复杂区域疼痛综合征临床分析

Clinical characteristics of complex regional pain syndrome

目的探讨复杂区域疼痛综合征的临床特点及治疗方法。方法回顾性分析我院2000年4月-2016年9月收治的51例复杂区域疼痛综合征患者的临床资料,按病程长短及性别分组,探讨该病的诱因及常见伴随疾病,总结该病的临床表现及治疗方法。结果 22例(43.1%)有软组织损伤史,25例(49%)伴随睡眠障碍,发病年龄主要集中在40~65岁,男女比例为1∶1.2,疼痛为所有患者的主诉,短病程(≤1年)患者易出现肢体运动功能障碍(χ~2=4.404,P=0.036);下肢关节易受累(χ~2=10.667,P=0.001)、多部位受累(χ~2=32.980,P=0.000)的患者更为常见;合并骨质疏松的女性患者多于男性患者(χ~2=4.554,P=0.033),而男性患者易出现肢体肿胀(χ~2=5.368,P=0.026)。21例行CT检查患者中19例(91%)表现为典型的斑片状骨质疏松、骨小囊样变;所有行全身骨扫描(ECT)检查的患者均提示患处放射性浓聚;22例(43.1%)使用双膦酸盐及17例(33.3%)使用激素治疗的患者疼痛显著减轻。结论本组复杂区域疼痛综合征常以软组织损伤起病,以中年为主,以下肢关节受累为主;CT或ECT检查可指导临床诊断,激素及双膦酸盐可作为首选治疗方案。

Objective To investigate the clinical characteristics and treatment of complex regional pain syndrome（CRPS）.Methods Clinical data about 51 patients with complex regional pain syndrome admitted to our hospital from April 2000 to September2016 were retrospectively analyzed. The patients were divided into different groups according to the disease course and gender, then the predisposing factors, concomitant disease, clinical manefestation and treatment for patients with CRPS were summarized.Results There were 22 cases（43.1%） with soft tissue injury history and 25 cases（49%） with sleep disorders. Pain was the chief complaint for all patients. Patients with short disease course（≤1 year） were prone to have limb dysfunction（χ^2=4.404, P=0.036）, patients with joint of lower extremity（χ^2= 10.667, P=0.001） and multi-sited（χ^2=32.980, P=0.000） involvement were more common seen. There were more female patients with osteoporosis than male patients（χ^2=4.554, P=0.033）, while male patients were prone to have limb swelling（χ^2=5.368, P=0.026）. CT was performed in 21 patients and 19（91%） of them showed typical patchy osteoporosis and bone cyst degeneration. Patients who underwent bone scan（ECT） all showed lesion radioactivity, and 22 patients（43.1%） treated with bisphosphonates and 17（33.3%） with hormone all achieved satisfactory pain relief. Conclusion CRPS is mainly caused by soft tissue injury, and middle-aged people are at high-risk. Joints of lower limbs are more likely to be involved. CT or ECT examination can guide clinical diagnosis, and steroids and bisphosphonates treatment are preferred therapies for patients with CRPS.