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A compression device versus compression stockings in long-term therapy of lower limb primary lymphoedema after liposuction.

一种压迫装置与压力袜在吸脂术后下肢原发性淋巴水肿长期治疗中的比较。

  • 影响因子:1.59
  • DOI:10.12968/jowc.2020.29.1.28
  • 作者列表:"Karafa M","Karafová A","Szuba A
  • 发表时间:2020-01-02
Abstract

OBJECTIVE:Primary lymphoedema is rare and in most cases develops in the lower extremities. In some cases, conservative treatment is insufficient and can be supported by surgical procedure. The aim of this case study was to show the difference in the effectiveness of a compression wrap device and compression stockings in the treatment of primary lymphoedema. METHOD:Before and after liposuction the patient was treated on an outpatient basis every day for three weeks. This consisted of complex decongestive therapy (CDT) including manual lymph drainage, tailored exercises, skin and nail care, compression therapy and intermittent pneumatic compression. After CDT, the patient was provided with a flat-knit compression garment. Measurements were taken at one week and at three months of wearing the compression garment. The oedema severity was measured by summary calculation method. For both healthy and swollen limbs, the sum of circumferences taken at nine fixed measuring points was determined. The difference between these sums expressed in percents was presented as a relative metric coefficient of leg lymphoedema (RMCL). RESULTS:At the start of therapy, the difference in circumference between the healthy and swollen limb was 21.85%. After CDT (RMCL: 13.46%), the patient was provided with a flat-knit compression stocking (class 3). After one week, the RMCL was 15.92%, while after three months RCML was 20.84%. Because fluid retention was observed the patient was again treated with CDT (RMCL: 13.89%). The patient was provided with compression stocking (class 4). After one week of wearing, the RMCL was 15.77%, while after three months RMCL was 20.26%. As the results proved unsatisfactory, the patient was treated with CDT (RMCL: 13.60%) and a combination of two class 4 compression stockings was used. After one week, RMCL was 14.91%, while after three months RMCL was 19.25%. As the effects of oedema reduction were insufficient, the patient was treated again with CDT (RMCL: 13.89%) and advised to replace one of the stockings with a CirAid device (adjustable compression wrap). After one week, RMCL was 14.18% and after three months RMCL was 14.76%. The patient then qualified for liposuction (RMCL: 7.81%). At three months after surgery, the compression stocking was replaced by an adjustable compression wrap, to reduce the difference in circumference between healthy and swollen limbs (from 21.85 % to 8.68%). CONCLUSION:This case study shows that in primary oedema one class of compression garment is not always sufficient, nor is the combination of two garments with varying degrees of compression. In some cases, the situation requires the use of non-elastic leg binders such as a CircAid device which, thanks to its greater stiffness, helps improve clinical outcomes.

摘要

目的: 原发性淋巴水肿是罕见的,在大多数情况下发生在下肢。在某些情况下,保守治疗是不够的,可以通过外科手术来支持。本病例研究的目的是显示压缩包裹装置和压缩长袜在治疗原发性淋巴水肿中的有效性差异。 方法: 抽脂前后,每天门诊治疗三周。这包括复杂的减充血疗法 (CDT),包括手动淋巴引流,量身定制的练习,皮肤和指甲护理,压缩疗法和间歇性气动压缩。CDT后,为患者提供平针织压缩服。在穿着压缩服装的一周和三个月时进行测量。通过汇总计算方法测量水肿严重程度。对于健康和肿胀的肢体,确定在九个固定测量点处获得的周长的总和。以百分比表示的这些总和之间的差异表示为腿淋巴水肿 (RMCL) 的相对度量系数。 结果: 在治疗开始时,健康肢体与肿胀肢体之间的周长差异为21.85%。CDT (RMCL: 13.46%) 后,为患者提供扁平针织压缩袜 (3级)。一周后,RMCL为15.92%,而三个月后,RCML为20.84%。由于观察到液体潴留,患者再次用CDT治疗 (RMCL: 13.89%)。为患者提供加压袜 (4级)。穿戴一周后,RMCL为15.77%,而三个月后,RMCL为20.26%。由于结果证明不令人满意,患者用CDT (RMCL: 13.60%) 治疗,并使用两种4类压缩长袜的组合。一周后,RMCL为14.91%,而三个月后,RMCL为19.25%。由于水肿减轻的效果不充分,患者再次接受CDT (RMCL: 13.89%) 治疗,并建议用CirAid装置 (可调节的压缩包装) 替换其中一个长袜。一周后,RMCL为14.18%,三个月后RMCL为14.76%。然后,患者有资格进行吸脂 (RMCL: 7.81%)。手术后三个月,用可调节的压缩包裹物代替压缩袜,以减少健康和肿胀肢体之间的周长差异 (从21.85% 到8.68%)。 结论: 该案例研究表明,在原发性水肿中,一类压缩服装并不总是足够的,两种服装的组合也不具有不同程度的压缩。在一些情况下,这种情况需要使用非弹性腿部粘合剂,例如圆环装置,由于其更大的刚度,有助于改善临床结果。

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发表时间:2020-01-01
DOI:10.1177/1357633X18792808
作者列表:["Laustsen S","Oestergaard LG","van Tulder M","Hjortdal VE","Petersen AK"]

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DOI:10.1080/08941939.2018.1483445
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运动疗法方向

运动疗法是指利用器械、徒手或患者自身力量,运动疗法通过某些运动方式,使患者获得全身或局部运动功能、感觉功能恢复的训练方法。

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