Roh Young Hak, Lee Beom Koo, Noh Jung Ho, Baek Jong Ryoon, Oh Joo Han, Gong Hyun Sik, Baek Goo Hyun
Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, 1198 Kuwol-dong, Namdong-gu, 405-760, Incheon, Korea.
Arch Orthop Trauma Surg. 2014 Dec;134(12):1775-81. doi: 10.1007/s00402-014-2094-5. Epub 2014 Oct 14.
Wrist fracture is considered a typical initiating trauma for complex regional pain syndrome type I (CRPS I). However, few studies have comprehensively evaluated factors associated with the occurrence of CRPS I after the surgical treatment of a distal radius fracture (DRF). This study evaluates the factors influencing the occurrence of CRPS I after the surgical treatment of a DRF.
A total of 477 patients with a DRF who had been treated surgically were enrolled in this prospective observational study. Patients were followed for 6 months after surgery, and CRPS I was diagnosed using the Budapest diagnostic criteria for research. The factors assessed for the development of CPRS I were age, gender, the body mass index, the type of fracture, the energy of trauma, the number of trial reductions, the type of surgery, and the duration of immobilization. A multivariate logistic regression analysis was conducted to identify independent predictors of the occurrence of CRPS I.
Among the 477 patients, 42 (8.8 %) satisfied the Budapest criteria for CRPS I within 6 months of surgery. Female patients developed CRPS I more frequently, and the patients who developed CRPS I were older and more likely to sustain a high energy injury or have a comminuted fracture. According to the multivariate analysis, female patients and those with a high energy trauma or severe fracture type were significantly more likely to develop CRPS I (p = 0.02, 0.01, and 0.01, respectively).
High energy injuries, severe fractures, and the female gender contribute to the development of CRPS I after the surgical treatment of DRF. The results have important implications for physicians who wish to identify patients at high risk for CRPS I after operative fixation for DRF and instigate treatment accordingly.
腕部骨折被认为是Ⅰ型复杂性区域疼痛综合征（CRPSⅠ）的典型起始创伤。然而，很少有研究全面评估桡骨远端骨折（DRF）手术治疗后与CRPSⅠ发生相关的因素。本研究评估影响DRF手术治疗后CRPSⅠ发生的因素。
本前瞻性观察性研究共纳入477例接受手术治疗的DRF患者。术后对患者进行6个月的随访，并使用布达佩斯研究诊断标准诊断CRPSⅠ。评估与CRPSⅠ发生相关的因素包括年龄、性别、体重指数、骨折类型、创伤能量、试行复位次数、手术类型和固定时间。进行多因素逻辑回归分析以确定CRPSⅠ发生的独立预测因素。
在477例患者中，42例（8.8%）在术后6个月内符合CRPSⅠ的布达佩斯标准。女性患者发生CRPSⅠ的频率更高，发生CRPSⅠ的患者年龄更大，更有可能遭受高能量损伤或有粉碎性骨折。根据多因素分析，女性患者以及遭受高能量创伤或骨折类型严重的患者发生CRPSⅠ的可能性显著更高（p分别为0.02、0.01和0.01）。
高能量损伤、严重骨折和女性性别是DRF手术治疗后CRPSⅠ发生的影响因素。这些结果对于希望识别DRF手术固定后发生CRPSⅠ高风险患者并据此进行治疗的医生具有重要意义。
