Gordon N
Brain Dev. 1996 Jul-Aug;18(4):257-62. doi: 10.1016/0387-7604(96)00037-x.
Reflex sympathetic dystrophy presents with pain out of proportion to the cause, loss of function, and significant evidence of an autonomic disorder. These findings are often accompanied by psychological disturbances, which can dominate the condition. There are differences in the symptoms and signs during childhood. It is more frequent among girls than boys, and the legs are more often affected than the arms; and trophic changes may be absent. There may be no history of trauma, and the response to treatment is often satisfactory. There are a number of theories on etiology. A disorder of the sympathetic nervous system with increased activity has been suggested, but on the evidence available super-sensitivity to neurotransmitters is more likely. Also there may be a spinal, as well as a peripheral, component to the sensitivity. Other suggestions include the release of a pain substance, a disturbance of natural opioid metabolism, and an exaggerated inflammatory response. The diagnosis is mainly clinical, supported by X-ray examination, bone scans with Technetium 99m labelled diphosphonates, and a characteristic scintograph pattern. Laser Doppler flowmetry can also, be useful. The most effective preventative measure is control of pain and early mobilisation. Many treatments have been tried, but the response is variable. Drugs include analgesics, non-steroid anti-inflammatory drugs, anti-depressants, and steroids. Betablockers, with gradually increasing doses may help; as may vasodilators. Calcitonin, by intramuscular injection has been given a particularly favourable report. Physiotherapy is of prime importance. Some treatments are only likely to be considered in older children. Blocking of sympathetic pathways can be tried with paravertebral or epidural injections of local anesthetics. Regional intravenous injections of alpha adrenergic blocking agents distal to a tourniquet can relieve pain, but usually only transiently; and ketanserin may act favourably as a serotonin antagonist. Surgical sympathectomy can also be considered.
反射性交感神经营养不良表现为疼痛与病因不相称、功能丧失以及自主神经功能障碍的明显证据。这些表现常伴有心理障碍，而心理障碍可能在病情中占主导地位。儿童期的症状和体征存在差异。女孩比男孩更常见，腿部比手臂更常受累；且可能没有营养改变。可能没有创伤史，对治疗的反应通常令人满意。关于病因有多种理论。有人提出交感神经系统功能紊乱且活动增强，但根据现有证据，对神经递质超敏更有可能。此外，敏感性可能既有脊髓成分，也有外周成分。其他推测包括疼痛物质的释放、天然阿片类物质代谢紊乱以及过度的炎症反应。诊断主要依靠临床，X线检查、用锝99m标记的二膦酸盐进行骨扫描以及特征性的闪烁扫描图可提供支持。激光多普勒血流仪也可能有用。最有效的预防措施是控制疼痛和早期活动。人们尝试了许多治疗方法，但反应各不相同。药物包括镇痛药、非甾体抗炎药、抗抑郁药和类固醇。逐渐增加剂量的β受体阻滞剂可能有帮助；血管扩张剂也可能有用。肌肉注射降钙素的报告特别乐观。物理治疗至关重要。一些治疗方法可能只在年龄较大的儿童中考虑。可尝试用局部麻醉药进行椎旁或硬膜外注射来阻断交感神经通路。在止血带远端区域静脉注射α肾上腺素能阻滞剂可缓解疼痛，但通常只是暂时的；酮色林作为5-羟色胺拮抗剂可能有良好作用。也可考虑手术交感神经切除术。
