Bernstein Robert M, Watts Hugh G, Setoguchi Yoshio
Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
J Pediatr Orthop. 2008 Jan-Feb;28(1):86-90. doi: 10.1097/bpo.0b013e31815b4da8.
Short upper extremity amputation stumps are difficult to fit with an appropriate-level prosthesis. Fitting at a more proximal level generally results in decreased function. Options in the past have included stump and prosthetic modification, both of which provide limited improvement in function. Anecdotal reports of lengthening short amputation stumps have been published. This article reviews our experience with lengthening short upper extremity amputation stumps in children.
All patients who underwent an upper extremity stump lengthening at Shriners Hospital Los Angeles with at least 1-year follow-up were included. Charts and radiographs were retrospectively reviewed and prosthetic use preoperatively and postoperatively, complications, and additional procedures were documented. Stump length was measured on radiographs as the length between the proximal flexion crease and the tip of the bone.
Eleven patients with 14 amputation stumps underwent lengthening. Mean stump length increase was 264% (4 cm). Nine patients desired prosthetic fitting; all except 1 were able to be fit with an appropriate-level prosthesis. Two of the 9 patients reported only using the prosthesis on rare occasions. The 2 remaining patients underwent lengthening to improve function but did not desire a prosthesis preoperatively.
Lengthening is a viable but controversial option for very short upper extremity amputation stumps and may result in better function and/or more appropriate prosthetic fitting. Complications and additional procedures are common. Soft tissue coverage seems to be the main limiting factor to lengthening.
上肢短残肢难以适配合适水平的假肢。在更近端的水平进行适配通常会导致功能下降。过去的选择包括残肢和假肢的改良，但两者在功能改善方面都有限。已有关于延长短截肢残肢的轶事报道。本文回顾了我们在儿童上肢短截肢残肢延长方面的经验。
纳入所有在洛杉矶施莱宁儿童医院接受上肢残肢延长且随访至少1年的患者。对病历和X线片进行回顾性分析，并记录术前和术后的假肢使用情况、并发症及其他手术操作。在X线片上测量残肢长度，即近端屈曲皱襞与骨端之间的长度。
11例患者的14个截肢残肢接受了延长。残肢平均长度增加了264%（4厘米）。9例患者希望安装假肢；除1例患者外，其他患者均能适配合适水平的假肢。9例患者中有2例仅在极少数情况下使用假肢。其余2例患者接受延长是为了改善功能，但术前不希望安装假肢。
对于非常短的上肢截肢残肢，延长是一种可行但存在争议的选择，可能会带来更好的功能和/或更合适的假肢适配。并发症和其他手术操作很常见。软组织覆盖似乎是延长的主要限制因素。
