Lipman Marc D, Hess Daniel E, Werner Brian C, Deal D Nicole
1 University of Virginia Health System, Charlottesville, USA.
Hand (N Y). 2019 Jul;14(4):516-522. doi: 10.1177/1558944717735949. Epub 2017 Oct 11.
Complex regional pain syndrome (CRPS) can be a devastating complication following extremity injury, but risk factors are not well understood. The purpose of this study was to investigate the association between fibromyalgia and the development of CRPS after distal radius fracture. The PearlDiver Medicare database was queried using (ICD-9) and Current Procedural Terminology (CPT) codes for diagnoses and treatments of distal radius fractures. Patients were separated into fibromyalgia and control cohorts, and the prevalence of CRPS was measured at 3, 6, 9, and 12 months from the date of injury or procedure. Demographic factors, treatment modality, and comorbid conditions were analyzed by multivariable logistic regression to reduce confounding and identify additional risk factors. Database queries yielded 853 186 patients diagnosed or treated for distal radius fracture, with 6% having previous diagnosis of fibromyalgia. The prevalence of CRPS following distal radius fracture was increased at 3, 6, 9, and 12 months in the fibromyalgia cohort compared with the control c, with a 1-year incidence of 0.51% compared with 0.20% (odds ratio [OR], 2.54, < .001). Multivariable logistic regression supported the association, with estimated OR of 2.0 ( < .001). In addition, female gender, surgical or manipulative treatment, and anxiety were positively associated with CRPS, and age >65, diabetes, and heart failure were negatively associated. While the basis of the association between fibromyalgia and CRPS is unknown, our data suggest that it could serve as a useful predictor of CRPS risk, promoting increased vigilance for CRPS symptoms and earlier recognition and treatment, thereby improving patient outcomes.
复杂性区域疼痛综合征（CRPS）可能是肢体损伤后一种极具破坏性的并发症，但相关风险因素尚未完全明确。本研究旨在探讨纤维肌痛与桡骨远端骨折后CRPS发生之间的关联。利用国际疾病分类第九版（ICD - 9）和现行手术操作术语（CPT）编码查询PearlDiver医疗保险数据库，以获取桡骨远端骨折的诊断和治疗信息。将患者分为纤维肌痛队列和对照组，并在受伤或手术日期后的3、6、9和12个月测量CRPS的患病率。通过多变量逻辑回归分析人口统计学因素、治疗方式和合并症，以减少混杂因素并识别其他风险因素。数据库查询得到853186例诊断或治疗过桡骨远端骨折的患者，其中6%既往诊断为纤维肌痛。与对照组相比，纤维肌痛队列中桡骨远端骨折后3、6、9和12个月时CRPS的患病率均有所升高，1年发病率分别为0.51%和0.20%（优势比[OR]为2.54，P <.001）。多变量逻辑回归支持这种关联，估计OR为2.0（P <.001）。此外，女性、手术或手法治疗以及焦虑与CRPS呈正相关，而年龄>65岁、糖尿病和心力衰竭与CRPS呈负相关。虽然纤维肌痛与CRPS之间关联的基础尚不清楚，但我们的数据表明，它可作为CRPS风险的有用预测指标，提高对CRPS症状的警惕性，更早地识别和治疗，从而改善患者预后。
