体外冲击波治疗桡骨远端骨折复杂区域疼痛综合征的疗效观察-现代医学

体外冲击波治疗桡骨远端骨折复杂区域疼痛综合征的疗效观察

单位：1. 茂名市中医院骨三科, 广东茂名 525000;
2. 中山大学第一附属医院创伤显微手外科, 广东广州 510000

分类号：R681.7

出版年·卷·期（页码）：2020·48·第十期（1254-1258）

摘要：

目的：探索体外冲击波治疗桡骨远端骨折复杂区域疼痛综合征的疗效。方法：选择92例桡骨远端骨折保守治疗后出现复杂区域疼痛综合征患者，按治疗意愿分为治疗组（47例）和对照组（45例）。入组时应用双能X线吸收法检测患者骨密度，依据骨密度值对两组患者进行分层。治疗组给予体外冲击波治疗，对照组不给予体外冲击波治疗；两组患者均接受相同的康复方案。测定干预后2周的骨转换相关指标，随访2个月内不同时点的视觉模拟量表（VAS）评分，按骨密度值分层分析。结果：正常骨密度分层中不同时点的VAS评分两组间差异无统计学意义（P＞0.05）；低骨密度分层中，治疗组接受治疗后第1天VAS评分均值为（4.68±1.07）分高于对照组的（3.16±1.17）分，治疗后第2周及第2月时的VAS评分均值[（2.42±1.17）、（1.90±1.27）分]低于对照组的（3.04±0.84）和（2.76±1.12）分，差异具有统计学意义（P<0.05）。治疗后第2周时，治疗组的抗酒石酸酸性磷酸酶5b（TRAP5b）、β-胶原特殊序列（β-CTX）均低于对照组；在低骨密度分层中，治疗组BAP高于对照组，以上差异均具有统计学意义（P<0.05）。结论：体外冲击波治疗有助于缓解合并低骨密度的桡骨远端骨折复杂区域疼痛综合征患者的疼痛症状，该作用可能与冲击波治疗抑制了局部骨吸收反应有关。

Objective: To evaluate the effect of extracorporeal shock wave therapy for the treatment of complex regional pain syndrome(CRPS) after distal radius fracture. Methods: 92 patients with CRPS after conservative treatment of distal radius fractureweredivided into treatment group(47 patients) and control group(45 patients) according to their treatment decisions. T-score levels as an indicator of the bone mineral density(BMD) were measured with dual-energy X-ray absorption method before interventions. The treatment group received extracorporeal shock wave therapy, and the control group did not receive extracorporeal shock wave therapy; both groups received the same rehabilitation program. Visual analog scale(VAS) score was used to evaluate the therapeutic effect during the 2-month follow-up. In addition, serum levels of bone turnover biomarkers were measured at 2 weeks after treatments. The analysis was stratified by bone mineral density.Results: There was no significant difference in VAS between the two groups in patients with normal bone density at different time points(P>0.05); in the stratification with low bone density, the mean VAS of the treatment group(4.68±1.07) on the first day after treatment was higher than the control group(3.16±1.17), and the mean VAS of the treatment group in the second week and second month(2.42±1.17, 1.90±1.27)were lower than that of the control group(3.04±0.84, 2.76±1.12). The differences between the two groups were statistically significant(P<0.05). Compared with different bone density stratifications, the mean values of tartrate-resistant acid phosphatase 5b(TRAP5b) and beta-isomerized C-telopeptide(β-CTX) were lower than those of the control group, the mean level of BAP in the treatment group was higher than that in the control groupin the low bone density stratification, the differences between the above comparisons were statistically significant(P<0.05).Conclusion: Extracorporeal shock wave therapy can help relieve the pain symptoms of patients with complex regional pain syndrome after distal radius fractures with low bone density. This effect may be related to the suppression of local bone resorption by extracorporeal shock wave therapy.

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