以高壓氧治療SARS復原病患的髖關節缺血性壞死

HBO Treatment of Femoral Head Avascular Necrosis in a Recovedred SARS Patient

陳宏銘(Hong-Ming Chen) ； 璩大成(Da-Chen Chu) ； 陳志成(Chi-Cheng Chen)

《北市醫學雜誌》 2卷12期 (2005/12) Pp. 1159-1164

https://doi.org/10.6200/TCMJ.2005.2.12.10

摘要

嚴重急性呼吸道症候群(SARS)肆掠臺灣事件將屆滿週年，而當初慘遭SARS感染後倖存病患的夢靨卻尚未結束－這些病患於SARS治療後的後遺症正慢慢出現：在SARS病患的後續追蹤治療中陸續發現股骨頭缺血性壞死的案例，這極可能是因SARS治療使用大量類固醇所導致！股骨頭缺血性壞死的患者會出現很嚴重的疼痛現象，與眾不同的是：股骨頭缺血性壞死的病人並不像其他骨頭疼痛的病人只在運動或工作的時候疼痛，而是不僅工作時痛，休息和睡覺時更痛，走路會因此而跛行，如果不接受治療，病況會持續惡化。我們於此報告－染SARS病患痊癒半年後，確定罹患髖關節缺血性壞死第一期的病例；期在類似病患能於疾病早期及早診斷，並在醫療設備及資源許可下合併使用高壓氧治療，以提高關節缺血性壞死治癒率並避免造成SARS病患的二度傷害。

關鍵字

嚴重急性呼吸道症候群 ； 股骨頭缺血性壞死 ； 高壓氧

並列摘要

Background and Purpose: The outbreak of severe acute respiratory syndrome (SARS) has drawn enormous attention and caused fear worldwide since early 2003. SARS is associated with considerable morbidity and mortality in the acute phase. The worldwide case mortality rate is 11% (ranging from 7% to 27%) for the most severely affected regions: nearly 90% of SARS patients survived after the disease disaster. The disease is now under control. However, many sequelae of SARS are emerging: radiological, functional and psychological abnormalities of varying degrees are reported at clinical follow-up. We report on a 24-year-old female with femoral head avascular necrosis six months after recovery from SARS. Avascular necrosis occurs when the intraosseous microcirculation is disturbed and leads to osteonecrosis. The earliest sign is preceded by bone marrow edema, as seen on magnetic resonance imaging. Hyperbaric oxygen therapy can restore tissue oxygenation, reduce edema and induce angiogenesis. By reducing the intraosseous pressure, venous drainage is restored and microcirculation improves. Therefore, HBO therapy for femoral head avascular necrosis is indicated since its actions address the specific needs of the endangered bone and bone marrow cells. Conclusion: A significant proportion of patients who survived the SARS disaster have a lot of impairments in their overall functional capacity and health status in the first few months after recovery. However, the long-term sequelae are still largely unknown. It is necessary to follow up these patients and perform comprehensive assessments for detection and appropriate management of any persistent or emerging long-term sequelae thoroughly. We hope that doctors will be much more alert to musculoskeletal complaints in patients surviving SARS and treat such sequelae as early as possible, especially with hyperbaric oxygen therapy, if equipment is available.

並列關鍵字

Severe Acute Respiratory Syndrome SARS ； femoral head avascular necrosis ； hyperbaric oxygen therapy