重复经颅磁刺激联合常规康复对桡骨远端骨折后复杂区域性疼痛综合征I型患者上肢功能影响1例报道

doi:10.3969/j.issn.1006-9771.2020.02.017

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (2): 232-236.doi: 10.3969/j.issn.1006-9771.2020.02.017

重复经颅磁刺激联合常规康复对桡骨远端骨折后复杂区域性疼痛综合征I型患者上肢功能影响1例报道

古丽加克拉·艾山,陈婵,高天昊,凌骏麒,孙莉敏,白玉龙()

复旦大学附属华山医院康复医学科,上海市 200040

收稿日期:2019-01-14 修回日期:2019-05-05 出版日期:2020-02-25 发布日期:2020-03-19
通讯作者: 白玉龙 E-mail:dr_baiyl@fudan.edu.cn
作者简介:古丽加克拉•艾山(1987-),女,维吾尔族,新疆乌鲁木齐市人,硕士,医师,主要研究方向:运动伤病和内科疾病康复。
基金资助:
1.上海市科学技术委员会科研项目(15441900803);上海市科学技术委员会科研项目(17511107802);2.宝山区科技创新专项资金项目(17-E-31)

Effect of Repetitive Transcranial Magnetic Stimulation Combined with Conventional Rehabilitation on Upper Extremity Function for A Patient with Complex Regional Pain Syndrome I after Distal Radius Fracture

GULIJIAKELA Ai-shan,CHEN Chan,GAO Tian-hao,LING Jun-qi,SUN Li-min,BAI Yu-long()

Department of Rehabilitation, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China

Received:2019-01-14 Revised:2019-05-05 Published:2020-02-25 Online:2020-03-19
Contact: BAI Yu-long E-mail:dr_baiyl@fudan.edu.cn
Supported by:
Shanghai Science and Technology Committee Research Program(15441900803);Shanghai Science and Technology Committee Research Program(17511107802);Special Fund for Scientific and Technological Innovation in Baoshan District(17-E-31)

摘要/Abstract

摘要：

目的探讨左侧桡骨远端骨折后并发复杂区域性疼痛综合征(CRPS)患者的发生发展以及重复经颅磁刺激(rTMS)联合常规康复的疗效。方法对1例患者采用rTMS联合常规康复治疗3周。采用视觉模拟评分(VAS)评价疼痛,测量手体积和手指周径测量评价水肿情况,并测量被动关节活动度,采用改良Barthel指数评价日常生活活动能力。结果治疗前,患者VAS评分8分,左手容积330 ml,皮温36.8 ℃,左侧肘关节前屈、伸展,左前臂旋前、旋后,左侧腕关节屈曲、伸展、尺侧偏、桡侧偏,左手掌指关节(MCP),近段指间关节(PIP),远端指间关节(DIP)活动均受限,左侧手指周径明显大于右侧,改良Barthel指数85分。3周后,患者VAS疼痛评分2分,左手容积310 ml,皮温33.8 ℃,左侧肘关节,左侧腕关节及左侧MCP、PIP、DIP关节活动度均较前好转,改良Barthel指数100分。结论采用rTMS联合常规康复治疗桡骨远端骨折后CRPS患者取得较好的疗效,患者左上肢关节活动度、水肿程度明显好转,日常生活活动能力提高。

关键词: 桡骨远端骨折, 复杂区域性疼痛综合征, 重复经颅磁刺激

Abstract:

Objective To summarize the development of a patient with complex regional pain syndrome (CRPS) after distal radius fracture and the effect of repetitive transcranial magnetic stimulation (rTMS) combined with conventional rehabilitation on it.Methods One patient with CRPS after left distal radius fracture was treated with rTMS combined with conventional rehabilitation for three weeks. The pain degree was evaluated with Visual Analogue Score (VAS), the edema was assessed with volume of hand and circumference of finger, and motion of joint was measured with passive range of motion. The activities of daily living was assessed with modified Barthel Index (MBS).Results Before treatment, the VAS score was 8, the volume of left hand was 330 ml, the temperature of skin was 36.8 ℃. The activity of flexion and extension of left elbow joint, pronation and supination of left forearm, the flexion, extension, ulnar deviation and temporal deviation of left wrist, and metacarpophalangeal joints (MCP), proximal interphalangeal joint (PIP) and distal interphalangeal joint (DIP) of left hand were all limited. The circumference of left finger was larger than right finger, and the score of MBI was 85. After three weeks of treatment, the VAS score was 2, the volume of the left hand was 310 ml, the temperature of the skin was 33.8 ℃. The activities of left elbow joint, left wrist joint and left MCP, PIP, and DIP were better than before. The score of MBI was 100.Conclusion rTMS combined with conventional rehabilitation is effective on CRPS after distal radius fracture, in the range of motion and edema of upper extremity, and activities of daily living.

