Introduction

Powered robotic exoskeleton (PRE) physiotherapy programmes are a relatively novel frontier which allow patients with reduced mobility to engage in supported walking. Research is ongoing regarding their utility, risks, and benefits. This article describes the case of two fractures occurring in one patient using a PRE.

Case

We report the case of a 54 year old man who sustained bilateral tibial fractures while using a PRE, on a background of T10 AIS A SCI. The initial session was discontinued due to acute severe bilateral knee swelling after approximately 15 min. The patient attended their local hospital the following day, where radiographs demonstrated bilateral proximal tibial fractures. The patient was treated with manipulation under anaesthetic and long-leg casting for five weeks, at which point he was stepped down to hinged knee braces which were weaned gradually while he remained non-weight bearing for 12 weeks. The patient was investigated with DEXA scan and was diagnosed with osteoporosis. He was liaised with rheumatology services and bone protection was initiated. Fracture healing was achieved and weight-bearing precautions were discontinued, however this period of immobilisation led to significant spasticity. The patient was discharged from orthopaedic services, with ongoing rehabilitation and physiotherapy follow-up.

Conclusion

PRE assisted physiotherapy programmes are a promising concept in terms of rehabilitation and independence, however they are not without risk and it is important that both providers and patients are aware of this. Furthermore, SCI patients are at increased risk for osteoporosis and should be monitored and considered for bone protection.

中文翻译：

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与动力外骨骼在完全性脊髓损伤中使用相关的双侧胫骨骨折——病例报告和文献综述

介绍

动力机器人外骨骼（PRE）物理治疗项目是一个相对新颖的前沿领域，它允许行动不便的患者进行支撑行走。关于它们的效用、风险和收益的研究正在进行中。本文描述了一名患者使用 PRE 发生两处骨折的案例。

案件

我们报告了一名 54 岁男性的病例，他在使用 PRE 时发生双侧胫骨骨折，背景为 T10 AIS A SCI。大约 15 分钟后，由于双侧膝关节急性严重肿胀，最初的治疗中止。患者第二天前往当地医院就诊，X光片显示双侧胫骨近端骨折。该患者接受了为期 5 周的麻醉推拿和长腿石膏治疗，随后他被戴上铰链式膝关节支架，并逐渐脱离支架，同时他在 12 周内保持非负重状态。患者接受 DEXA 扫描检查后被诊断患有骨质疏松症。他与风湿科服务机构联络，并开始进行骨骼保护。骨折已愈合，负重预防措施也已停止，但这段固定时间导致了严重的痉挛。该患者已从骨科服务机构出院，并正在进行康复和物理治疗随访。

结论

就康复和独立而言，预辅助物理治疗计划是一个有前途的概念，但它们并非没有风险，重要的是提供者和患者都意识到这一点。此外，SCI 患者患骨质疏松症的风险增加，应进行监测并考虑进行骨保护。