Schmidhammer Robert, Nimmervoll Roman, Pelinka Linda E, Huber Wolfgang, Schrei Karl, Kroepfl Albert, Redl Heinz
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology at the Research Center for Traumatology of AUVA, Vienna, Austria.
J Trauma. 2004 Oct;57(4):824-31. doi: 10.1097/01.ta.0000075521.52640.92.
This retrospective study investigated three very similar cases of bilateral lower leg amputation. The aim was to determine which of two therapeutical procedures is associated with better long-term outcome: replantation or primary treatment of the stumps and subsequent prosthetic replacement.
Evaluation included clinical examination, gait analysis, and a workup of the psychosocial background. Health problems were documented using the Nottingham Health Profile. Follow-up assessments were performed 6, 7, and 18 years after the trauma.
One patient underwent successful bilateral lower leg replantation and continued to work for the same employer. Two patients underwent prosthetic replacement. One became a social outcast confined to a wheelchair. The other patient had a good psychosocial background, similar to that of the patient who underwent replantation. He showed a better gait analysis on even ground than the replantation patient, but the findings were vice versa for uneven ground.
The decision between replantation and prosthetic replacement after bilateral lower leg amputation is case related and cannot be generalized. Patients who have undergone these procedures require long-term psychological and physiotherapeutic care to achieve a good long-term surgical outcome.
本回顾性研究调查了三例非常相似的双侧小腿截肢病例。目的是确定两种治疗方法中的哪一种与更好的长期结果相关：再植术还是残端的一期治疗及随后的假肢置换。
评估包括临床检查、步态分析以及对社会心理背景的检查。使用诺丁汉健康量表记录健康问题。在创伤后6年、7年和18年进行随访评估。
一名患者成功进行了双侧小腿再植，并继续为同一家雇主工作。两名患者接受了假肢置换。其中一名成为局限于轮椅的社会弃儿。另一名患者有良好的社会心理背景，与接受再植术的患者相似。在平坦地面上，他的步态分析结果优于接受再植术的患者，但在不平坦地面上结果则相反。
双侧小腿截肢后再植术和假肢置换之间的决策因病例而异，无法一概而论。接受这些手术的患者需要长期的心理和物理治疗护理，以获得良好的长期手术效果。
