Duwayri Yazan, Vallabhaneni Raghuveer, Kirby John P, Mueller Michael J, Volshteyn Oksana, Geraghty Patrick J, Sicard Gregorio A, Curci John A
Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Ann Vasc Surg. 2012 Feb;26(2):242-9. doi: 10.1016/j.avsg.2011.08.001. Epub 2011 Nov 1.
The goal of rehabilitation following lower extremity amputation is to restore the highest level of independent function. As much as possible, this includes the functional use of a prosthetic device fitted to the residual limb. Early prosthetic fit depends, in turn, on rapid healing of the amputation site.
We hypothesized that compliance with a novel custom-designed amputation protection and compression system (CAPCS) to the residual limb can accelerate and improve the likelihood of successful prosthesis use. We conducted a retrospective study of all patients who were offered CAPCS by certified prosthetists (Hanger Prosthetics and Orthotics, Bethesda, MD) during the period between April 2004 and November 2009. Variables included age, sex, indication for amputation, and compliance with CAPCS. Compliance was defined as consistent observed wearing of the CAPCS as directed. The primary end point was the fitting of a prosthetic device to the amputated limb, with time to prosthetic fit being the secondary outcome.
Out of 100 patients who were offered CAPCS (n = 100) during the study period, 76% were considered compliant (n = 76). Sixty five patients (65%) were ultimately fitted with prosthetic limbs. In multivariate analysis, we found that patients who had compliant use of CAPCS were significantly more likely to be successfully fit with prosthesis (72 vs. 42%, p = 0.005). At 100 days post amputation, the cumulative incidence of prosthesis fitting was significantly higher in CAPCS compliant patients (69.7 vs. 22.2%, p = 0.012).
Compliant use of a CAPCS following amputation is associated with earlier and more frequent use of a prosthetic. Based on this limited data set, a conclusion can be drawn that the potential exists to significantly improve functional outcomes after amputation, but well-designed prospective studies are needed to confirm this association.
下肢截肢后的康复目标是恢复最高水平的独立功能。这尽可能包括对安装在残肢上的假肢进行功能性使用。而早期安装假肢又反过来取决于截肢部位的快速愈合。
我们推测，对残肢使用一种新型定制的截肢保护与加压系统（CAPCS）能够加速并提高成功使用假肢的可能性。我们对2004年4月至2009年11月期间由认证假肢师（马里兰州贝塞斯达的汉格假肢与矫形器公司）提供CAPCS的所有患者进行了一项回顾性研究。变量包括年龄、性别、截肢指征以及对CAPCS的依从性。依从性定义为按照指示持续观察到佩戴CAPCS。主要终点是为截肢肢体安装假肢，安装假肢的时间为次要结果。
在研究期间提供了CAPCS的100名患者（n = 100）中，76%被认为依从（n = 76）。65名患者（65%）最终安装了假肢。在多变量分析中，我们发现依从使用CAPCS的患者成功安装假肢的可能性显著更高（72%对42%，p = 0.005）。截肢后100天时，CAPCS依从患者安装假肢的累积发生率显著更高（69.7%对22.2%，p = 0.012）。
截肢后依从使用CAPCS与更早且更频繁地使用假肢相关。基于这个有限的数据集，可以得出结论，截肢后存在显著改善功能结果的潜力，但需要精心设计的前瞻性研究来证实这种关联。
