复合性局部疼痛综合征
小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 慢性疼痛
- 辐射性肢痛
- 痛觉异常和痛觉过敏
- 躯体基模
- 水肿
- 皮肤和指甲营养变化
- 红斑或蓝色外观
- 局部泌汗变化或泌汗不对称
- 肌无力
其他诊断因素
- 震颤
- 肌张力不全性姿势
- 挛缩
- 袜套样分布的感知觉缺失
- 局部毛发生长变化
- 皮肤大疱
危险因素
- 创伤
- 制动
- 女性
- 其他激发事件
诊断性检查
首要检查
- 依临床症状诊断，不需进行检测
需考虑的检查
- 肌电图
- 利用表面电极的神经传导检查
- 皮肤钻孔活检
- 患肢 X 光片
- 锝99 m 骨闪烁扫描法
- 双能 X 线骨密度测量仪 (DXA) 测定
- 定量 CT 扫描
- MRI 检查
- 血管组织检查
- 交感神经阻滞
- 静脉内局部麻醉阻滞
新兴检查
- 定量感觉测定
- 温度记录
- 激光多普勒血流仪
- 发汗（催汗）试验
治疗流程
早期 CRPS（发病的 6 个月内）
慢性 CRPS（自发病以来 6 个月以上）
撰稿人
作者
Nicholas Shenker, BM BCh, MA, PhD, FRCP
Consultant in Rheumatology
Cambridge University Hospitals NHS Foundation Trust
Addenbrooke's Hospital
Cambridge
UK
利益声明
NS is medical adviser to Cambridge Nutraceuticals with stock options. He has received consultancy fees from Roche to provide unrestricted sponsored educational meetings, and grants from Versus Arthritis, the National Institute for Health Research Clinical Research Network, and the Medical Research Council. NS is an author of references cited in this topic.
Gaurav Chhabra, MBBS, FRCA, FFPMRCA
Consultant in Pain Medicine and Anaesthesia
North Bristol NHS Trust
Bristol
UK
利益声明
GC has been sponsored by Medtronic, Boston Scientific, Abbott, Nevro, Stimwave, and Polar Medical for attending various conferences and cadaveric workshops relevant to pain medicine and neuromodulation. GC is an associate examiner for the European Society of Regional Anaesthesia & Pain Therapy European Diploma of Pain Medicine exam and is also the regional advisor for pain medicine for the South West Severn deanery.
鸣谢
Dr Nicholas Shenker and Dr Gaurav Chhabra would like to gratefully acknowledge Dr Steven H. Horowitz, a previous contributor to this topic.
利益声明
SHH declares that he has no competing interests.
同行评议者
Andre Tomasino, MD
Department of Neurological Surgery
Weill Cornell Medical College
New York-Presbyterian Hospital
New York
NY
利益声明
AT declares that he has no competing interests.
Ari Weinreb, MD, PhD
Associate Chief of Rheumatology
VA Greater Los Angeles Healthcare System
Associate Professor of Medicine
David Geffen School of Medicine
UCLA
Los Angeles
CA
利益声明
AW declares that he has no competing interests.
Jonathan Berman, MBBS
Consultant in Pain Management and Anaesthesia
Pain Management Department
Royal National Orthopaedic Hospital NHS Trust
Middlesex
UK
利益声明
JB has been reimbursed by Pfizer for lectures given at Pfizer-sponsored meetings and courses.
鉴别诊断
- 感染
- 动脉血流减少
- 骨组织病变
更多 鉴别诊断指南
- 成人神经性疼痛：非专科机构中的药物管理
- 复杂性区域疼痛综合征的诊断和管理标准
更多 指南
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