Bezsmertnyi Yurii Oleksiiovych, Bondarenko Dmytro Vadymovych, Shevchuk Viktor Ivanovych, Bezsmertna Halyna Viktorivna
Scientific Department, Scientific and Research Institute of Rehabilitation of National Pirogov Memorial Medical University, Vinnytsia, Ukraine.
Orthop Res Rev. 2024 Nov 25;16:273-281. doi: 10.2147/ORR.S485472. eCollection 2024.
Limb amputation and subsequent prosthetics lead to significant disturbances in bone residual limb remodeling.
To familiarize specialists with the possibility of simultaneous bilateral stress fractures of amputation residual limbs resulting from intensive loads and poor-quality prosthetics causing chronic compartment syndrome. A case of bilateral stress fractures of the tibia in a 28-year-old male military serviceman with paired transtibial amputation is presented. The fractures occurred in the process of active exploration of poorly fitting prostheses, complicated by chronic compartment syndrome that masked the clinical picture.
Rest, reopolyglucin, heparin 5000 U, furosemide, B vitamins, ascorbic acid, calcium, vitamin D, percutaneous electrical stimulation of muscles.
Radiography, ultrasound, blood biochemistry, measurement of subfascial pressure.
After treatment, the phenomena of compartment syndrome disappeared, stress fractures healed, new receiving sleeves of prostheses were made, gradual dosed loads were started. 7 months after the diagnosis of stress fractures and compartment syndrome, the patient started using the prosthesis without aids. Examined 18 months later. Worked as a warehouse manager, walking an average of 4 km per day.
With complaints from the patient with an amputation stump of muscle and bone pain that appeared after exercise, passed after rest, and reparative reaction detected on radiographs, functional overstrain of the bone should be suspected, which can potentially lead to a stress fracture. The causes of stress fractures in the patient were acute overstrain of the bone tissue during prosthesis development, noncompliance with the loading and resting regimes, and local disturbance of the bone blood supply due to the narrowed rigid socket of the prosthesis. Stress fractures of the bone tissue of the amputation stump contain elements of insufficiency and fatigue. Chronic compartment syndrome may exacerbate and mask the stress fracture.
肢体截肢及后续的假肢安装会导致骨残肢重塑出现显著紊乱。
让专家了解因高强度负荷和劣质假肢导致慢性骨筋膜室综合征而引发双侧截肢残肢同时发生应力性骨折的可能性。本文介绍了一名28岁男性军人双侧胫骨应力性骨折的病例，该患者为双侧经胫骨截肢。骨折发生在积极试用不合适假肢的过程中，并伴有慢性骨筋膜室综合征，这掩盖了临床表现。
休息、使用右旋糖酐、5000单位肝素、速尿、维生素B族、抗坏血酸、钙、维生素D、经皮肌肉电刺激。
放射摄影、超声检查、血液生化检查、骨筋膜下压力测量。
治疗后，骨筋膜室综合征症状消失，应力性骨折愈合，制作了新的假肢接受腔，并开始逐渐增加负荷量。在诊断应力性骨折和骨筋膜室综合征7个月后，患者开始无需辅助器具使用假肢。18个月后进行复查。患者担任仓库经理，平均每天步行4公里。
对于截肢残肢患者出现运动后肌肉和骨疼痛、休息后缓解且X线片显示有修复反应的情况，应怀疑存在骨功能过度劳损，这可能会导致应力性骨折。该患者应力性骨折的原因包括假肢适配过程中骨组织急性过度劳损、未遵守负荷和休息方案以及由于假肢硬接受腔变窄导致骨血供局部紊乱。截肢残肢骨组织的应力性骨折包含不足性和疲劳性因素。慢性骨筋膜室综合征可能会加重并掩盖应力性骨折。
