Pardasaney Poonam K, Sullivan Patricia E, Portney Leslie G, Mankin Henry J
MGH Institute of Health Professions, Boston, Massachusetts 02129, USA.
Clin Orthop Relat Res. 2006 Mar;444:201-8. doi: 10.1097/01.blo.0000195413.16150.bc.
Although function after lower extremity amputation and limb salvage has been compared, no study has assessed individual functional variables by surgical level. Our aim was to determine whether risks of long-term psychologic and physical limitations were associated with amputation or limb salvage at four levels: below-knee, above-knee, hip, and pelvis. We included 408 patients with sarcomas and postoperative followup of 2 years or greater who had completed a quality-of-life self-report questionnaire. The mean length of followup was 8.91 +/- 5.15 years (range, 2-27 years). Relative risk analysis was done on 12 dichotomous general health, psychologic, and physical function variables. At the below-knee level, outcomes were similar after both procedures. At the above-knee level, amputation was associated with increased risk of limp (RR = 1.6), walking aid use (RR = 2.1), anxiety (RR = 2.4), and inability to drive (RR = 3), and decreased risk of muscle weakness (RR = 0.57). At the hip and pelvic levels, outcomes were descriptively compared because of the small number of amputations. At these higher levels, limitations were more common after amputation. The difference in results between the below-knee and above-knee levels supports the importance of distinguishing surgical levels. Limb salvage offers a functional advantage at proximal tumor locations.
Therapeutic study, Level III (retrospective, comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
尽管已经对下肢截肢和保肢术后的功能进行了比较，但尚无研究按手术水平评估个体功能变量。我们的目的是确定在四个水平（膝下、膝上、髋关节和骨盆）进行截肢或保肢时，长期心理和身体受限的风险是否与之相关。我们纳入了408例肉瘤患者，这些患者术后随访2年或更长时间，并完成了一份生活质量自我报告问卷。平均随访时间为8.91±5.15年（范围为2至27年）。对12个二分法的总体健康、心理和身体功能变量进行了相对风险分析。在膝下水平，两种手术的结果相似。在膝上水平，截肢与跛行风险增加（相对风险[RR]=1.6）、使用助行器（RR=2.1）、焦虑（RR=2.4）以及无法开车（RR=3）相关，而肌肉无力风险降低（RR=0.57）。在髋关节和骨盆水平，由于截肢病例数较少，对结果进行了描述性比较。在这些较高水平，截肢后受限情况更常见。膝下和膝上水平结果的差异支持了区分手术水平的重要性。在近端肿瘤部位，保肢具有功能优势。
治疗性研究，III级（回顾性比较研究）。有关证据水平的完整描述，请参阅《作者指南》。
