【摘要】 目的 探讨手外伤术后康复中复杂区域疼痛综合征(complex regional pain syndrome,CRPS)产生的机理和分布类型以及最佳预防手段。方法 对213例手外伤术后康复患者的疼痛情况进行问卷调查,对调查数据进行统计学分析,并结合相关文献资料的研究,分析出复杂区域疼痛综合征在手外伤康复中的发病率。结果 CRPS在手外伤康复中发病率约为42%,其中CRPSⅡ型占97%,CRPSⅠ型占3%。通过对年龄、性别等基本情况分析,女性在手外伤康复中CRPS发病率为72%,高于男性28%的发病率。青少年手外伤康复中CRPS发病率为10%,低于成年人24%的发病率。通过对手外伤康复情况分析,刀砍伤95例,发生CRPS 36例,发病率37%;牵拉伤63例,发生CRPS 25例,发病率39%;挤轧伤27例,发生CRPS 13例,发病率48%;撕脱伤28例,发生CRPS 15例,发病率53%。从受伤到开始康复时间长短来看,CRPS发生在2周~1个月,2周以内,1~2个月,2个月以上。从受伤部位来看,手部1区的损伤发生CRPS的几率极低,在本次调查中1区损伤15例发生CRPS的概率为0。相关文献证实,CRPS在手部1区损伤的发病率不足1%,手部3区为47%,手部5区为26%,手部4区为49%,手部2区为54%,前臂30%,上臂62%。骨折占10%~14%,韧带拉伤或扭伤占13%~22%,神经损伤占30%~44%,挫伤和挤轧伤占8%~18%。结论 CRPS平均发病年龄为36~46岁,以女性居多;CRPS在手外伤康复中以CRPSⅡ型为主,儿童和青少年CRPS发病率很低,开放性损伤更容易发生;手外伤的早期康复治疗应在2周以后进行,这样对患者康复比较安全和有效,同时也防止了CRPS的发生。更多还原

【Abstract】 Objective To investigate the mechanism and distribution types caused by CRPS and put forward the best prevention methods in the surgical rehabilitation after the hand trauma.Methods 213 patients in the surgical rehabilitation after hand trauma were investigated by questionnaires,and the survey data was analyzed combined with the study of relevant literatures to conclude the incidence of CRPS.Results The incidence of CRPS was about 42%after hand surgery.CRPS Ⅱ and CRPS Ⅰ took up 97%and 3%respectively among the patients.Based on the age and gender,female incidence of CRPS was 72%,higher than the male CRPS incidence(28%).Compared with the CRPS incidence,it was 10%among the adolescents,lower than the adults(24%).According to the recovery condition,the cases of CRPS were 36,25,13,15 among 95 chopping wound cases,63 stretch injury cases,27 squeezing injury cases and 28avulsion cases.The incidences of CRPS were 37%,39%,48%and 53%respectively.As for the process from the injured to recovery,the CRPS was most likely to happen between the 2nd week and the 1st month,and the following periods were within the first 2 weeks,within the first 2 months and beyond 2months.About the injured areas,the incidence of CRPS in the hand zone 1 was extremely low.The incidence of CRPS was 0 in hand zone 1 among 15 cases.According to the relative literatures,the incidence of CRPS was less than 1%in hand zone 1,about 47%,26%,49%,54%,30%,62%,10%to 14%,13%to22%,30%to 44%and 8%to 18%in hand zone 3,hand zone 5,hand zone 4,hand zone 2,the forearm,the upper arm,fractures,ligament strain or sprain,nerve injury,the contusion and crush injuries respectively.Conclusion The average age of CRPS onset is 36 to46,and the major patients of CRPS are women.CRPS Ⅱ is the main problem during hand injury rehabilitation.The incidence of CRPS is very low among children and adolescents.The open injury is more likely to cause CRPS.The early rehabilitation therapy of hand trauma should be taken after the first2 weeks to prevent the CRPS effectively during the hand trauma rehabilitation.更多还原