Department of Clinical Sciences, Lund University, Sweden.
Am J Phys Med Rehabil. 2010 Apr;89(4):293-303. doi: 10.1097/PHM.0b013e3181cf1bee.
To study the outcomes of a new surgical and rehabilitation program for initial unilateral transtibial amputation in patients with peripheral vascular disease. The program consists of sagittal incision, rigid dressing, compression therapy using silicone liner, and direct manufacturing prosthetic technique.
A prospective cohort study with 1-yr follow-up.
Of the 217 consecutive patients with peripheral vascular disease who underwent transtibial amputation (mean age, 77 yrs; 51% diabetic; 116 could walk before amputation), 119 (55%) were fitted with a prosthesis at a median time of 41 (range, 12-147) days after amputation. Of the prosthetic recipients, 76 (64%) obtained good function with the prosthesis within 6 mos. Within 1 yr, reamputation was performed on 8.2%, and contralateral amputation was performed on 5.5%. The 90-day mortality was 24% (53 patients). The total 1-yr mortality was 40% (86 patients): 17% among patients who received a prosthesis and 67% among those who did not receive a prosthesis or had undergone reamputation.
Following this standardized surgical and rehabilitation program, prosthetic fitting was achieved in more than half of transtibial amputees, almost two-thirds of prosthetic recipients obtained good function, and the reamputation rate was low. Comparison with outcomes of alternative strategies is needed.
研究新的外科和康复方案在治疗周围血管疾病初次单侧胫骨截肢患者中的应用效果。该方案包括矢状切口、刚性包扎、使用硅酮衬里的压缩治疗以及直接制造假肢技术。
前瞻性队列研究，随访 1 年。
217 例连续的周围血管疾病胫骨截肢患者（平均年龄 77 岁；51%为糖尿病患者；116 例截肢前可行走）中，119 例（55%）在截肢后中位数 41 天（范围：12-147 天）内安装了假肢。在接受假肢的患者中，76 例（64%）在 6 个月内获得了良好的假肢功能。1 年内，8.2%的患者需要再次截肢，5.5%的患者对侧肢体截肢。90 天死亡率为 24%（53 例）。总 1 年死亡率为 40%（86 例）：接受假肢的患者为 17%，未接受假肢或再次截肢的患者为 67%。
遵循这种标准化的手术和康复方案，超过一半的胫骨截肢患者能够安装假肢，近三分之二的假肢接受者获得了良好的功能，且再次截肢率较低。需要与其他策略的结果进行比较。
