脂肪水肿中使用的振动设备的影响：不同医学观点的客观讨论

参考文献

1. 1
   Schneider Rainer (2020). Low-frequency vibrotherapy considerably improves the effectiveness of manual lymphatic drainage (MLD) in patients with lipedema: A two-armed, randomized, controlled pragmatic trial.. Physiotherapy theory and practice. PubMed.https://doi.org/10.1080/09593985.2018.1479474

   ▼摘要

   : Although the exact prevalence of lipedema is unknown the number of women suffering from this condition is ever-growing. When treated conservatively, manual lymphatic drainage is regarded the gold standard. However, the rate of its effectiveness varies considerably with some women showing minimal to no improvement depending on severity of the disease and medical history. : Thirty female patients diagnosed with lipedema stage 2-3 referred to physiotherapeutic treatment were randomly allocated to either six treatments of MLD or to six treatments of combined MLD and vibrotherapy treatment. Outcome parameters were the volume of lipedema at four locations of either the lower ( = 29) or the upper extremities ( = 1), as well as quality of life. : A very large superiority of effectiveness was found for the combined treatment. Reduction of the sizes of lipedema varied between 1.1 <  < 3.2. These patients' quality of life was also considerably better ( = 1.0). : Combining MLD with vibrotherapy treatment drastically enhances the effectiveness of treating lipedema.
2. 2
   Wright Thomas, Scarfino Crystal D, O'Malley Ellen M (2023). Effect of pneumatic compression device and stocking use on symptoms and quality of life in women with lipedema: A proof-in-principle randomized trial.. Phlebology. PubMed.https://doi.org/10.1177/02683555221145779

   ▼摘要

   Does short-term use of pneumatic compression devices (PCD) and off-the-shelf compression alleviate symptoms and improve quality of life in women with lipedema and secondary lipolymphedema? Prospective, randomized controlled, industry-sponsored, proof-in-principle study comparing PCD plus conservative care (PCD+CC) to CC alone (control). Adult females with bilateral lipedema and secondary lymphedema were randomized to PCD+CC or CC. Outcome measures were lower limb and truncal circumferential measurements, bioimpedance, and quality-of-life, symptom, and pain intensity questionnaires. Both groups experienced improvements in leg circumference and bioimpedance with more improvement in the PCD+CC group than the CC group. Pain scores of the SF-36 survey and numerical rating scales were improved in the PCD+CC group. Wong-Baker Faces scores showed trends toward improvement in both groups. This proof-in-principle study supports conservative management with graduated compression and with or without PCD for improvement in leg circumference, bioimpedance measurements, and pain in patients with lipedema.
3. 3
   Reich-Schupke Stefanie, Schmeller Wilfried, Brauer Wolfgang Justus, Cornely Manuel E, Faerber Gabriele, Ludwig Malte, Lulay Gerd, Miller Anya, Rapprich Stefan, Richter Dirk Frank, Schacht Vivien, Schrader Klaus, Stücker Markus, Ure Christian (2017). S1 guidelines: Lipedema.. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG. PubMed.https://doi.org/10.1111/ddg.13036

   ▼摘要

   The present, revised guidelines on lipedema were developed under the auspices of and funded by the German Society of Phlebology (DGP). The recommendations are based on a systematic literature search and the consensus of eight medical societies and working groups. The guidelines contain recommendations with respect to diagnosis and management of lipedema. The diagnosis is established on the basis of medical history and clinical findings. Characteristically, there is a localized, symmetrical increase in subcutaneous adipose tissue in arms and legs that is in marked disproportion to the trunk. Other findings include edema, easy bruising, and increased tenderness. Further diagnostic tests are usually reserved for special cases that require additional workup. Lipedema is a chronic, progressive disorder marked by the individual variability and unpredictability of its clinical course. Treatment consists of four therapeutic mainstays that should be combined as necessary and address current clinical symptoms: complex physical therapy (manual lymphatic drainage, compression therapy, exercise therapy, and skin care), liposuction and plastic surgery, diet, and physical activity, as well as psychotherapy if necessary. Surgical procedures are indicated if - despite thorough conservative treatment - symptoms persist, or if there is progression of clinical findings and/or symptoms. If present, morbid obesity should be therapeutically addressed prior to liposuction.
4. 4
   Dinnendahl Rebecca, Tschimmel Dominik, Löw Vanessa, Cornely Manuel, Hucho Tim (2024). Non-obese lipedema patients show a distinctly altered quantitative sensory testing profile with high diagnostic potential.. Pain reports. PubMed.https://doi.org/10.1097/PR9.0000000000001155

