Veldman P H, Reynen H M, Arntz I E, Goris R J
Department of Surgery, University Hospital, Nijmegen, Netherlands.
Lancet. 1993 Oct 23;342(8878):1012-6. doi: 10.1016/0140-6736(93)92877-v.
The pathogenesis of reflex sympathetic dystrophy--variously known as Sudeck's atrophy, causalgia, algodystrophy, and peripheral trophoneurosis--is not yet understood, and diagnosing and treating patients is difficult. We have prospectively studied 829 patients, paying particular attention to early signs and symptoms. In its early phase, reflex sympathetic dystrophy is characterised by regional inflammation, which increases after muscular exercise. Pain was present in 93% of patients, and hypoaesthesia and hyperpathy were present in 69% and 75% respectively. With time, tissue atrophy may occur as well as involuntary movements, muscle spasms, or pseudoparalysis. Tremor was found in 49% and muscular incoordination in 54% of patients. Sympathetic signs such as hyperhidrosis are infrequent and therefore have no diagnostic value. We found no evidence consistent with the presence of three consecutive phases of the disease. Early symptoms are those of an inflammatory reaction and not of a disturbance of the sympathetic nervous system. These data support the concept of an exaggerated regional inflammatory response to injury or operation in reflex sympathetic dystrophy.
反射性交感神经营养不良（又称苏戴克萎缩、灼性神经痛、痛性营养不良和周围营养神经病）的发病机制尚未明确，对患者的诊断和治疗也存在困难。我们前瞻性地研究了829例患者，特别关注早期症状和体征。在早期阶段，反射性交感神经营养不良的特征是局部炎症，运动后炎症会加重。93%的患者存在疼痛，69%和75%的患者分别存在感觉减退和感觉过敏。随着时间推移，可能会出现组织萎缩以及不自主运动、肌肉痉挛或假性麻痹。49%的患者出现震颤，54%的患者存在肌肉不协调。诸如多汗症等交感神经体征并不常见，因此没有诊断价值。我们没有发现与该疾病存在连续三个阶段相一致的证据。早期症状是炎症反应的症状，而非交感神经系统紊乱的症状。这些数据支持了反射性交感神经营养不良中对损伤或手术的局部炎症反应过度的概念。
