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桡骨远端骨折后复杂性区域疼痛综合征:流行病学、病理生理模型、诊断与治疗

[Complex regional pain syndrome following distal fractures of the radius : Epidemiology, pathophysiological models, diagnostics and therapy].

作者信息

Harhaus L, Neubrech F, Hirche C, Schilling T, Kohler H, Mayr A, Riesmeier A, Bickert B, Kneser U

机构信息

Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Universität Heidelberg, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.

Abteilung für Berufsgenossenschaftliche Rehabilitation und Heilverfahrenssteuerung, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.

出版信息

Unfallchirurg. 2016 Sep;119(9):732-41. doi: 10.1007/s00113-016-0217-x.

Abstract

The complex regional pain syndrome (CRPS) still represents an incompletely etiologically understood complication following fractures of the distal radius. The incidence of CRPS following fractures of the distal radius varies between 1 % and 37 %. Pathophysiologically, a complex interaction of inflammatory, somatosensory, motor and autonomic changes is suspected, leading to a persistent maladaptive response and sensitization of the central and peripheral nervous systems with development of the corresponding symptoms. Decisive for the diagnostics are a detailed patient medical history and a clinical hand surgical, neurological and pain-related examination with confirmation of the Budapest criteria. Among the types of apparatus used for diagnostics, 3‑phase bone scintigraphy and temperature measurement have a certain importance. A multimodal therapy started as early as possible is the most promising approach for successful treatment. As part of a multimodal rehabilitation the main focus of therapy lies on pain relief and functional aspects.

摘要

复杂区域疼痛综合征(CRPS)仍是桡骨远端骨折后病因尚未完全明确的一种并发症。桡骨远端骨折后CRPS的发病率在1%至37%之间。在病理生理学上,怀疑存在炎症、躯体感觉、运动和自主神经变化的复杂相互作用,导致持续的适应不良反应以及中枢和外周神经系统的致敏,并出现相应症状。诊断的关键是详细的患者病史以及符合布达佩斯标准的临床手部外科、神经科和疼痛相关检查。在用于诊断的设备类型中,三相骨闪烁显像和温度测量具有一定重要性。尽早开始多模式治疗是成功治疗最有前景的方法。作为多模式康复的一部分,治疗的主要重点在于缓解疼痛和功能方面。

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