Kotsougiani-Fischer D, Choi J S, Oh-Fischer J S, Diehm Y F, Haug V F, Harhaus L, Gazyakan E, Hirche C, Kneser U, Fischer S
BG Trauma Center Ludwigshafen, Department for Hand-, Plastic- and Reconstructive Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
BMC Surg. 2020 Dec 1;20(1):306. doi: 10.1186/s12893-020-00982-7.
BACKGROUND: Complex regional pain syndrome (CRPS) is a rare but feared complication in hand surgery. Although multimodal therapy concepts are recommended, there is only low evidence on efficacy of such approaches. Furthermore, recommendations regarding therapy duration are lacking. Aim of this study was to validate the efficacy of an International Classification of Functioning, Disability and Health (ICF)-based multidisciplinary rehabilitation concept for treatment of CRPS of the hand and to find correlations between therapy duration and outcome measures. METHODS: Patients with CRPS of the hand after occupational trauma that underwent an ICF-based rehabilitation program between 2010 and 2014 were included in this retrospective study. Besides demographic data, outcomes included pain (VAS), range of motion assessed by fingertip-to-palm-distance (PTPD) and fingernail-to-table-distance (FTTD) as well as strength in grip, 3-point pinch and lateral pinch. All measures were gathered at admission to and discharge from inpatient rehabilitation therapy as well as at follow-up. Statistical analysis included paired t-test, ANOVA and Pearson's correlation analysis. RESULTS: Eighty-nine patients with a mean age of 45 years were included in this study. Duration of rehabilitation therapy was 53 days on average. All outcomes improved significantly during rehabilitation therapy. Pain decreased from 6.4 to 2.2. PTPD of digit 2 to 5 improved from 2.5, 2.8, 2.6, and 2.3 cm to 1.3, 1.4, 1.2, and 1.1 cm, respectively. FTTD of digit 2 to 5 decreased from 1.5, 1.7, 1.5, and 1.6 cm to 0.6, 0.8, 0.7, and 0.7 cm, respectively. Strength ameliorated from 9.5, 3.7, 2.7 kg to 17.9, 5.6, 5.0 kg in grip, lateral pinch, and 3-point pinch, respectively. Improvement in range of motion significantly correlated with therapy duration. 54% of patients participated at follow-up after a mean of 7.5 months. Outcome measures at follow-up remained stable compared to discharge values without significant differences. CONCLUSION: The ICF-based rehabilitation concept is a reliable and durable treatment option for CRPS of the hand. Range of motion improved continuously with therapy duration and thus may serve as an indicator for optimum length of therapy.
背景：复杂性区域疼痛综合征（CRPS）是手部手术中一种罕见但令人担忧的并发症。尽管推荐采用多模式治疗理念，但关于此类方法疗效的证据有限。此外，缺乏关于治疗持续时间的建议。本研究的目的是验证基于国际功能、残疾和健康分类（ICF）的多学科康复理念对手部CRPS治疗的有效性，并找出治疗持续时间与结局指标之间的相关性。 方法：本回顾性研究纳入了2010年至2014年间因职业创伤导致手部CRPS并接受基于ICF康复计划的患者。除人口统计学数据外，结局指标包括疼痛（视觉模拟评分法[VAS]）、通过指尖到手掌距离（PTPD）和指甲到桌面距离（FTTD）评估的活动范围以及握力、三点捏力和侧捏力。所有测量数据均在住院康复治疗入院时、出院时以及随访时收集。统计分析包括配对t检验、方差分析和Pearson相关性分析。 结果：本研究纳入了89例平均年龄为45岁的患者。康复治疗平均持续时间为53天。康复治疗期间所有结局指标均有显著改善。疼痛从6.4降至2.2。第2至5指的PTPD分别从2.5、2.8、2.6和2.3厘米改善至1.3、1.4、1.2和1.1厘米。第2至5指的FTTD分别从1.5、1.7、1.5和1.6厘米降至0.6、0.8、0.7和0.7厘米。握力、侧捏力和三点捏力分别从9.5、3.7、2.7千克改善至17.9、5.6、5.0千克。活动范围的改善与治疗持续时间显著相关。平均7.5个月后，54%的患者参与了随访。随访时的结局指标与出院时相比保持稳定，无显著差异。 结论：基于ICF的康复理念是手部CRPS一种可靠且持久的治疗选择。活动范围随着治疗持续时间不断改善，因此可作为最佳治疗时长的指标。
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