Reflex Sympathetic Dystrophy - A Case Report

反射性交感神經失養症(RSD)自1864年首次被描述後，即以不同的定義與名稱出現在文獻上。最近的文獻提到反射性交感神經失養症的診斷至少必須包含四個特徵中的兩個。那就是持續的疼痛，血管張力失調，功能恢復遲緩以及組織失養性變化。有關於反射性交感神經失養症的報告是比較偏重上肢而忽略下肢的，但最近的報告提到在不明原因之持續性膝關節疼痛的病例中，反射性交感神經失養症是相當常見的原因。我們所要報告的病例是個40歲的女性，主訴兩膝腫痛達3年之久。三次住院均在貢斷確立後施以適當之手術，但病患仍有不明原因持續之疼痛；我們由皮膚之變化與不適切之疼痛而懷疑反射性交感神經常養症之可能；再由紅內線溫度測量儀得知病患有異常的溫度調節反應，進而確立反射性交感神經失養症之診斷。射性交感神經失養症的病理機轉並不十分清楚以致處理困難，良好的預後端賴早期診斷與治療。因此我們提出這個病例報告，希望有助於這類病患的早期發現與治療。

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並列摘要

Reflex sympathetic dystrophy (RSD) has appeared in the literature under a confusing array of designations and confronted physicians since its original description in 1864. Recent reports have suggested that sym-pathetic dystrophy syndromes are frequent causes of unexplained per-sistent pain of the Knees, and are extremely difficult problems to deal with . Advanced definition has been proposed to address the entire breadth of presentations of RSD. RSD is the departure from orderly and predict-able response of an extremity to an insult; the depature should include at least two of its four characteristics: intense and/or unduly prolonged pain, vasomotor disturbance, delayed functional recovery and trophic changes. We report a female patient who was admitted with the chief com-plain of both knees pain for 3 years, She was still bothered with painful knees in spite of the fact that arthroscopic lateral retinacular release, discectomy, and tube realignment (Insall’s method) had been performed for pain relief. We performed the isolated cold stress test, which revealed abnormal pattern of thermoregulation; then the diagnosis of RSD was established. We treatd the patient with reserpin. Effectiveness of this treat-ment was demonstrated on an improved thermogram 3 months later. We report this case with an aim to call attention to this thorny problem and facilitate early diagnosis and treatment.

並列關鍵字

knee ； reflex sympathetic dystrophy

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Reflex Sympathetic Dystrophy - A Case Report

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