Choda Naoki, Kanata Yoshihiro, Kodama Norihiko, Iwasa Saya, Kawaguchi Takayuki, Uchiyama Yuki, Futani Hiroyuki, Domen Kazuhisa
Rehabilitation Center, Hyogo Medical University Sasayama Medical Center, Tambasasayama, JPN.
Department of General Medicine and Community Health Science, Hyogo Medical University Sasayama Medical Center, Tambasasayama, JPN.
Cureus. 2024 May 20;16(5):e60716. doi: 10.7759/cureus.60716. eCollection 2024 May.
Total humeral endoprosthetic replacement (THR) is a rare surgery for malignant humeral bone tumors. Studies focusing on its surgical methods and functional status are limited. Furthermore, rehabilitation treatment after THR has not been reported. Therefore, this case report aimed to investigate its postoperative rehabilitation treatment and reinstatement. A 69-year-old woman was diagnosed with chondrosarcoma of her left humerus. THR was performed the day following patient admission. The wide resection caused the loss of her left shoulder motor function. She had a left ulnar nerve disorder and carpal tunnel syndrome. Rehabilitation treatments such as joint range of motion training were initiated on postoperative day (POD) 1. We designed a shoulder abductor brace to maintain her left shoulder in an abducted and flexed position so she could use her left hand effectively. The manual muscle testing scores for elbow joint movements gradually improved. On POD47, she was transferred to a convalescent rehabilitation hospital to receive training in activities of daily living and barber work. The patient was discharged on POD107. The Disabilities of the Arm, Shoulder, and Hand score improved from 86.2 (POD7) to 17.2 (POD107). She continued outpatient rehabilitation and reinstated work on POD143. The use of a brace and seamless rehabilitation from the acute phase to convalescence and community-based rehabilitation enabled the patient with THR to return to work. This study suggests that precise assessment of the disorders and consecutive rehabilitation treatment with a brace should be considered after THR.
全肱骨假体置换术（THR）是一种针对恶性肱骨骨肿瘤的罕见手术。聚焦于其手术方法和功能状态的研究有限。此外，THR术后的康复治疗尚未见报道。因此，本病例报告旨在探讨其术后康复治疗及恢复情况。一名69岁女性被诊断为左肱骨软骨肉瘤。患者入院次日即行THR。广泛切除导致其左肩运动功能丧失。她存在左尺神经障碍和腕管综合征。术后第1天（POD1）开始进行诸如关节活动度训练等康复治疗。我们设计了一种肩部外展支具，以将她的左肩维持在外展和屈曲位置，以便她能有效地使用左手。肘关节活动的徒手肌力测试评分逐渐提高。在POD47时，她转至康复疗养院接受日常生活活动和理发工作方面的训练。患者于POD107出院。手臂、肩部和手部功能障碍评分从（POD7时的）86.2改善至（POD107时的）17.2。她继续接受门诊康复治疗，并于POD143恢复工作。使用支具以及从急性期到康复期和社区康复的无缝衔接康复使接受THR的患者能够重返工作岗位。本研究表明，THR术后应考虑对功能障碍进行精确评估并使用支具进行连续的康复治疗。
