Smith Douglas G, McFarland Lynne V, Sangeorzan Bruce J, Reiber Gayle E, Czerniecki Joseph M
Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA 98104, USA.
J Rehabil Res Dev. 2003 May-Jun;40(3):213-24.
Postamputation management is an important determinant of recovery from amputation. However, consensus on the most effective postoperative management strategies for individuals undergoing transtibial amputation (TTA) is lacking. Dressings can include simple soft gauze dressings, thigh-high rigid cast dressings, shorter removable rigid dressings, and prefabricated pneumatic dressings. Postoperative prosthetic attachments can be added to all but simple soft dressings. These dressings address the need to cleanly cover a fresh surgical wound, but not all postoperative dressings are designed to facilitate the strategic goals of preventing knee contractures, reducing edema, protecting from external trauma, or facilitating early weight bearing. The type of dressing and management strategy often overlap and are certainly interrelated. Current protocols and decisions are based on local practice, skill, and intuition. The current available literature is challenging, and difficulties include variations in healing potential, in comorbidity, in surgical-level selection, in techniques and skill, in experience with postoperative strategies, and with poorly defined outcome criteria. This paper reviews the published literature and compares measures of safety, efficacy, and clinical outcomes of the various techniques. Analysis of 10 controlled studies supported only 4 of the 14 claims cited in uncontrolled, descriptive studies.
截肢术后管理是截肢恢复的一个重要决定因素。然而，对于接受胫骨截肢（TTA）的个体，目前尚缺乏关于最有效术后管理策略的共识。敷料可包括简单的软纱布敷料、大腿高的硬性石膏敷料、较短的可移除硬性敷料和预制充气敷料。除简单的软敷料外，所有敷料术后均可添加假肢附件。这些敷料满足了清洁覆盖新鲜手术伤口的需求，但并非所有术后敷料都旨在促进预防膝关节挛缩、减轻水肿、防止外部创伤或促进早期负重等战略目标。敷料类型和管理策略常常重叠且相互关联。当前的方案和决策基于当地的实践、技能和直觉。现有的文献颇具挑战性，困难包括愈合潜力、合并症、手术水平选择、技术和技能、术后策略经验以及结果标准定义不明确等方面的差异。本文回顾了已发表的文献，并比较了各种技术的安全性、有效性和临床结果的衡量指标。对10项对照研究的分析仅支持了非对照描述性研究所引用的14项主张中的4项。
