Petersen Pelle B, Mikkelsen Kim L, Lauritzen Jes B, Krogsgaard Michael R
Section for Sports Traumatology M51, Bispebjerg-Frederiksberg Hospital (Part of IOC Research Center Copenhagen), University of Copenhagen, Copenhagen, Denmark.
Danish Patient Compensation Association, Copenhagen, Denmark.
Pain Pract. 2018 Mar;18(3):341-349. doi: 10.1111/papr.12610. Epub 2017 Sep 20.
Complex regional pain syndrome is a challenging condition that includes a broad spectrum of sensory, autonomic, and motor features predominantly in extremities recovering from a trauma. Few large-scale studies have addressed occurrence of and factors associated with complex regional pain syndrome (CRPS) following orthopedic treatment. The present study aimed to identify factors associated with post-treatment development of CRPS.
Using the Danish Patient Compensation Association's database, we identified 647 patients claiming post-treatment CRPS between 1992 and 2015. Age, gender, initial diagnosis, treatment, and amount of compensation were extracted. Multivariate logistic regressions were performed to identify variables associated with approval of the claim. For carpal tunnel syndrome (CTS) patients, we registered whether symptoms were bilateral or unilateral and if neurophysiology prior to treatment was pathologic.
The following ratios were found: women:men was 4:1, primary diagnosis to the upper limb:lower limb was 2.5:1, and surgical:nonsurgical treatment was 3:1. Mean age was 47.5 ± 13.7 years, and no intergender difference was detected. Antebrachial fracture (23%) and CTS (9%) were the most common primary conditions. Surgical treatment was associated with approval of the claim (odds ratio 3.5, 95% confidence interval 2.3 to 5.3; P < 0.001). Half of CTS patients had normal neurophysiology prior to surgery; among patients with unilateral symptoms, 71.4% had normal neurophysiology.
Female gender, surgical treatment, and treatment to the upper limb were risk factors. Elective surgery accounted for a large number of post-treatment CRPS patients. In CTS patients developing CRPS, normal neurophysiological examination findings were common, and it could be suspected that these patients were suffering from an pre-clinical stage of CRPS, not CTS.
复杂性区域疼痛综合征是一种具有挑战性的病症，主要包括从创伤中恢复的四肢广泛的感觉、自主神经和运动特征。很少有大规模研究探讨骨科治疗后复杂性区域疼痛综合征（CRPS）的发生情况及相关因素。本研究旨在确定与治疗后CRPS发生相关的因素。
利用丹麦患者赔偿协会的数据库，我们确定了1992年至2015年间647例声称治疗后发生CRPS的患者。提取了年龄、性别、初始诊断、治疗情况和赔偿金额。进行多因素逻辑回归以确定与索赔获批相关的变量。对于腕管综合征（CTS）患者，我们记录症状是双侧还是单侧，以及治疗前神经生理学检查是否异常。
发现以下比例：女性与男性之比为4:1，上肢与下肢的原发性诊断之比为2.5:1，手术治疗与非手术治疗之比为3:1。平均年龄为47.5±13.7岁，未检测到性别差异。前臂骨折（23%）和CTS（9%）是最常见的原发性疾病。手术治疗与索赔获批相关（比值比3.5，95%置信区间2.3至5.3；P<0.001）。一半的CTS患者手术前神经生理学检查正常；在单侧症状患者中，71.4%神经生理学检查正常。
女性、手术治疗和上肢治疗是危险因素。择期手术占治疗后CRPS患者的很大比例。在发生CRPS的CTS患者中，神经生理学检查结果正常很常见，可能怀疑这些患者患有CRPS的临床前期，而非CTS。
