Winburn G B, Wood M C, Hawkins M L, Wynn J J, Nesbit R R, Wray C H, Sutton J T
Department of Surgery, Medical College of Georgia, Augusta 30912-4000.
Am J Surg. 1991 Dec;162(6):647-50; discussion 650-1. doi: 10.1016/0002-9610(91)90128-z.
Cryoamputation or physiologic amputation has been used at our institution for more than 30 years. From 1971 through 1989, 891 major lower extremity amputations were performed in 750 patients. With the use of dry ice or mechanical refrigeration, 320 (36%) physiologic amputations were performed in 292 patients. After physiologic amputation, the initially elevated white blood cell count and temperature decreased. Complications of physiologic amputation were unusual; 3% of patients developed minor freezing above the tourniquet, which did not alter the amputation level, while 1% had purulence at the level of surgical amputation that required delayed stump closure. The overall operative mortality rate in patients who underwent physiologic amputation was 11%, which was equivalent to the rate in patients undergoing primary amputation. Revision was required in 9% of amputations after preliminary physiologic amputation compared with 17% of primary amputations. Physiologic amputation is a simple technique, controls local infection, avoids emergency surgery, and allows for medical stabilization prior to surgery. Amputation revision after physiologic amputation is required less often than after primary amputation, while the mortality rate is comparable to that of patients undergoing primary amputation.
在我们机构，冷冻截肢术或生理性截肢术已应用超过30年。从1971年到1989年，750例患者接受了891次下肢大截肢手术。使用干冰或机械制冷，292例患者进行了320次（36%）生理性截肢。生理性截肢术后，最初升高的白细胞计数和体温下降。生理性截肢的并发症并不常见；3%的患者在止血带上方出现轻微冻伤，但未改变截肢平面，而1%的患者在手术截肢平面出现化脓，需要延迟残端闭合。接受生理性截肢的患者总体手术死亡率为11%，与接受一期截肢的患者死亡率相当。初步生理性截肢术后9%的截肢需要翻修，而一期截肢术后这一比例为17%。生理性截肢是一种简单的技术，可控制局部感染，避免急诊手术，并允许在手术前进行医学稳定处理。生理性截肢术后截肢翻修的需求比一期截肢后少，而死亡率与接受一期截肢的患者相当。
