Orthopaedic Surgery Service, Integrated Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, 6900 Georgia Avenue N.W., Building 2, Clinic 5A, Washington, DC 20307, USA.
J Bone Joint Surg Am. 2010 Dec 15;92(18):2934-45. doi: 10.2106/JBJS.J.00258.
Trauma is the most common reason for amputation of the upper extremity. The morphologic and functional distinctions between the upper and lower extremities render the surgical techniques and decision-making different in many key respects. Acceptance of the prosthesis and the outcomes are improved by performing a transradial rather than a more proximal amputation. Substantial efforts, including free tissue transfers when necessary, should be made to salvage the elbow. Careful management of the peripheral nerves is critical to minimize painful neuroma formation while preserving options for possible future utilization in targeted muscle reinnervation and use of a myoelectric prosthesis. Rapid developments with targeted muscle reinnervation, myoelectric prostheses, and composite tissue allotransplantation may dramatically alter surgical treatment algorithms in the near future for patients with severe upper-extremity trauma.
创伤是上肢截肢的最常见原因。上肢和下肢在形态和功能上的区别使得手术技术和决策在许多关键方面有所不同。通过桡骨而非更靠近近端的截肢，可以提高对假肢的接受程度和手术结果。应做出巨大努力，包括必要时进行游离组织转移，以挽救肘部。仔细管理周围神经对于最小化疼痛性神经瘤的形成至关重要，同时保留未来在靶向肌肉再支配和使用肌电假体方面的可能性。靶向肌肉再支配、肌电假体和复合组织同种异体移植的快速发展可能会在不久的将来极大地改变严重上肢创伤患者的手术治疗方案。
