Bodde Marlies I, Dijkstra Pieter U, Schrier Ernst, van den Dungen Jan J, den Dunnen Wilfred F, Geertzen Jan H
Department of Rehabilitation Medicine, Center for Rehabilitation (M.I.B., P.U.D., E.S., and J.H.G.), Department of Oral and Maxillofacial Surgery (P.U.D.), Department of Surgery (J.J.v.d.D.), and Department of Pathology and Medical Biology (W.F.d.D.), University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands.
J Bone Joint Surg Am. 2014 Jun 4;96(11):930-934. doi: 10.2106/JBJS.M.00788.
Literature on complex regional pain syndrome type I (CRPS-I) discussing the decision to amputate or not, the level of amputation, or the timing of the amputation is scarce. We evaluated informed decision-making regarding amputation for CRPS-I.
We describe our findings in a retrospective study of the decision-making process of thirty-six patients who underwent amputation for CRPS-I at our university medical center from 2000 to 2012. Additionally, we present the incidents preceding the CRPS-I, the reasons for and the levels of the amputation, and the outcomes after the amputations.
Team members and the patient decided together whether or not to amputate and the level of amputation. Issues such as level of pain or allodynia, infection, desired length of the residual limb, joint range of motion, strength of all extremities, ability to use walking aids, and psychological "green, yellow, and red flags" were weighed in this process. There were no complications during the amputation surgery, a 22% rate of complications (infection in all but one patient) immediately postoperatively (reamputation not required), a 72% rate of phantom pain immediately after or within the first three months after the amputation, and a 77% rate of phantom pain more than one year after the amputation.
Informed decision-making regarding amputation for CRPS-I remains a complex process for which little evidence is available to support patient choices; patient-specific outcomes are not predictable. However, amputation should not be ignored as a treatment option for long-standing therapy-resistant CRPS-I.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
关于Ⅰ型复杂性区域疼痛综合征（CRPS-Ⅰ）中讨论截肢与否、截肢水平或截肢时机的文献较少。我们评估了关于CRPS-Ⅰ截肢的知情决策过程。
我们在一项回顾性研究中描述了2000年至2012年在我校医学中心因CRPS-Ⅰ接受截肢手术的36例患者的决策过程。此外，我们还介绍了CRPS-Ⅰ发病前的事件、截肢原因和水平以及截肢后的结果。
团队成员和患者共同决定是否截肢以及截肢水平。在此过程中，权衡了疼痛或痛觉过敏程度、感染、残肢期望长度、关节活动范围、四肢力量、使用助行器的能力以及心理“绿、黄、红信号”等问题。截肢手术期间无并发症，术后立即出现并发症的发生率为22%（除1例患者外均为感染，无需再次截肢），截肢后立即或术后前三个月内幻肢痛发生率为72%，截肢一年后幻肢痛发生率为77%。
关于CRPS-Ⅰ截肢的知情决策仍然是一个复杂的过程，几乎没有证据支持患者的选择；特定患者的结果不可预测。然而，对于长期治疗抵抗的CRPS-Ⅰ，截肢作为一种治疗选择不应被忽视。
治疗性四级。有关证据水平的完整描述，请参阅作者指南。
