRPS1. No CRPS1 patients were symptom free at 12 months (T3). At baseline, patients with CRPS1 had significantly more pain than patients without CRPS1 (P<.001). The incidence of the diagnosis of CRPS1 after a single fracture depends to a large extent on the diagnostic criteria used. After a fracture, 7% of the patients developed CRPS1 and none of the patients were free of symptoms at 1-year follow-up.
关于复杂性区域疼痛综合征 1 型（CRPS1）的发病率以及发生 CRPS1 的人口统计学和医疗风险因素，目前数据有限。本研究的目的是使用 3 套诊断标准调查骨折患者 CRPS1 的发病率，并评估哈顿和布鲁尔标准诊断的 CRPS1 发病与人口统计学/医疗因素之间的关联。一项前瞻性多中心队列研究纳入了 3 家荷兰医院急诊室的 596 名（年龄 18 岁及以上）单一腕部、舟状骨、踝关节或第 V 跖骨骨折患者。在 596 名参与者中，根据哈顿和布鲁尔标准，有 42 名（7.0%）被诊断为 CRPS1，289 名（48.5%）根据国际疼痛研究协会标准，127 名（21.3%）根据维尔德曼标准。对医疗和人口统计学差异的分析表明，后来发展为 CRPS1 的患者更常发生关节内骨折、骨折脱位、类风湿关节炎或肌肉骨骼合并症。踝关节骨折、脱位和关节内骨折显著有助于预测 CRPS1 的发生。在 12 个月（T3）时，没有 CRPS1 患者无症状。在基线时，CRPS1 患者的疼痛明显多于无 CRPS1 患者（P<.001）。单一骨折后诊断为 CRPS1 的发生率在很大程度上取决于使用的诊断标准。骨折后，7%的患者发生了 CRPS1，在 1 年随访时没有患者无症状。
