- 期刊
Kienböck's Disease in a Patient with Hemiparetic Stroke: A case report
半側偏癱中風病人合併月狀骨無菌性壞死：病例報告
摘要
Kienböck's disease of the wrist is a multifactorial, progressive osteonecrosis of the lunate bone. Patients with this disease often complain of dorsal wrist pain and other wrist dysfunctions. Image studies are usually required for definite diagnosis; however, careful history taking and physical examination are also necessary. Treatment varies according to the stage of the disease; although surgery is needed in most of the cases, rehabilitation after the surgery seems helpful as well. Kienböck's disease is rarely seen in our daily practice, and even though we do recognize the disease, diagnosing it correctly in patients with comorbidities such as stroke is often difficult. We thereby present a case of a patient with hemiparetic stroke in our ward who complained of shoulder and wrist pain. The patient was diagnosed of shoulder-hand syndrome first, but he then turned out to be a victim of Kienböck's disease. This case report provides an important insight for physiatrists to have a second thought of any refractory wrist pain in a patient with stroke even though it is being treated as a more prevalent disease. Furthermore, physiatrist could further instruct the therapists to adjust their rehabilitation program accordingly and collaborate with orthopedic surgeons to provide a more thorough care for the patients.
並列摘要
發生在手腕上的月狀骨無菌性壞死是一種多因素造成的月狀骨缺血性壞死。患者通常會抱怨手腕背側疼痛，並伴隨一些手腕功能上的限制。此病的確切診斷通常需要仰賴影像學檢查，但細心的病史詢問以及理學檢查仍然是不可或缺的一環。治療的部分會依據不同的疾病嚴重度分級而有所不同，大部分的此類病人需要外科手術的介入，而文獻也顯示術後的復健也有助於病人功能恢復。月狀骨無菌性壞死在一般的病房或門診都算不常見，即便我們知道且了解這個疾病，但在一些有各種共病症的病患身上也很難診斷出來，例如中風病患。因此，我們在此報告一個住院中抱怨肩膀及手腕疼痛的腦中風半側偏癱患者。他一開始被診斷為肩手症候群，但後來也被證實同時患有月狀骨無菌性壞死。這個案例可以提醒復健科醫師，當中風病人被診斷罹患了其他盛行率較高的疾病，若治療後手腕的疼痛仍然持續，必須重新審視是否可能有其他潛在的病因存在。而復健科醫師在正確診斷後，也可以進一步引導治療師改變其治療策略，並且跟骨科醫師合作，以提供病人更好且更全面的照護。
參考文獻
延伸閱讀
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