Bickerstaff D R, Kanis J A
Department of Human Metabolism and Clinical Biochemistry, University of Sheffield Medical School.
Br J Rheumatol. 1994 Mar;33(3):240-8. doi: 10.1093/rheumatology/33.3.240.
Algodystrophy is a poorly recognized condition of uncertain aetiology which presents with pain and tenderness, vascular instability, swelling and stiffness of an affected limb. It is most commonly seen after trauma. In order to ascertain its incidence, natural history and the degree of morbidity induced we studied prospectively 274 patients with Colles' fracture. Algodystrophy, as judged by the presence of bone pain or tenderness, vasomotor symptoms, swelling and stiffness of the hand was noted in 28% of patients. There was a significant association between the presence of these features (P < 0.0001). The degree of trauma sustained was identified as a predisposing factor. Actuarial analysis showed a gradual resolution of symptoms. Six months after injury, the proportion of patients complaining of pain and swelling had fallen to 20-30%, vascular instability and tenderness to 50% and stiffness to 80%. Failure to improve was associated with a significant loss of hand function (P < 0.0001). By 1 yr, pain and tenderness, vascular instability and swelling had decreased still further but stiffness was still apparent in 50%. We believe that algodystrophy is a neglected disorder and is far more common than formerly appreciated. Although it often resolves spontaneously, it is associated with a significant increase in short-term morbidity in the majority of patients and persistent dysfunction in a minority.
反射性交感神经营养不良是一种病因不明、认识不足的病症，表现为患肢疼痛、压痛、血管不稳定、肿胀和僵硬。最常见于创伤后。为了确定其发病率、自然病程以及所引发的发病程度，我们对274例Colles骨折患者进行了前瞻性研究。根据骨痛或压痛、血管舒缩症状、手部肿胀和僵硬的表现判断，28%的患者出现了反射性交感神经营养不良。这些特征之间存在显著关联（P < 0.0001）。所遭受的创伤程度被确定为一个诱发因素。精算分析显示症状逐渐缓解。受伤6个月后，主诉疼痛和肿胀的患者比例降至20% - 30%，血管不稳定和压痛降至50%，僵硬降至80%。症状未改善与手部功能显著丧失相关（P < 0.0001）。到1年时，疼痛和压痛、血管不稳定和肿胀进一步减轻，但50%的患者仍有僵硬表现。我们认为反射性交感神经营养不良是一种被忽视的病症，远比以前认为的更为常见。尽管它通常会自发缓解，但在大多数患者中会导致短期发病率显著增加，少数患者会出现持续功能障碍。
