Mannitol as salvage treatment for Complex Regional Pain Syndrome Type I

Introduction

Complex Regional Pain Syndrome Type I (CRPS I) is a continuation of symptoms and signs due to a pathological exaggerated reaction in an extremity of the human body after an injury or operation. Although the clinical picture of CRPS I in the majority of patients is well known, the underlying pathophysiology remains unclear. In the Netherlands, intravenous mannitol administration used as hydroxyl radical scavenger for patients who do not respond to conservative treatment of CRPS I is advocated but little evidence supports this salvage strategy. In this study the effect of mannitol as salvage medication was evaluated in a well-defined multimodal step-up treatment protocol.

Patients and methods

A consecutive group of 68 adult patients with persistent CRPS I was analysed, who underwent a total of 100 mannitol infusions. The effect of treatment was considered per sign and per symptom according to the Veldman et al. criteria for CRPS I.

Results

Overall improvement of CRPS I after mannitol treatment was successful in 24% after 1 week, and in 30% after 1 month. Mannitol treatment had some effect in patients with initially warm CRPS I in contrast to patients with cold CRPS I (OR = 6.30 with CI [2.37-16.75]). Also patients with CRPS I at the upper extremity had more benefit than patients with CRPS I at the lower extremity (OR = 3.26 with CI [1.34-7.93]). Poor results of mannitol treatment were associated with cold CRPS I (p < 0.001), chronic CRPS I (p = 0.04) and multiple mannitol treatments (p = 0.04).

Conclusion

Mannitol did not significantly contribute to the overall success of treatment in patients with CRPS I. Patients, presenting with acute, warm CRPS I in the upper extremity may have some benefit.     

人工股骨头置换术治疗高龄非稳定性股骨转子间骨折

目的探讨高龄患者非稳定性股骨转子间骨折行人工股骨头置换术的临床疗效。方法本组74例，年龄75～89岁，平均80．3岁；骨折类型按Evans分类：ⅢA型31例，ⅢB型24例，Ⅳ型19例。其中3例为经内固定治疗失败病例，合并内科疾病者69例，在相关内科协同治疗后行双极骨水泥型人工股骨头置换术，术后早期进行康复锻炼。结果74例都顺利通过手术，住院期间无死亡病例；72例获得随访，随访时间3～16个月，平均9．2个月；无一例出现畸形，髋关节功能接近或恢复到受伤前水平，生活可自理；2例于出院后5个月、11个月死于其他疾病。结论人工股骨头置换术治疗高龄非稳定性股骨转子间骨折是一种效果确切的治疗方法，操作简单、创伤小、卧床时间短、并发症低、死亡率低，提高了高龄患者的生活质量。     

Quality of life in adults with childhood-onset of Complex Regional Pain Syndrome type I

Introduction

The clinical presentation of Complex Regional Pain Syndrome type I (CRPS I) in children differs compared to the presentation in adults. Reported results of treatment of CRPS I in children are usually more favourable and seem better than the reported treatment of adults with CRPS I. We investigated the quality of life (QoL) in adults who have been treated for childhood-onset CRPS I.

Methods

We performed a retrospective chart review on signs, symptoms and treatment of all patients, seen and treated for CRPS I in childhood (age <16 years). At one time point a survey was sent by mail to all adult patients with onset CRPS I in childhood with a postal reminder after one month. The first part of the survey consisted of questions focused on the experience of chronic pain and other current complaints in the affected extremity. The second part consisted of a generic-health-related quality of life instrument (SF-36).

Results

Forty-two patients (75%) responded to our survey. The median follow-up period was 12 years (SD 4.7; range 2-22). Fifty-two percent of all patients complained about pain at the time of follow-up. Of the 12 symptoms and signs, 4 are improved, 1 is worse and the remainder are unchanged. Fifteen patients experienced one or more documented relapses. General health and physical functioning (2 out of 8 scales on the SF 36) were lower in patients compared to those of the literature.

Conclusion

In contrast to the literature, the prognosis of childhood-onset CRPS I seems less favourable than usually reported, and is comparable to the prognosis of the adult-onset CRPS I in view of a decreased quality of life and a large relapse percentage (33%) at long-term follow-up.