Kosy Jonathan D, Middleton Simon W F, Bradley Benjamin M, Stroud Rowenna M, Phillips Jonathan R A, Toms Andrew D
Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon, England.
J Knee Surg. 2018 Sep;31(8):797-803. doi: 10.1055/s-0037-1615746. Epub 2018 Jan 2.
Previous studies suggest that complex regional pain syndrome (CRPS) occurs in up to 21% of patients following total knee arthroplasty (TKA). However, this diagnosis has a substantial impact on the patient's management if it is incorrect. We aimed to identify cases, using updated internationally accepted criteria, while investigating potential causes of misdiagnosis.We prospectively studied a consecutive series of 100 primary TKA patients. Each patient was assessed 6-week post-TKA. Pain levels were recorded with the presence of symptoms and signs of CRPS (Budapest Diagnostic Criteria) assessed in those with excessive pain. An alternative diagnosis was sought, in these patients, including the presence of neuropathic pain.We found no cases of CRPS (no patients had symptoms or signs in greater than two of four subgroups). Seventeen patients had excessive pain levels (nine had an alternative diagnosis explaining this). The commonest signs were sensory and sudomotor, whereas motor/trophic changes were not seen. Using a previous definition (Orlando Criteria), eight patients may have been diagnosed with CRPS. Over half of the patients with unexplained excessive pain had evidence of neuropathic pain.CRPS is a rare diagnosis following TKA using modern criteria. Isolated signs and symptoms may lead to the overdiagnosis of CRPS in the presence of unexplained pain following TKA. New diagnostic criteria, with strict definitions and treatment algorithms, are now accepted. Delays in managing more common causes (such as neuropathic pain) may negatively affect the patient's outcome.
先前的研究表明，全膝关节置换术（TKA）后，高达21%的患者会发生复杂性区域疼痛综合征（CRPS）。然而，如果诊断错误，这一诊断会对患者的治疗产生重大影响。我们旨在依据最新的国际公认标准识别病例，同时调查误诊的潜在原因。我们前瞻性地研究了连续的100例初次TKA患者。每位患者在TKA术后6周接受评估。记录疼痛程度，对疼痛过度的患者评估是否存在CRPS的症状和体征（布达佩斯诊断标准）。在这些患者中寻找其他诊断，包括是否存在神经性疼痛。我们未发现CRPS病例（没有患者在四个亚组中的两个以上出现症状或体征）。17例患者疼痛程度过度（9例有其他诊断可以解释）。最常见的体征是感觉和出汗异常，而未观察到运动/营养改变。按照先前的定义（奥兰多标准），8例患者可能被诊断为CRPS。超过一半原因不明的疼痛过度患者有神经性疼痛的证据。按照现代标准，CRPS在TKA后是一种罕见的诊断。在TKA后存在无法解释的疼痛时，孤立的体征和症状可能导致CRPS的过度诊断。新的诊断标准，具有严格的定义和治疗算法，现已被接受。对更常见原因（如神经性疼痛）的治疗延迟可能会对患者的预后产生负面影响。
