Choi I H, Kumar S J, Bowen J R
Alfred I. duPont Institute, Wilmington, Delaware 19899.
J Bone Joint Surg Am. 1990 Oct;72(9):1391-9.
Thirty-two patients who had ablation of the foot by the Syme or Boyd technique for partial or total absence of the fibula, with subsequent fitting of a prosthesis, were compared with eleven patients who had lengthening of the lower limb by the Wagner method, to assess the long-term results of each procedure. The final results were evaluated on the basis of pain, limp, limb-length discrepancy, level of physical activity, and satisfaction of the patient. Of the thirty-two patients who had an amputation, twenty-eight (88 per cent) had a satisfactory result, compared with only six (55 per cent) of the eleven patients who had limb-lengthening. The amount of inequality between the lower limbs was classified as follows: Group I--the foot of the shorter extremity was at the distal third of the contralateral, normal limb, and the percentage of shortening was 15 per cent or less; Group II--the foot of the shorter extremity was at the level of the middle third of the contralateral, normal limb, and the percentage of shortening was between 16 and 25 per cent; and Group III--the foot of the shorter extremity was at the level of the proximal third of the contralateral, normal limb, and the percentage of shortening was greater than 26 per cent. Lengthening was best suited for patients in Group I who had stable hips, knees, and ankles and a plantigrade foot. Patients in Groups II and III were best served by ablation of the foot and fitting of a prosthesis.
32例因腓骨部分或完全缺失而采用Syme或Boyd技术进行足部截肢并随后安装假肢的患者，与11例采用Wagner方法进行下肢延长的患者进行了比较，以评估每种手术的长期效果。根据疼痛、跛行、肢体长度差异、身体活动水平和患者满意度对最终结果进行评估。在32例接受截肢手术的患者中，28例（88%）取得了满意的结果，而在11例接受肢体延长手术的患者中，只有6例（55%）取得了满意的结果。下肢不等长的程度分类如下：第一组——较短肢体的足部位于对侧正常肢体的远端三分之一处，缩短百分比为15%或更低；第二组——较短肢体的足部位于对侧正常肢体的中间三分之一处，缩短百分比在16%至25%之间；第三组——较短肢体的足部位于对侧正常肢体的近端三分之一处，缩短百分比大于26%。延长手术最适合于髋关节、膝关节和踝关节稳定且足部为跖行足的第一组患者。第二组和第三组患者最好采用足部截肢并安装假肢的治疗方法。
