Moran B J, Buttenshaw P, Mulcahy M, Robinson K P
Limb Surgery Unit, Queen Mary's University Hospital, London, UK.
Br J Surg. 1990 Oct;77(10):1118-20. doi: 10.1002/bjs.1800771014.
During a 10-year period 104 patients (mean age 72 years) had 106 through-knee amputations. Indications for surgery were: limb gangrene, 67 (64 per cent); ischaemic ulceration, 22 (21 per cent); rest pain, 9; knee contractures, 6. Thirty patients had had previous unsuccessful vascular reconstructive surgery and five had had a failed femoral embolectomy. The through-knee disarticulation used lateral skin flaps. The mortality was 21 (20 per cent). Of the 83 survivors, 59 (71 per cent) underwent uncomplicated primary wound healing; 36 (43 per cent) of the survivors were unsuitable for rehabilitation on a prosthesis. The remaining 47 (57 per cent) were walking before discharge 30-130 days (mean 68 days) after amputation. Through-knee amputation is a rapid, relatively bloodless, amputation and is a useful debridement procedure. The many surgical and functional advantages, in conjunction with the recent reports of better rehabilitation compared with the above-knee or Gritti-Stokes amputation, suggests that the through-knee amputation deserves greater consideration.
在10年期间，104例患者（平均年龄72岁）接受了106次经膝关节截肢手术。手术指征为：肢体坏疽67例（64%）；缺血性溃疡22例（21%）；静息痛9例；膝关节挛缩6例。30例患者曾接受过血管重建手术但未成功，5例患者股动脉取栓术失败。经膝关节离断术采用外侧皮瓣。死亡率为21例（20%）。在83名幸存者中，59例（71%）伤口一期愈合顺利；36例（43%）幸存者不适合安装假肢进行康复。其余47例（57%）在截肢后30 - 130天（平均68天）出院前能够行走。经膝关节截肢是一种快速、相对不出血的截肢手术，也是一种有效的清创方法。与大腿截肢或格里蒂 - 斯托克斯截肢相比，经膝关节截肢具有诸多手术和功能优势，且近期有关于其康复效果更好的报道，这表明经膝关节截肢值得更多考虑。
