Suzuki Naoki, Miyagi Midori, Furusawa Yoshihito, Miura Takahiro, Agarie Takumi, Imaizumi Yuki, Nakazawa Chihiro, Takahashi Tamao, Obata Keisuke, Izumiyama Yumi, Nishijima Kazunori, Miyauchi Hiroyuki, Iwata Naoya, Sobu Tomoe, Sekiguchi Yusuke, Ataka Kota, Takahashi Kumiko, Takeuchi Masashi, Okazaki Tatsuma, Ebihara Satoru
Department of Rehabilitation Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Sasaki Prosthetics and Orthotics Co., Ltd, Sendai, Japan.
Prog Rehabil Med. 2024 Nov 16;9:20240036. doi: 10.2490/prm.20240036. eCollection 2024.
Streptococcal toxic shock syndrome (STSS) is a notifiable disease under Japan's Infectious Disease Control Law and has become a pandemic following COVID-19. STSS often leads to necrotizing fasciitis, with a mortality rate exceeding 30%. Even in surviving patients, limb amputations are common.
A 39-year-old woman developed STSS. She underwent 18 surgeries and vacuum-assisted closure therapy, which resulted in ultra-short right transfemoral amputation. With a strong desire to walk again, she began fitting for a provisional prosthesis 3 months post-amputation. Given the preserved hip muscle strength, an ultra-short transfemoral prosthesis was selected over a hip disarticulation prosthesis. The key components included a plug-in quadrilateral socket, a belt used to suspend the transfemoral prosthesis, a hydraulic knee joint, and an energy-storing foot. She regained walking ability using crutches. To address pain and skin issues in the stump load-bearing area, compression and adhesion were improved using thick fabric spats. Muscle mass, including that of the paraspinal muscles, was maintained during follow-up evaluations using computed tomography, dual-energy X-ray absorptiometry, and bioelectrical impedance analysis. The phantom limb pain in the right leg diminished with medication and prosthetic training. Her quality-of-life scores measured using the 36-item Short Form Questionnaire and the Prosthesis Evaluation Questionnaire also showed improvement. She was discharged home 5 months post-amputation.
This case highlights the importance of high motivation, multidisciplinary collaboration, preservation of the trunk muscle reserve from pre-illness exercise habits, and early trunk rehabilitation to achieve successful gait acquisition with a customized transfemoral prosthesis.
链球菌中毒性休克综合征（STSS）是日本《传染病防治法》规定的须上报疾病，在新冠疫情之后已成为一种大流行病。STSS常导致坏死性筋膜炎，死亡率超过30%。即使在存活患者中，肢体截肢也很常见。
一名39岁女性患上了STSS。她接受了18次手术及负压封闭引流治疗，最终进行了超短右侧经股骨截肢术。由于强烈渴望再次行走，她在截肢后3个月开始试穿临时假肢。鉴于保留的髋部肌肉力量，选择了超短经股骨假肢而非髋关节离断假肢。关键部件包括插入式四边形接受腔、用于悬吊经股骨假肢的腰带、液压膝关节和储能脚。她借助拐杖恢复了行走能力。为解决残肢承重区域的疼痛和皮肤问题，使用厚织物鞋罩改善了压迫和粘连情况。在随访评估中，通过计算机断层扫描、双能X线吸收法和生物电阻抗分析维持了包括椎旁肌在内的肌肉质量。右腿的幻肢痛通过药物治疗和假肢训练有所减轻。使用36项简明健康调查问卷和假肢评估问卷测量的生活质量评分也有所改善。她在截肢后5个月出院回家。
本病例强调了高度的积极性、多学科协作、从病前运动习惯中保留躯干肌肉储备以及早期躯干康复对于使用定制经股骨假肢成功获得步态的重要性。
