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腹腔镜袖状胃切除术后患者出现单侧腓总神经病变。

Unilateral peroneal neuropathy in a patient following laparoscopic sleeve gastrectomy.

机构信息

Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, Canterbury, New Zealand.

Beckford Sports, Christchurch, New Zealand.

出版信息

Postgrad Med. 2024 Sep;136(7):782-787. doi: 10.1080/00325481.2024.2398413. Epub 2024 Sep 4.

Abstract

Peroneal neuropathy, characterized by the occurrence of a foot drop, can develop due to a variety of factors, such as tumors, trauma, or metabolic conditions, making it one of the most prevalent peripheral neuropathies of the lower limbs. This condition is becoming more identifiable among patients who have undergone substantial weight reduction through bariatric surgery. The condition may present with symptoms like pain, sporadic paresthesia, and functional restrictions, primarily linked to foot drop. This case study explores an episode of acute foot drop in a patient who underwent a sleeve gastrectomy, leading to substantial weight loss.The patient, a middle-aged woman with a history of obesity, underwent sleeve gastrectomy and achieved normal body mass index (BMI) within a year. Eleven months post-surgery, she experienced a right-sided foot drop following a minor knee injury. Detailed history taking revealed noncompliance with vitamin supplementation, recurrent vomiting episodes, and a recent diagnosis of pancreatic insufficiency. Peripheral neuropathy, particularly peroneal nerve involvement, was confirmed through nerve conduction studies and radiological imaging. The mechanism of injury was attributed to rapid weight loss, potential nutrient deficiencies, and possible traction to the nerve.This case underscores the importance of early identification, comprehensive nutritional assessment, and timely intervention in managing neurological complications of post-bariatric surgery. Increased awareness among healthcare providers, particularly musculoskeletal specialists, is crucial as the prevalence of bariatric surgery continues to grow, ensuring optimal care for patients in this vulnerable population.

摘要

腓总神经病,以足下垂为特征,可由多种因素引起,如肿瘤、创伤或代谢状况等,是下肢最常见的周围神经病之一。这种情况在接受过减重手术(如胃旁路手术)的患者中越来越常见。这种情况可能出现疼痛、间歇性感觉异常和功能受限等症状,主要与足下垂有关。本病例研究探讨了一位接受袖状胃切除术的患者出现急性足下垂的情况,导致体重显著减轻。

该患者为中年女性,有肥胖史,接受了袖状胃切除术,一年内体重指数(BMI)恢复正常。术后 11 个月,她在轻微膝关节损伤后出现右侧足下垂。详细的病史采集显示,她未遵医嘱补充维生素,反复出现呕吐症状,最近还被诊断为胰腺功能不全。神经传导研究和影像学检查证实存在周围神经病,特别是腓总神经受累。损伤机制归因于体重快速下降、潜在的营养缺乏以及可能对神经的牵拉。

本病例强调了早期识别、全面营养评估和及时干预管理减重手术后神经并发症的重要性。随着减重手术的普及,提高医疗保健提供者(特别是肌肉骨骼专家)的认识至关重要,以确保为这一脆弱人群提供最佳护理。

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