Fondazione Santa Lucia IRCCS, Rome, Italy.
Eur J Phys Rehabil Med. 2012 Dec;48(4):613-23. Epub 2012 May 28.
The factors that determine successful rehabilitation after lower limb amputation have been widely investigated in the literature, but little attention has been paid to the type of prosthesis and clinical state of the residual limb, particularly the presence of open ulcers.
The aim of this study was to investigate the effects of a vacuum-assisted socket system (VASS) in a sample of trans-tibial amputees with wounds or ulcers on the stump and to evaluate prosthesis use as a primary outcome. Secondary outcome measures were mobility with the prosthesis, pain associated with prosthesis use, and wound/ulcer healing.
Randomized controlled study.
Inpatient.
Twenty dysvascular transtibial amputees suffering from ulcers due to prosthesis use or delayed wound healing post-amputation were enrolled.
Participants were separated into two groups: the experimental group was trained to use a VASS prosthesis in the presence of open ulcers/wounds on the stump; and the control group was trained to use a standard suction socket system prosthesis following ulcers/wounds healing.
At the end of the 12-week rehabilitation program, all VASS users were able to walk independently with their prosthesis as reflected by a median Locomotor Capability Index (LCI) value of 42, whereas only five participants in the control group were able to walk independently with a median LCI value of 21. At the two-month follow-up, the participants used their VASS prostheses for 62 hours a week (median; range: 0-91), which was significantly longer than the control group using the standard prosthesis for 5 hours per week (range: 0-56, p=0.003). At the six-month follow-up, the difference between VASS-users (80, range: 0-112 hours a weeks) and control-users (59, range: 0-91) was no longer significant (p=0.191). Despite more intense use of the prosthesis, pain and wound healing did not significantly differ between the two groups.
These results showed that the VASS prosthesis allowed early fitting with prompt ambulation recovery without inhibiting wound healing or increasing pain.
下肢截肢后成功康复的因素在文献中已被广泛研究，但很少关注假肢的类型和残肢的临床状况，特别是开放性溃疡的存在。
本研究旨在调查真空辅助套系统（VASS）在患有残端伤口或溃疡的胫骨截肢患者中的应用效果，并将义肢使用作为主要结果进行评估。次要结果测量指标包括使用义肢的移动能力、与义肢使用相关的疼痛以及伤口/溃疡的愈合情况。
随机对照研究。
住院。
20 名患有因使用义肢或截肢后伤口愈合延迟而导致溃疡的血管性胫骨截肢患者。
将参与者分为两组：实验组在残端有开放性溃疡/伤口的情况下接受 VASS 义肢训练；对照组在溃疡/伤口愈合后接受标准吸力套系统义肢训练。
在 12 周的康复计划结束时，所有 VASS 用户都能够独立使用义肢行走，反映在中位数的移动能力指数（LCI）值为 42，而对照组只有 5 名参与者能够独立使用义肢，中位数 LCI 值为 21。在两个月的随访中，参与者每周使用 VASS 义肢 62 小时（中位数；范围：0-91），明显长于对照组每周使用标准义肢 5 小时（范围：0-56，p=0.003）。在六个月的随访中，VASS 用户（每周 80 小时，范围：0-112 小时）和对照组用户（每周 59 小时，范围：0-91 小时）之间的差异不再显著（p=0.191）。尽管义肢使用更频繁，但两组之间的疼痛和伤口愈合情况没有显著差异。
这些结果表明，VASS 义肢允许早期适配，迅速恢复行走能力，而不会抑制伤口愈合或增加疼痛。
