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複合性局所疼痛症候群に対する切断術

含まれた研究の大多数(11のうち8患者数= 54)は組み合わせ非手術治療では難治性のCRPSでは正当な選択肢として選択した切断を支持。切断を受けた患者の中で、66%が生活の質(QOL)の改善を経験し、37%が義手(義足)を使用でき、16%がQOLの明らかな低下を示し、12%の患者について、明確な詳細は示されませんでしたが、これらの患者は切断後は悪化を経験。幻肢痛、CRPSの再発、断端痛の合併症は、切断後各々65%, 45% および30%で生じ、患者の2/3は満足。切断は、QOLを改善し、多岐にわたる治療の後、専門センターでの重度の難治性CRPSの苦痛を伴う耐え難い痛みを和らげるための選択肢として臨床医と患者によって考慮されますが、証拠が限られており、CRPSや幻肢痛の悪化や再発および予測不可能なリハビリの合併症の危険性があることを認識しなければなりません。治療抵抗性のCRPSを考えた場合、切断は専門センターで実施されるべきであるandafter MDT involvement before and after surgery複数の治療法の後に改善できなかった生活の質の低い患者から要求された場合にのみ切断を考慮すべきである。重症度の低い段階とは異なる挙動を示すCRPSの重症型を理解するには、さらに高品質で包括的な研究が必要です。

EFORT Open Rev. 2019 Sep 3;4(9):533-540. doi: 10.1302/2058-5241.4.190008.eCollection 2019 Sep.

Quality oflife after amputation in patients with advanced complex regional pain syndrome: a systematic review.

AyyaswamyB1, Saeed B1, Anand A1, Chan L2, Shetty V1.

1

Department of Orthopaedics, Blackpool TeachingHospitals NHS Trust, Blackpool, UK.

2

Edge Hill University, Ormskirk, UK.

Abstract

The majority of included studies (8 out of 11, n = 54)supported the concept of considering amputation for selected, unresponsivecases of complex regional pain syndrome (CRPS) asa justifiable alternative to an unsuccessful multimodality nonoperative option.Ofpatients who underwent amputation, 66% experienced improvement in quality oflife (QOL) and 37% were able to use a prosthesis, 16% had an obvious decline inQOL and for 12% of patients, no clear details were given, although it wassuggested by authors that these patients also encountered deterioration afteramputation.Complications of phantom limb pain, recurrence of CRPS and stump pain were predominant risks and were noticed in 65%, 45%and 30% of cases after amputation, respectively and two-thirds of patients weresatisfied.Amputation can be considered by clinicians and patients as an optionto improve QOL and to relieve agonizing, excruciating painof severe, resistant CRPS at a specialized centre after multidisclipinaryinvolvement but it must be acknowledged that evidence is limited, and the thereare risks of aggravating or recurrence of CRPS, phantom painand unpredictable consequences of rehabilitation.Amputation, if considered forresistant CRPS, should be carried out at specialist centres and after MDTinvolvement before and after surgery. It should only be considered if requestedby patients with poor quality of life who have failed to improve after multipletreatment modalities.Further high quality and comprehensive research is neededto understand the severe form of CRPS which behaves differently form lesssevere stages. Cite this article: EFORT Open Rev 2019;4:533-540. DOI:10.1302/2058-5241.4.190008.




by fibromyalgia11 | 2019-10-14 14:13 | 複合性局所疼痛症候群
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世界標準の線維筋痛症を専門家が説明します


by fibromyalgia11
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