Yahata Tetsutaro, Takeuchi Akihiko, Yoshida Shinya, Tsuchiya Hiroyuki
Section of Physical and Rehabilitation Medicine, Central Medical Facilities, Kanazawa University Hospital, Kanazawa, Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan.
BMJ Case Rep. 2014 Oct 21;2014:bcr2014206315. doi: 10.1136/bcr-2014-206315.
A 23-year-old man with Parkes-Weber syndrome suffered ischaemia on the toes of his left foot with overactive high-shunting. The symptoms were refractory and persistent, and trans-tibial amputation was finally performed; all detectable active lesions that had been involved by arteriovenous shunts were removed. Marked stump swelling was found a couple of times postoperatively when compression treatment was absent. Despite excessive enlargement, conventional compression treatment using elastic bandages was effective in suppressing the enlargement rapidly and in controlling the stump volume. Additionally, 8 months postoperatively, stump enlargement has not recurred using silicone liner as compressive measures. We speculated that marked stump swelling may have been caused by postoperative temporal venous congestion due to the residual varicosities in the stump. Excessive volume change of the stump confused us and stagnated prosthetic rehabilitation. Recognition of such clinical characteristics will facilitate smooth and favourable prosthetic rehabilitation in fresh amputees with Parkes-Weber syndrome.
一名患有帕克斯-韦伯综合征的23岁男性,左脚脚趾出现缺血,伴有过度活跃的高分流。症状顽固且持续,最终进行了经胫骨截肢;所有被动静脉分流累及的可检测到的活跃病变均被切除。术后有几次在未进行压迫治疗时发现残端明显肿胀。尽管肿胀过度,但使用弹性绷带进行的传统压迫治疗能有效迅速抑制肿胀并控制残端体积。此外,术后8个月,使用硅胶衬垫作为压迫措施,残端肿胀未再复发。我们推测,残端明显肿胀可能是由于残端残留静脉曲张导致术后暂时性静脉充血所致。残端的过度体积变化让我们感到困惑,并阻碍了假肢康复。认识到这些临床特征将有助于患有帕克斯-韦伯综合征的新截肢者顺利且良好地进行假肢康复。