Helgeson Melvin D, Potter Benjamin K, Burns Travis C, Hayda Roman A, Gajewski Donald A
Department of Orthopedics and Rehabilitation, Walter Reed Army Medical Center, Washington, District of Columbia, USA.
Orthopedics. 2010 Sep 7;33(9):669. doi: 10.3928/01477447-20100722-02.
We studied patients with combat-related injuries that required delayed amputation at least 4 months after the initial injury due to dysfunction, persistent pain, and patient desires. Late amputations were performed 22 times in 22 patients (21 men, 1 woman) since 2003. Fourteen patients underwent transtibial amputation, 5 transfemoral amputations, 1 knee disarticulation, and 2 transradial amputations. The primary indications for late amputation were neurologic dysfunction in 6 patients, persistent or recurrent infection in 6, neurogenic pain in 3, non-neurogenic pain in 5, and a globally poor functional result in 2. Sixteen of 22 patients reported multiple indications for electing to undergo amputation, with an average of 2.1 specific indications per patient. At final clinical follow-up an average of 13 months after amputation, all patients reported subjectively improved function and reported that they would undergo amputation again under similar circumstances. When medically and functionally practicable, every effort is given to limb salvage following severe combat-related extremity injuries. There is no single risk factor that increases the likelihood of delayed amputation, but the combination of complex pain symptoms with neurologic dysfunction appears to increase the risk, particularly if the initial insult is a severe hindfoot injury or distal tibia fracture. With appropriately selected and counseled patients, elective late amputation results in a high degree of patient satisfaction and subjectively improved function.
我们研究了因功能障碍、持续性疼痛和患者意愿等因素，在初次受伤至少4个月后需要延迟截肢的与战斗相关损伤患者。自2003年以来，对22例患者（21名男性，1名女性）进行了22次晚期截肢手术。14例患者接受了经胫骨截肢术，5例接受了经股骨截肢术，1例接受了膝关节离断术，2例接受了经桡骨截肢术。晚期截肢的主要指征为：6例存在神经功能障碍，6例存在持续性或复发性感染，3例存在神经源性疼痛，5例存在非神经源性疼痛，2例整体功能结果较差。22例患者中有16例报告了选择接受截肢的多种指征，每位患者平均有2.1种具体指征。在截肢后平均13个月的最终临床随访中，所有患者主观上均报告功能有所改善，并表示在类似情况下会再次接受截肢手术。在医学和功能可行的情况下，对于严重的与战斗相关的肢体损伤，会尽一切努力保肢。没有单一的危险因素会增加延迟截肢的可能性，但复杂的疼痛症状与神经功能障碍相结合似乎会增加风险，特别是如果初始损伤是严重的后足损伤或胫骨远端骨折。对于经过适当选择和咨询的患者，选择性晚期截肢会带来高度的患者满意度和主观上改善的功能。
