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一名战斗多发伤后三肢截肢军人的综合康复:来自乌克兰战时背景的案例研究

Comprehensive rehabilitation of a serviceman with triple limb amputation following combat polytrauma: a case study from Ukraine's wartime context.

作者信息

Kolisnyk Serhii, Muryn Oleh, Svyst Olha

机构信息

Department of Physical and Rehabilitation Medicine, National Pirogov Memorial Medical University, Vinnytsia; PRM Physician of Center of Medical Rehabilitation and Sports Medicine, Vinnytsia, Ukraine.

Departament of Rehabilitation of Superhumans Center, Lviv, Ukraine.

出版信息

J Rehabil Med. 2025 Mar 27;57:jrm42950. doi: 10.2340/jrm.v57.42950.

DOI:10.2340/jrm.v57.42950
PMID:40143672
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11971939/
Abstract

The ongoing war in Ukraine has led to a significant rise in combat-related polytrauma injuries, including high-level multiple amputations, delayed evacuations, infectious complications, and limited access to rehabilitation services. This clinical case demonstrates a comprehensive, patient-centred approach to the rehabilitation of a 25-year-old serviceman with triple amputations caused by a mine-blast injury. The patient progressed through pre-prosthetic and prosthetic rehabilitation stages, achieved independent mobility with prosthetics, transitioned to the K3 functional level, and adapted to his independent life. The success of this case underscores the importance of a multidisciplinary approach, modern technologies, and adherence to evidence-based rehabilitation practices. The leading role of the physical and rehabilitation medicine physician was pivotal in coordinating and adjusting the rehabilitation process, ensuring the optimal use of available resources, and aligning the patient's care with clinical goals. Challenges such as delays in rehabilitation initiation and limited resources highlight the need to expand inpatient rehabilitation capacity and standardize protocols. A coordinated bio-psycho-social rehabilitation model must be the framework for increasing the effectiveness of rehabilitation services and optimizing functioning and quality of life after severe injuries. Implementing multidisciplinary approaches tailored to wartime settings is crucial for combatants' effective recovery and reintegration.

摘要

乌克兰持续的战争导致与战斗相关的多发伤显著增加,包括高位多处截肢、延迟后送、感染并发症以及康复服务获取受限。本临床病例展示了一种以患者为中心的综合方法,用于一名因地雷爆炸伤导致三处截肢的25岁军人的康复治疗。该患者经历了假肢安装前和假肢康复阶段,借助假肢实现了独立移动,达到了K3功能水平,并适应了独立生活。该病例的成功凸显了多学科方法、现代技术以及遵循循证康复实践的重要性。物理医学与康复医师的主导作用对于协调和调整康复过程、确保可用资源的最佳利用以及使患者护理与临床目标保持一致至关重要。康复启动延迟和资源有限等挑战凸显了扩大住院康复能力和规范方案的必要性。协调的生物 - 心理 - 社会康复模式必须成为提高康复服务效果以及优化重伤后功能和生活质量的框架。实施针对战时环境量身定制的多学科方法对于战斗人员的有效康复和重新融入至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3f79/11971939/9c75821de374/JRM-57-42950-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3f79/11971939/9c75821de374/JRM-57-42950-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3f79/11971939/9c75821de374/JRM-57-42950-g001.jpg

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本文引用的文献

1
The Physiatrist's Approach to Limb Loss: Pre-amputation Through Lifelong Care.《理疗医师在肢体丧失方面的方法:从截肢前到终身关怀》。
Phys Med Rehabil Clin N Am. 2024 Nov;35(4):691-705. doi: 10.1016/j.pmr.2024.05.004. Epub 2024 Jul 9.
2
Misuse of Tourniquets in Ukraine may be Costing More Lives and Limbs Than They Save.乌克兰对止血带的滥用可能导致更多的生命和肢体损失,而不是拯救生命。
Mil Med. 2024 Nov 5;189(11-12):304-308. doi: 10.1093/milmed/usad503.
3
White Book on Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 6. Knowledge and skills of PRM physicians.
欧洲物理医学与康复医学白皮书。第 6 章。物理医学与康复医师的知识与技能。
Eur J Phys Rehabil Med. 2018 Apr;54(2):214-229. doi: 10.23736/S1973-9087.18.05150-X.
4
Special Considerations for Multiple Limb Amputation.多肢体截肢的特殊考虑因素。
Curr Phys Med Rehabil Rep. 2014;2(4):273-289. doi: 10.1007/s40141-014-0067-9.