骨科英文书籍精读（45）｜骨折晚期并发症之复杂区域疼痛综合征
COMPLEX REGIONAL PAIN SYNDROME (ALGODYSTROPHY)
Sudeck, in 1900, described a condition characterized by painful osteoporosis of the hand. The same condition sometimes occurs after fractures of the extremities and for many years it was called Sudeck’s atrophy. It is now recognized that this advanced atrophic disorder is the late stage of a post-traumatic reflex sympathetic dystrophy (also known as algodystrophy), which is much more common than originally believed (Atkins, 2003) and that it may follow relatively trivial injury. Because of continuing uncertainty about its nature, the term complex regional pain syndrome (CRPS) has been introduced (see page 261).
Two types of CRPS are recognized:
· Type 1 –a reflex sympathetic dystrophy that develops after an injurious or noxious event.
· Type 2 – causalgia that develops after a nerve injury.
The patient complains of continuous pain, often described as ‘burning’ in character. At first there is local swelling, redness and warmth, as well as tenderness and moderate stiffness of the nearby joints. As the weeks go by the skin becomes pale and atrophic, movements are increasingly restricted and the patient may develop fixed deformities. X-rays characteristically show patchy rarefaction of the bone.
The earlier the condition is recognized and treatment begun, the better the prognosis. Elevation and active exercises are important after all injuries, but in CRPS they are essential. In the early stage of the condition anti-inflammatory drugs and adequate analgesia are helpful. Involvement of a pain specialist who has familiarity with desensitization methods, regional anaesthesia, and use of drugs like amitriptyline, carbamazepine and gabapentin may help; this, combined
with prolonged and dedicated physiotherapy, is the mainstay of treatment.
---from 《Apley’s System of Orthopaedics and Fractures》P723
重点词汇整理：
atrophy/ˈætrəfi/n. 萎缩，萎缩症；发育停止vi. 萎缩；虚脱
a post-traumatic reflex sympathetic dystrophy创伤后反射性交感神经营养不良
sympathetic /ˌsɪmpəˈθetɪk/n. 交感神经；容易感受的人adj. 同情的；交感神经的；共鸣的；赞同的；和谐的；合意的
dystrophy/ˈdɪstrəfi/n. 营养障碍；营养失调
algodystrophy骨痛退化症
trivial /ˈtrɪviəl/adj. 不重要的，琐碎的；琐细的
noxious /ˈnɑːkʃəs/adj. 有害的；有毒的；败坏道德的；讨厌的
causalgia /kɔ:'zældʒiə/n. [临床] 灼痛
local swelling, redness and warmth,局部红肿发热
movements are increasingly restricted and the patient may develop fixed deformities. 运动越来越受限，病人可能会发展成固定畸形。
patchy/ˈpætʃi/adj. 零散的；分布不匀的；不完整的
rarefaction/,rɛrə'fækʃən/n. [声] 稀疏；（气体）稀薄
analgesia /ˌænəlˈdʒiːʒə/n. 痛觉缺失;镇痛; 无痛术
dedicated physiotherapy专用的物理治疗
dedicated /ˈdedɪkeɪtɪd/adj. 专用的；专注的；献身的v. 以…奉献；把…用于（dedicate的过去式和过去分词）
mainstay /ˈmeɪnsteɪ/n. 支柱；中流砥柱；主要的依靠；主桅支索
百度翻译：
复杂区域疼痛综合征（算法营养不良）
1900年，Sudeck描述了一种以手部疼痛性骨质疏松为特征的疾病。同样的情况有时发生在四肢骨折后，多年来被称为Sudeck萎缩。现在人们认识到，这种晚期萎缩性疾病是创伤后反射性交感神经营养不良（也称为算法营养不良）的晚期，这种情况比最初认为的要普遍得多（Atkins，2003年），并且可能伴随着相对轻微的损伤。由于对其性质的持续不确定性，引入了复杂区域疼痛综合征（CRPS）一词（见第261页）。
可识别两种类型的CRP：
·1型-伤害性或伤害性事件后发生的反射性交感神经营养不良。
·2型-神经损伤后出现的焦痛。
病人抱怨持续的疼痛，通常被描述为性格上的“灼热”。起初有局部肿胀、发红、发热，附近关节有压痛和中度僵硬。随着时间的推移，皮肤变得苍白和萎缩，活动越来越受到限制，患者可能会出现固定畸形。X光片特征性地显示出骨的片状稀疏。
病情认识越早，治疗越早，预后越好。所有损伤后，仰卧起坐和积极运动都很重要，但在CRPS中，它们是必不可少的。在病情早期使用消炎药和适当的镇痛是有帮助的。一位熟悉脱敏方法、局部麻醉和使用阿米替林、卡马西平和加巴喷丁等药物的疼痛专家的参与可能会有所帮助；这两者结合起来
随着物理治疗时间的延长和专心致志，是治疗的主体。