Key words: distal radius fracture, complex regional pain syndrome, repetitive transcranial magnetic stimulation

中图分类号:

R681.7

古丽加克拉·艾山,陈婵,高天昊,凌骏麒,孙莉敏,白玉龙. 重复经颅磁刺激联合常规康复对桡骨远端骨折后复杂区域性疼痛综合征I型患者上肢功能影响1例报道[J]. 《中国康复理论与实践》, 2020, 26(2): 232-236.

GULIJIAKELA Ai-shan,CHEN Chan,GAO Tian-hao,LING Jun-qi,SUN Li-min,BAI Yu-long. Effect of Repetitive Transcranial Magnetic Stimulation Combined with Conventional Rehabilitation on Upper Extremity Function for A Patient with Complex Regional Pain Syndrome I after Distal Radius Fracture[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(2): 232-236.

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参考文献 29

[1]	de Mos M, de Bruijn A G, Huygen F J, et al. The incidence of complex regional pain syndrome: a population-based study[J]. Pain, 2007, 129(1):12-20. doi: 10.1016/j.pain.2006.09.008
[2]	Sandroni P, Benrud-Larson L M, McClelland R L, et al. Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study[J]. Pain, 2003, 103(1-2):199-207. pmid: 12749974
[3]	Harden R N, Bruehl S, Perez R S, et al. Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome[J]. Pain, 2010, 150(2):268-274. doi: 10.1016/j.pain.2010.04.030
[4]	Bean D J, Johnson M H, Kydd R R. The outcome of complex regional pain syndrome type 1: a systematic review[J]. Pain, 2014, 15(7):677-690.
[5]	Dutton K, Littlejohn G. Terminology, criteria, and definitions in complex regional pain syndrome: challenges and solutions[J]. J Pain Res, 2015, 8:871-877.
[6]	Eisenberg E, Chistyakov A V, Yudashkin M, et al. Evidence for cortical hyperexcitability of the affected limb representation area in CRPS: a psychophysical and transcranial magnetic stimulation study[J]. Pain, 2005, 113(1-2):99-105. pmid: 15621369
[7]	Li W W, Sabsovich I, Guo T Z, et al. The role of enhanced cutaneous IL-1beta signaling in a rat tibia fracture model of complex regional pain syndrome[J]. Pain, 2009, 144(3):303-313. doi: 10.1016/j.pain.2009.04.033
[8]	Santamato A, Ranieri M, Panza F, et al. Role of biphosphonates and lymphatic drainage type Leduc in the complex regional pain syndrome (shoulder-hand syndrome)[J]. Pain Med, 2009, 10(1):179-185. doi: 10.1111/j.1526-4637.2008.00539.x
[9]	Herlyn P, Müller-Hilke B, Wendt M, et al. Frequencies of polymorphisms in cytokines, neurotransmitters and adrenergic receptors in patients with complex regional pain syndrome type I after distal radial fracture[J]. Clin J Pain, 2010, 26(3):175-181. doi: 10.1097/AJP.0b013e3181bff8b9
[10]	Baron R, Schattschneider J, Binder A, et al. Relation between sympathetic vasoconstrictor activity and pain and hyperalgesia in complex regional pain syndromes: a case-control study[J]. Lancet, 2002, 359(9318):1655-1660. pmid: 12020526
[11]	Oaklander A L, Rissmiller J G, Gelman L B, et al. Evidence of focal small-fiber axonal degeneration in complex regional pain syndrome-I (reflex sympathetic dystrophy)[J]. Pain, 2006, 120(3):235-243. pmid: 16427737
[12]	Smart K M, Wand B M, O'Connell N E. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II [J]. Cochrane Datadase Syst Rev, 2016, 2: CD010853
[13]	Diaz-Garcia R J, Chung K C. The evolution of distal radius fracture management: a historical treatise[J]. Hand Clin, 2012, 28(2):105-111. doi: 10.1016/j.hcl.2012.02.007 pmid: 22554653
[14]	Beil F T, Barvencik F, Gebauer M, et al. The distal radius, the most frequent fracture localization in humans: a histomorphometric analysis of the microarchitecture of 60 human distal radii and its changes in aging[J]. J Trauma, 2011, 70(1):154-158.
