- 期刊
外傷性腦傷併股骨骨折之多處異位性骨化症：個案報告
Multiple Heterotopic Ossifications in a Patient with Traumatic Brain Injury and Femoral Fracture: A Case Report
摘要
後天性異位性骨化症常併發於脊髓損傷、外傷性腦傷、電燒傷、髖臼或手肘骨折或全髖關節關節置換術等患者。外傷性腦傷併多重異位性骨化症的個案並不常見，尤其是發生在不對稱的四肢關節。本個案係一位23歲女性患者，因車禍導致顱內出血併股骨骨折，發病後二個月內，接連在左側肘關節及右側髖關節發生局部紅腫熱痛，降低關節活動度，嚴重影響復健訓練。由臨床症狀，X光攝影檢查，實驗診斷數據排除蜂窩性組織炎及深層靜脈栓塞後，臆斷此患者爲雙側多處異位性骨化症並給予藥物及復健治療，陸續追蹤實驗診斷數據及臨床表現，發現治療效果良好，證實診斷爲多重異位性骨化。外傷性腦傷患者合併異位性骨化症的個案，常因患者可能合併意識及認知障礙、語言障礙、嚴重的肢體障礙或外傷性骨折，因此臨床上常被誤認爲扭傷、挫傷、骨折術後疼痛或感覺異常，再加上患者無法正確的表達，除非發生明顯的腫痛或關節活動度受限，往往會造成臨床上的忽略。如何早期診斷，給予更積極的治療，以降低可能造成的功能障礙，實在是不容輕忽的課題。
並列摘要
Sporadic heterotopic ossification is a common complication in patients with spinal cord injury, traumatic brain injury, electrical burns, hip fracture, elbow fracture or total hip arthroplasty. However, multiple heterotopic ossifications in a traumatic brain injury case are quite rare. We report a case of a 23 year-old female patient with traumatic brain injury and a right femoral open fracture due to a traffic accident. She started to develop local erythema, swelling, warmth and pain over the left elbow and right hip about two months after the accident. The range of motion of the affected joints decreased and this severely impeded her rehabilitation training program. The radiological findings were the presence of multiple areas of abnormal calcification, which were accompanied by clinical symptoms, signs and laboratory findings that supported a diagnosis of heterotopic ossification. Clinically, the symptoms and signs of heterotopic ossification may mimic an associated traumatic sprain, a contusion, post fracture surgery pain or paraesthesia. A diagnosis of heterotopic ossification should be considered if the patient's clinical state has not improved or a limitation of joint motion is found to exist. An early diagnosis is important because it allows more aggressive treatment and helps to reduce physical dysfunction, which are important issues worthy of attention.
延伸閱讀
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