维生素C减轻腕关节骨折的患者复杂性区域疼痛综合征发生率的研究报告
Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures?维生素C能预防有腕关节骨折的患者出现复杂性区域疼痛综合征吗?
A Randomized, Controlled, Multicenter Dose-Response Study
一项随机对照,多中心的剂量反应研究报导
P.E. Zollinger, MD1, W.E. Tuinebreijer, MD, PhD, MSc, MA2, R.S. Breederveld, MD, PhD3 and R.W. Kreis, MD, PhD3
Background: Complex regional pain syndrome type I is treated symptomatically. A protective effect of vitamin C (ascorbic acid) has been reported previously. A dose-response study was designed to evaluate its effect in patients with wrist fractures.
背景:复杂性区域疼痛综合征I型的治疗方法是对症治疗。维生素C (抗坏血酸)的保护效应过去已有报导。 此剂量-反应研究的设计是为了评价其对于有腕关节骨折患者的作用。
Methods: In a double-blind, prospective, multicenter trial, 416 patients with 427 wrist fractures were randomly allocated to treatment with placebo or treatment with 200, 500, or 1500 mg of vitamin C daily for fifty days. The effect of gender, age, fracture type, and cast-related complaints on the occurrence of complex regional pain syndrome was analyzed.
方法:采用双盲,前瞻性,多中心试验，416名有427侧腕关节骨折的患者被随机分配至维C治疗组或安慰剂组中，治疗组每日服用200 , 500 , 或1500毫克的维生素C ，连服50天。对性别,年龄,骨折类型及与石膏管型固定相关的主诉对复杂性区域疼痛综合征出现的影响作用进行了分析。
Results: Three hundred and seventeen patients with 328 fractures were randomized to receive vitamin C, and ninety-nine patients with ninety-nine fractures were randomized to receive a placebo. The prevalence of complex regional pain syndrome was 2.4% (eight of 328) in the vitamin C group and 10.1% (ten of ninety-nine) in the placebo group (p = 0.002); all of the affected patients were elderly women. Analysis of the different doses of vitamin C showed that the prevalence of complex regional pain syndrome was 4.2% (four of ninety-six) in the 200-mg group (relative risk, 0.41; 95% confidence interval, 0.13 to 1.27), 1.8% (two of 114) in the 500-mg group (relative risk, 0.17; 95% confidence interval, 0.04 to 0.77), and 1.7% (two of 118) in the 1500-mg group (relative risk, 0.17; 95% confidence interval, 0.04 to 0.75). Early cast-related complaints predicted the development of complex regional pain syndrome (relative risk, 5.35; 95% confidence interval, 2.13 to 13.42).
结果: 有328处骨折的317名患者随机服用了维生素C,而99侧骨折的99名患者则随机接受了安慰剂。复杂性区域疼痛综合征的现患率在维生素C组中是2.4% (328例中的8例 ) ,而安慰剂组为10.1% ( 10 /99 ) , ( P = 0.002 ) ; 所有受累患者都是老年妇女. 分析不同剂量的维生素C组中患复杂性区域疼痛综合征的发生率显示：在200毫克组是4.2% ( 4 /96 ) , (相对危险度, 0.41 ; 95%可信区间为0.13至1.27 ) , 在500毫克组是 1.8% ( 2 /114 ) ，(相对危险度, 0.17 ; 95%可信区间为0.04至0.77 ) , 在1500毫克组是1.7% ( 2 /118 ) (相对危险度, 0.17 ; 95%可信区间为0.04至0.75 )。 用早期与石膏管型相关的主诉来预测复杂性区域疼痛综合征的进展其(相对危险度为5.35 ; 95%可信区间为2.13至13.42 )。
Conclusions: Vitamin C reduces the prevalence of complex regional pain syndrome after wrist fractures. A daily dose of 500 mg for fifty days is recommended.
结论:维生素C可减少腕关节骨折后出现复杂性区域疼痛综合征的比率。建议按每天500毫克的剂量服用50天。
Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
证据水平:治疗性 等级I级。参见作者对证据水平的详细描述说明。
[[i] 本帖最后由 daike_ren 于 2008-7-1 12:48 编辑 [/i]]
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