reflex sympathetic dystrophy syndrome
Introduction
Introduction to reflex sympathetic dystrophy syndrome Reflex Sympathetic Dystrophy Syndrome (RSDS) is a clinical syndrome characterized by severe pain in the distal extremities with autonomic dysfunction. Its name is more, such as burning neuralgia, Sudecks atrophy, post-traumatic atrophy, shoulder-hand syndrome, etc., has been gradually called the RSDS in the world. basic knowledge The proportion of illness: 0.004% Susceptible people: no special people Mode of infection: non-infectious Complications: autonomic dysfunction osteoporosis
Cause
Causes of reflex sympathetic dystrophy syndrome
Trauma (25%):
Most patients have a history of trauma, surgery, brain, spinal cord and peripheral nerve injury before onset. Peripheral nerve injury is divided into open injury and non-open injury. The former is generally associated with open injury of soft tissue, causing partial or complete truncation of the nerve; the latter is complicated by blunt non-open injury of soft tissue, causing contusion, compression or stretch of the nerve trunk, which occurs small in the nerve. Hemorrhage and edema, myelin edema and degeneration. The results of peripheral nerve injury are mainly manifested as nerve paralysis in the clinic.
Local spread of tumors (25%):
Some patients may be caused by the local spread of the tumor involving the autonomic nerve. Tumor is a disorder in which the body of a local tissue loses its normal regulation at the genetic level under the action of various carcinogenic factors, resulting in abnormal clonal hyperplasia. Academics generally divide tumors into benign and malignant categories.
Drugs (15%):
A small number of patients are caused by drugs such as isoniazid, phenobarbital, ergotamine, and cyclosporine.
20% to 30% can't find a clear trigger.
Pathogenesis
The pathogenesis is still unclear. It is generally believed that RSDS is an excessive reaction of the limb to the injury. When the tissue is damaged, the sensory nerve is stimulated to release a large amount of substance P. On the one hand, the substance P transmits the painful impulse to the center, and on the other hand, it causes local inflammation. Sexual media such as prostaglandins, bradykinin, 5-HT, histamine, etc. significantly increase, causing local pain and swelling of the limbs, acting on blood vessels to cause vasomotor dysfunction, while stimulating sympathetic output nerve fibers, releasing pain mediators and norepinephrine And increase the pain.
Prevention
Reflex sympathetic dystrophy syndrome prevention
1. Eliminate and reduce or avoid the disease factors, improve the living environment, develop good living habits, prevent infection, pay attention to food hygiene, rational diet, and avoid trauma.
2. Early detection and early diagnosis and early treatment, establish confidence in the fight against disease, adhere to treatment.
Complication
Reflex sympathetic dystrophy syndrome complications Complications, autonomic dysfunction, osteoporosis
Can be complicated by autonomic dysfunction, such as limbs cold and hot, red and white, dry or sweating, late appearance of skin and subcutaneous tissue atrophy and contracture.
Symptom
Symptoms of Reflex Sympathetic Dystrophy Syndrome Common Symptoms Congestive Soft Tissue Swelling Pigmented Spots are cold and hot,... Standing hair reflexes weaken osteoporosis, hair sucking reflex positive
RSDS is usually recognized by its characteristic clinical manifestations. Symptoms often appear within a few hours after injury, or gradually appear several days or weeks after injury, and last for weeks to years. The pain has the following characteristics: burning Pain, light touch or repeated mild irritation can cause severe pain. The pain is not proportional to the severity of the injury. The pain lasts longer than the expected recovery time. The affected limb pain is often accompanied by diffuse tenderness and swelling, and autonomic dysfunction occurs. The performance, such as cold and hot limbs, red and white, dry or sweating, the lesions progress slowly, the skin and subcutaneous tissue atrophy and contracture in the late stage, the hands and feet are the most common pain sites, other such as knee, tibia Pain can occur even on the shoulders, face, and single fingers or toes. When the distal extremity is involved, the shoulder joints can be painful and restricted in activity, leading to shoulder-hand syndrome.
Clinical is generally divided into three phases:
1. Acute phase: It is the post-traumatic pain period, which is characterized by burning pain and vasodilation of the affected limb, congestion of the affected limb, edema, and increased skin temperature in the injured area.
2. Malnutrition period: characterized by vasoconstriction, the skin in the affected area is chilly with reticular pigment spots and blemishes, hair is shed, nails are hard and brittle.
3. Atrophic period: limb pain develops to the proximal end, the skin becomes thinner, brighter, the fingers become thinner, the fascia becomes thinner, and the flexion contractures.
Examine
Examination of reflex sympathetic dystrophy syndrome
There was no abnormality in the laboratory examination.
1. Radiological examination: X-ray plain film usually shows segmental bone deficiency, typical of long bones of the extremities and short bones of the hands and feet, flaky decalcification and soft tissue edema, high-resolution X-ray film can also show subperiosteal absorption, The formation of streaks, the formation of subperiosteal holes and tunnels, and the CT and MRI examinations of the affected extremities seem to be of little or no diagnostic significance.
2. Triple phase bone scanning (TPBS): intravenous injection of nuclides (usually 99mTc) for 5s, 1 to 5min and 3 to 4h, respectively, blood flow imaging, blood pool imaging, Delayed development changes, it can be seen that the ingested radionuclide in the affected area is significantly higher than normal tissue, its diagnostic sensitivity is 60%, specificity is 80%, better than X-ray examination, suitable for early-stage limited RSDS or X-ray examination.
Diagnosis
Diagnosis and differentiation of reflex sympathetic dystrophy syndrome
The diagnosis is strictly dependent on clinical manifestations. The diagnostic criteria proposed by Genant et al include the following six items: 1 limb pain and tenderness; 2 soft tissue swelling; 3 decreased motor function; 4 nutritional skin changes; 5 unstable vascular motion; 6 patchy bone Osteoporosis, difficult to diagnose, can be used for experimental diagnosis of nerve closure.
Attention is distinguished from brain, spinal cord and peripheral nerve injury and its important diseases.