[15]	Li Z, Smith B P, Tuohy C, et al. Complex regional pain syndrome after hand surgery[J]. Hand Clin, 2010, 26(2):281-289. doi: 10.1016/j.hcl.2009.11.001
[16]	Safaz I, Tok F, Taşkaynatan M A, et al. Manual lymphatic drainage in management of edema in a case with CRPS: why the(y) wait?[J]. Rheumatol Int, 2011, 31(3):387-390. doi: 10.1007/s00296-009-1187-x
[17]	Demos M, Huygen F J, Stricker B H, et al. The association between ACE inhibitors and the complex regional pain syndrome: suggestions for a neuro-inflammatory pathogenesis of CRPS[J]. Pain, 2009, 142(3):218-224. doi: 10.1016/j.pain.2008.12.032
[18]	Moseley G L, Herbert R D, Parsons T, et al. Intense pain soon after wrist fracture strongly predicts who will develop complex regional pain syndrome: prospective cohort study[J]. J Pain, 2014, 15(1):16-23. doi: 10.1016/j.jpain.2013.08.009
[19]	Jellad A, Salah S, Ben Salah Frih Z. Complex regional pain syndrome type I: incidence and risk factors in patients with fracture of the distal radius[J]. Arch Phys Med Rehabil, 2014, 95(3):487-492. doi: 10.1016/j.apmr.2013.09.012
[20]	Goh E L, Chidambaram S, Ma D . Complex regional pain syndrome: a recent update[J]. Burns Trauma, 2017, 5(1):2.
[21]	Klein M M, Treister R, Raij T, et al. Transcranial magnetic stimulation of the brain: guidelines for pain treatment research[J]. Pain, 2015, 156(9):1601-1614. doi: 10.1097/j.pain.0000000000000210 pmid: 25919472
[22]	Lefaucheur J P, André-Obadia N, Antal A, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS)[J]. Clin Neurophysiol, 2014, 125(11):2150-2206. doi: 10.1016/j.clinph.2014.05.021
[23]	Lolloca C, Ludman T, Bouhassira D, et al. Neuropathic pain[J]. Nat Rev Dis Primers, 2017, 3:17002. doi: 10.1038/nrdp.2017.2
[24]	Finnerup N B, Haroutounian S, Kamerman P, et al. Neuropathic pain: an updated grading system for research and clinical practice[J]. Pain, 2016, 157(8):1599-1606. doi: 10.1097/j.pain.0000000000000492 pmid: 27115670
[25]	Mercier C, Léonard G. Interactions between pain and the motor cortex: insights from research on phantom limb pain and complex regional pain syndrome[J]. Physiother Can, 2011, 63(3):305-314. doi: 10.3138/ptc.2010-08p
[26]	Schwenkreis P, Janssen F, Rommel O, et al. Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand[J]. Neurology, 2003, 61(4):515-519. pmid: 12939426
[27]	Eisenberg E, Chistyakov A V, Yudashkin M, et al. Evidence for cortical hyperexcitability of the affected limb representation area in CRPS: a psychophysical and transcranial magnetic stimulation study[J]. Pain, 2005, 113(1-2):99-105. pmid: 15621369
[28]	Garcia-Larrea L, Peyron R. Motor cortex stimulation for neuropathic pain: from phenomenology to mechanisms[J]. Neuroimage, 2007, 37(1):71-79. doi: 10.1016/j.neuroimage.2007.05.018
[29]	Lefaucheur J P, Drouot X, Ménard-Lefaucheur I, et al. Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain[J]. Neurology, 2006, 67(9):1568-1574. pmid: 17101886

重复经颅磁刺激联合常规康复对桡骨远端骨折后复杂区域性疼痛综合征I型患者上肢功能影响1例报道

Effect of Repetitive Transcranial Magnetic Stimulation Combined with Conventional Rehabilitation on Upper Extremity Function for A Patient with Complex Regional Pain Syndrome I after Distal Radius Fracture

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时间	肘关节	前臂	腕关节
时间	屈曲/伸展	旋前/旋后	屈曲/伸展	桡侧偏/尺侧偏
治疗前	87	55	20	5
治疗后	100	90	42	30

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时间	拇指		示指			中指			环指			小指
时间	MCP	PIP	MCP	PIP	DIP	MCP	PIP	DIP	MCP	PIP	DIP	MCP	PIP	DIP
治疗前	25	20	20	20	15	25	35	0	10	20	10	5	15	10
治疗后	35	45	43	55	40	44	60	35	30	45	20	26	30	20