Atesalp A S, Erler K, Gür E, Köseğlu E, Kirdemir V, Demiralp B
Department of Orthopaedics and Traumatology, Gülhane Military Medical Academy, Ankara, Turkey.
Prosthet Orthot Int. 1999 Apr;23(1):50-4. doi: 10.3109/03093649909071610.
Landmine explosions cause most of the war injuries in the battlefield. Amputations resulting from severe injuries reveal serious problems despite the improvements in surgery. Bilateral lower limb amputations have more impact than unilateral on social life. Some 29 cases with lower limb amputations due to landmine injuries were treated in the Department of Orthopaedics and Traumatology, Gülhane Military Medical Academy between January 1992 and December 1996. Amputation levels were as follows: 1 case had hip disarticulation and a trans-femoral amputation, 6 had bilateral trans-femoral amputations, 6 had trans-femoral and trans-tibial amputations, 12 had bilateral trans-tibial amputations, 1 had trans-femoral and Chopart amputations and the remaining 3 cases had trans-tibial and Chopart amputations. The initial treatment was done for all cases in the first 6-8 hours after injury at the field hospitals. Aggressive debridement, excision and primary closure were performed. None of the stumps required reamputations and/or revision. No case had gas gangrene or tetanus. Postoperative, pre-prosthetic training programme which ranged between 30-120 days with an average 48 days; and prosthesis fitting and adequate post-prosthetic training programme which ranged 32-126 (average 94) days was applied. All the cases were followed-up with a mean of 38.5 months (14-72 months). Nine (9) cases (31%) returned to their previous occupation, while 20 (69%) cases had to change their jobs.
地雷爆炸导致战场上的大多数战争伤员。尽管手术有所改进，但重伤导致的截肢仍暴露出严重问题。双侧下肢截肢对社会生活的影响比单侧截肢更大。1992年1月至1996年12月期间，约29例因地雷伤导致下肢截肢的患者在盖勒哈内军事医学院骨科和创伤科接受了治疗。截肢水平如下：1例为髋关节离断和经股骨截肢，6例为双侧经股骨截肢，6例为经股骨和经胫骨截肢，12例为双侧经胫骨截肢，1例为经股骨和Chopart截肢，其余3例为经胫骨和Chopart截肢。所有病例均在伤后最初6 - 8小时内在野战医院进行了初始治疗。进行了积极的清创、切除和一期缝合。没有一个残端需要再次截肢和/或翻修。没有病例发生气性坏疽或破伤风。术后进行了为期30 - 120天（平均48天）的术前假肢训练计划；并应用了为期32 - 126天（平均94天）的假肢安装和充分的术后假肢训练计划。所有病例均进行了随访，平均随访38.5个月（14 - 72个月）。9例（占31%）恢复了以前的工作，而20例（占69%）不得不更换工作。
