Tanesue Ryo, Gotoh Masafumi, Mitsui Yasuhiro, Nakamura Hidehiro, Honda Hirokazu, Ohzono Hiroki, Shimokobe Hisao, Tokunaga Tsuyoshi, Imai Takaki, Okawa Takahiro, Shiba Naoto
Department of Orthopedic Surgery, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
Department of Orthopedic Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, Fukuoka, 839-0863, Japan.
J Orthop Sci. 2018 Jan;23(1):70-74. doi: 10.1016/j.jos.2017.09.007. Epub 2017 Sep 23.
It is known that complex regional pain syndrome (CRPS) occurs after arthroscopic rotator cuff repair (ARCR); however, few studies have investigated this complication. Therefore, the purpose of the present study was to evaluate CRPS after ARCR.
A total of 182 patients who underwent ARCR were enrolled in this study. The average age of patients was 62.8 ± 10.0 years, with an average follow-up period of 21.5 ± 38.1 months. CRPS criteria outlined by the Ministry of Health, Labor, and Welfare study team for CRPS in Japan (MHLWJ) and International Association for the Study of Pain (IASP 2005) were utilized for diagnosis. There are two rating systems for the "clinical purpose" and "research purpose" in both criteria, respectively. Clinical outcomes, including Japanese Orthopedic Association (JOA) and University of California, Los Angeles scores, were evaluated using univariate and multivariate analysis.
CRPS exclusively occurred in the hand of the operated limb, developing within 3 months of surgery. Two or more of the following symptoms were noted in patients with the hand lesion associated with CRPS: edema (93.4%), restricted range of motion (83.4%), hyperalgesia (30.1%), paridrosis (20.4%), and atrophic change (12.2%). Under these conditions, the incidences of CRPS were 24.2% (44/182) when evaluated by the MHLWJ rating system for the "clinical purpose;" 11% (22/182) by the MHLWJ rating system for the "research purpose;" 6% (11/182) by the IASP 2005 for the "clinical purpose;" and 0.5% (1/182) by the IASP 2005 for the "research purpose." Results of multivariate analysis demonstrated that "Function" in the JOA score was a risk factor for the development of CRPS after ARCR, when evaluated by a system for the "clinical purpose" of the MHLWJ.
Following ARCR, CRPS-induced hand lesions occur more frequently than is generally believed, thereby suggesting that its impact on surgical outcomes should be clarified in the future.
已知复杂区域疼痛综合征（CRPS）发生于关节镜下肩袖修复术（ARCR）后；然而，很少有研究调查这种并发症。因此，本研究的目的是评估ARCR后的CRPS。
本研究共纳入182例行ARCR的患者。患者的平均年龄为62.8±10.0岁，平均随访期为21.5±38.1个月。采用日本厚生劳动省研究团队制定的CRPS标准（MHLWJ）和国际疼痛研究协会（IASP 2005）的标准进行诊断。两种标准分别针对“临床目的”和“研究目的”有两种评分系统。使用单因素和多因素分析评估临床结果，包括日本骨科协会（JOA）评分和加州大学洛杉矶分校评分。
CRPS仅发生于手术肢体的手部，在术后3个月内出现。与CRPS相关的手部病变患者出现以下两种或更多症状：水肿（93.4%）、活动范围受限（83.4%）、痛觉过敏（30.1%）、出汗异常（20.4%）和萎缩性改变（12.2%）。在这些情况下，按照MHLWJ“临床目的”评分系统评估，CRPS的发生率为24.2%（44/182）；按照MHLWJ“研究目的”评分系统评估为11%（22/182）；按照IASP 2005“临床目的”评估为6%（11/182）；按照IASP 2005“研究目的”评估为0.5%（1/182）。多因素分析结果表明，按照MHLWJ“临床目的”系统评估，JOA评分中的“功能”是ARCR后发生CRPS的一个危险因素。
ARCR后，CRPS引起的手部病变发生率比一般认为的更高，这表明未来应阐明其对手术结果的影响。
