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一名股骨骨干感染性骨不连修复患者的物理治疗康复:病例报告

Physiotherapy Rehabilitation in an Infected Non-union Shaft of Femur Repair Patient: A Case Report.

作者信息

Patil Anushri R, Patil Deepali S, Jagzape Medhavi V

机构信息

Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.

出版信息

Cureus. 2023 Dec 19;15(12):e50786. doi: 10.7759/cureus.50786. eCollection 2023 Dec.

Abstract

While definitions may vary, infected non-union is generally described as a condition where a fracture fails to heal due to infection, typically persisting for a duration of six to eight months. Infected non-unions occurring in the shaft of the femur are infrequent and typically result from severe open fractures with deep fragmentation and segmental bone loss or following internal fixation of a severely fragmented closed fracture. Some associated factors contributing to non-union include positive bacterial cultures from deep wounds, histological evidence of bone necrosis, exposed bone without a vascularized periosteum for more than six weeks, and the presence of purulent discharge. Osteomyelitis, stiffness in adjacent joints, smoking, loss of soft tissue resulting in multiple sinus tracts, osteopenia, and deformities leading to limb length discrepancies are all complicating factors that impact treatment and prognosis. Infected non-union of bones, although rare, presents a significant challenge for physiotherapists striving to provide appropriate treatment. The level of stabilization at the fracture site is the most critical factor influencing whether a fracture progresses to non-union or successfully heals. Infection, such as osteomyelitis, also contributes to the development of non-union. Additionally, issues like tissue atrophy, joint stiffness, and muscle contractures can further complicate the non-union of a bone, posing a considerable challenge for physical therapists in helping patients achieve their recovery goals. Top of form this case report reviews the case of a 35-year-old male who was reported to Acharya Vinoba Bhave Rural Hospital (AVBRH) with an infective non-union of the shaft of the femur fracture after two months of repair. This case report highlights the recovery of patients from post-operative complications like non-union, stiffness, and reduced range of motion through tailored physiotherapy rehabilitation and improved quality of life.

摘要

虽然定义可能有所不同,但感染性骨不连通常被描述为一种由于感染导致骨折无法愈合的情况,通常持续六到八个月。发生在股骨干的感染性骨不连并不常见,通常由严重的开放性骨折伴深部粉碎和节段性骨丢失引起,或继发于严重粉碎性闭合骨折的内固定术后。导致骨不连的一些相关因素包括深部伤口细菌培养阳性、骨坏死的组织学证据、无血管化骨膜覆盖的暴露骨超过六周以及脓性分泌物的存在。骨髓炎、相邻关节僵硬、吸烟、软组织缺失导致多个窦道、骨质减少以及导致肢体长度差异的畸形都是影响治疗和预后的复杂因素。骨骼的感染性骨不连虽然罕见,但对努力提供适当治疗的物理治疗师来说是一个重大挑战。骨折部位的稳定程度是影响骨折是否发展为骨不连或成功愈合的最关键因素。感染,如骨髓炎,也会导致骨不连的发生。此外,组织萎缩、关节僵硬和肌肉挛缩等问题会使骨不连进一步复杂化,给物理治疗师帮助患者实现康复目标带来相当大的挑战。本病例报告回顾了一名35岁男性的病例,该患者在骨折修复两个月后因股骨干感染性骨不连被送往阿查里亚·维诺巴·巴韦农村医院(AVBRH)。本病例报告强调了患者通过量身定制的物理治疗康复,从骨不连、僵硬和活动范围减小等术后并发症中恢复,并提高了生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/62cc/10795792/2b3d42ea8757/cureus-0015-00000050786-i01.jpg

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