Scola A, Scola E
Klinik für Unfall-, Hand-, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert Einstein Allee 23, Ulm, Germany.
Unfallchirurg. 2013 Aug;116(8):723-32. doi: 10.1007/s00113-013-2450-x.
Posttraumatic dystrophy manifests as signs and symptoms of endothelial dysfunction in the microcirculation with pronounced involvement of arteriovenous (AV) anastomosis.
Blood gas analysis was performed in 28 patients with persistent painful swelling 6-14 weeks after distal radius fracture or hand injury. The patients showed higher levels of venous oxygenation on the affected side in comparison to the contralateral arm. Furthermore, an increased perfusion and an AV shunt situation were proven by radionuclide angiography. These findings correlate with insufficient oxygen utilization by the tissue (dystrophy = capillary malperfusion). Pathophysiologically, complex processes must be assumed which require a multimodal therapy and treatment focuses on open AV shunts.
The disastrous consequences of hand dystrophy (loss of function due to fibrosis) could be prevented in all patients. Statistical analyses between affected and normal hands showed significant differences.
Posttraumatic dystrophy needs early detection for successful therapy and should not be identified under the umbrella term "complex regional pain syndrome" (CRPS).
创伤后营养不良表现为微循环中内皮功能障碍的体征和症状，动静脉（AV）吻合处明显受累。
对28例桡骨远端骨折或手部损伤6 - 14周后持续疼痛肿胀的患者进行血气分析。与对侧手臂相比，患者患侧静脉氧合水平更高。此外，放射性核素血管造影证实灌注增加和AV分流情况。这些发现与组织氧利用不足（营养不良 = 毛细血管灌注不良）相关。在病理生理学上，必须假定存在复杂过程，这需要多模式治疗，且治疗重点是开放的AV分流。
所有患者手部营养不良的灾难性后果（因纤维化导致功能丧失）均得以预防。患手与正常手之间的统计分析显示出显著差异。
创伤后营养不良需要早期检测以获得成功治疗，不应在“复杂性区域疼痛综合征”（CRPS）这一统称下进行识别。