   ▼摘要

   Lipedema is a widespread severe chronic disease affecting mostly women. Characterized by painful bilateral fat accumulation in extremities sparing hands and feet, objective measurement-based diagnosis is currently missing. We tested for characteristic psychometric and/or sensory alterations including pain and for their potential for medical routine diagnosis. Pain psychometry was assessed using the German Pain Questionnaire. Sensory sensitivity toward painful and nonpainful stimuli was characterized in non-obese lipedema patients and matched controls using the validated quantitative sensory testing (QST) protocol of the German Research Network on Neuropathic Pain. Lipedema patients showed no overt psychometric abnormalities. Pain was reported as somatic rather than psychosomatic aversive. All QST measurements were normal, but the z-score of pressure pain thresholds (PPT) was twofold reduced and the z-score of vibration detection thresholds (VDT) was two and a half times increased. Both thresholds were selectively altered at the affected thigh but not the unaffected hand. Receiver operating characteristic analysis of the combination of PPT and VDT of thigh vs hand into a PVTH score (PPT, VDT, thigh, hand-score) shows high sensitivity and specificity, categorizing correctly 95.8% of the participants as lipedema patients or healthy controls. Bayesian inference analysis corroborated the diagnostic potential of such a combined PVTH score. We propose to assess PPT and VDT at the painful thigh and the pain-free hand. Combination in a PVTH score may allow a convenient lipedema diagnosis early during disease development.
5. 5
   Ciudad Pedro, Bustos Valeria P, Escandón Joseph M, Flaherty Emily G, Mayer Horacio F, Manrique Oscar J (2024). Outcomes of liposuction techniques for management of lipedema: a case series and narrative review.. Annals of translational medicine. PubMed.https://doi.org/10.21037/atm-24-165

   ▼摘要

   Lipedema is a commonly underdiagnosed chronic condition. This study aimed to evaluate liposuction techniques for lipedema by conducting a systematic review and presenting our experience. A case series study and a comprehensive review were conducted. We assessed surgical outcomes among patients with lipedema who underwent liposuction. Descriptive and inferential statistics were implemented. In our case series, we used tumescent liposuction, vibration amplification of sound energy at resonance (VASER) liposuction, and waterjet-assisted liposuction (WAL). We also performed a literature review of current concepts and state-of-the-art treatment for lipedema. Twenty-four female patients were included in this study with a median age of 37 years [interquartile range (IQR), 10 years]. A statistically significant difference between preoperative (29.65 kg/m) and postoperative body mass index (BMI) (26.95 kg/m; P<0.05) of patients was evidenced. The amount of total fat removal between surgical techniques was statistically different (P<0.001). A statistically significant difference in the amount of total fat removal between surgical techniques was found (P=0.0015). Post-hoc analysis with Dunn's test evidenced a significant difference only between tumescent suction-assisted lipectomy and WAL (P<0.001). Nineteen studies were included in this review. Low complication rates, improvement in patient-reported outcomes, and reduction in conservative therapy requirements were found when evaluating multiple studies in this review. Liposuction has been shown to be a safe and effective alternative in patients with lipedema. It positively impacts clinical and patient-reported outcomes.
6. 6
   Atan Tuğba, Bahar-Özdemir Yeliz (2021). The Effects of Complete Decongestive Therapy or Intermittent Pneumatic Compression Therapy or Exercise Only in the Treatment of Severe Lipedema: A Randomized Controlled Trial.. Lymphatic research and biology. PubMed.https://doi.org/10.1089/lrb.2020.0019

   ▼摘要

   Lack of diagnostic awareness of lipedema and frequent confusion with obesity or lymphedema may be an obstacle for treatment. The clinical effects of conservative treatment methods are not clearly known. This study investigated the effects of exercise-based rehabilitation combined with complete decongestive therapy (CDT) or intermittent pneumatic compression therapy (IPCT) or alone in patients with severe lipedema. Thirty-three women with severe (type 3, stage III or IV) lipedema diagnosed according to the revised-Wold criteria were randomized into three groups: Group 1 (CDT plus exercises), Group 2 (IPCT plus exercises), and Group 3 (control-exercises alone). All groups received 30 sessions of combined (aerobic, strengthening, and stretching) exercise program. In addition, there were CDT in Group 1 and IPCT in Group 2 five times a week for 6 weeks. The primary outcome measure was the limb volume measurements. The secondary outcome measures were anthropometric measurements (body weight, body mass index, waist-to-height ratio, waist-to-hip ratio), 6-minute walk test, visual analog scale for pain, fatigue severity scale, Beck Depression Inventory, and Short Form Health Survey-36 (SF-36). Thirty-one participants completed the interventions. Limb volumes ( = 0.017, ηp = 0.562 for right;  < 0.001, ηp = 0.775 for left), pain ( = 0.045, ηp = 0.199), and physical functioning subscore of SF-36 ( = 0.040, ηp = 0.465) differed significantly between treatments originating from Group 1. All programs improved outcome measurements after the intervention. However, when the difference between treatments was investigated, CDT administered in addition to the exercises has been shown to provide significant improvements in reducing limb volumes, pain, and physical function. The study was registered at the US National Institutes of Health (ClinicalTrials.gov) (NCT03924999) and available at https://clinicaltrials.gov/ct2/show/NCT03924999?term=lipedema&draw=2&rank=6.