Peripheral sympathetic function as a predictor of complex regional pain syndrome type I (CRPS I) in patients with radial fracture
Peripheral sympathetic function as a predictor of complex regional pain syndrome type I (CRPS I) in patients with radial fracture
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DOI：
10.1016/s1566-0702(00)00250-2
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发表时间：
2000-12-28
影响因子：
2.7
通讯作者：
Andress, HJ
中科院分区：
文献类型：
--
作者：
Schürmann, M;Gradl, G;Andress, HJ
复杂性局部疼痛综合征I型（CRPS I）是上肢创伤后常见的并发症。尽管在几项临床研究中发现了交感神经系统的紊乱，并且交感神经阻滞在许多情况下解决了症状，但这种疾病的病理生理学仍不清楚。探讨本病初发时交感神经功能障碍的意义。对27例桡骨远端骨折患者进行了前瞻性的临床症状和周围交感神经功能检查。交感神经功能通过测试血管收缩反应交感神经刺激-记录与激光多普勒流量计-的指尖的双手。4例患者在12周的观察时间内发生CRPS I，2例患者的临床CRPS I图像不完整（“边缘患者”）。所有患者（正常骨折患者、CRPS I患者、临界患者）的主诉在创伤后第一周内相似，重点是疼痛、运动障碍和自主神经症状。1或2周后，正常骨折患者与CRPS I或“边缘患者”之间出现了较大的临床差异。在CRPS I患者和“边缘患者”中，交感血管收缩反应从创伤后第一天开始在整个观察时间内减少或不存在，而正常骨折患者在创伤后第一天显示交感神经功能轻微受损，在其余的观察时间内结果正常。对于未受影响的对侧手，CRPS I患者也表现出交感神经功能受损。本研究的结果表明，在CRPS I患者的交感神经系统的干扰是全身性的，而不限于受影响的肢体。它们在疾病临床爆发之前的发生可以作为可能对早期治疗有用的标志物，并导致对CRPS I的病理生理学的进一步理解。(C)2000 Elsevier Science B. V.保留所有权利。
Complex regional pain syndrome type I (CRPS I) is a frequent complication after injuries of the upper limbs. The pathophysiology of this disease remains unclear, although disturbances of the sympathetic nervous system have been detected in several clinical studies, and sympathetic blocks resolve the symptoms in many of the cases. To investigate the meaning of sympathetic dysfunction at the beginning of the disease. 27 patients with distal radial fracture were examined prospectively during the course of the disease with regard to their clinical symptoms and their peripheral sympathetic nervous function. Sympathetic nervous function was examined by testing the vasoconstrictor response to sympathetic stimuli - recorded with laser Doppler fluxmetry - of the fingertips of both hands. Four patients developed CRPS I during the 12-week observation time and two patients presented an incomplete clinical CRPS I picture ('borderline patients'). The complaints of all patients (normal fracture patients, CRPS I patients, borderline patients) were similar during the first week after trauma with focus on pain, motoric disturbances and autonomic symptoms. After 1 or 2 weeks, a larger clinical difference developed between normal fracture patients and CRPS I or 'borderline patients'. In CRPS I patients and 'borderline patients', the sympathetic vasoconstrictor response was diminished or absent from the first posttraumatic day throughout the observation time, whereas the normal Fracture patients revealed slightly impaired sympathetic nervous function on the first posttraumatic day and normal results during the rest of the observation time. With regard to the unaffected contralateral hand, CRPS I patients also showed impaired sympathetic nervous function. The results of the present study suggest that the disturbances in the sympathetic nervous system in CRPS I patients are systemic and not limited to the affected limb. Their occurrence before the clinical breakout of the disease may serve as a marker that might be useful for early therapy and lead to further understanding of the pathophysiology of CRPS I. (C) 2000 Elsevier Science B.V. All rights reserved.