Mongon Mauricio Leal, Piva Felipe Alberto, Mistro Neto Sylvio, Carvalho Jose Andre, Belangero William Dias, Livani Bruno
Orthopedics and Traumatology Department, Hospital Estadual de Sumaré, UNICAMP, Rua Jose Augusto Silva 761 apto 31B, Campinas, Sao Paulo, zip 13087-570, Brazil,
Strategies Trauma Limb Reconstr. 2013 Apr;8(1):37-42. doi: 10.1007/s11751-013-0152-0. Epub 2013 Jan 31.
Amputation, especially of the lower limbs, is a surgical procedure that gives excellent results when conducted under the appropriate conditions. In 1949 Ertl developed a technique for transtibial osteomyoplastic amputation which restored the intraosseous pressure through canal obliteration and expanded the area of terminal support through a bony bridge between the fibula and distal tibia. The aim of this study was to investigate the effectiveness of a modification of the original Ertl's technique in which a cortical osteoperiosteal flap created from the tibia is used to form a bony bridge during transtibial amputation in adults. Nine patients underwent leg amputations with the cortical tibial osteoperiosteal flap technique for reconstruction of the stump. The average duration of follow-up was 30.8 (range, 18-41) months. The post-surgery examination included a clinical examination and radiography. A 6-min walk test (Enright in Respir Care 48(8):783-785, 2003) was performed in the 32nd week after amputation. At 24th week post-surgery, all patients had stumps that were painless and able to bear full weight through the end. The creation of a cortical osteoperiosteal flap from the tibia to the fibula during transtibial amputation is a safe and effective technique that provides a strong and painless terminal weight-bearing stump. This constitutes a useful option for young patients, athletes, and patients with high physical demands.
截肢手术，尤其是下肢截肢，在适当条件下进行时是一种能取得极佳效果的外科手术。1949年，厄特尔开发了一种经胫骨骨成形性截肢技术，该技术通过封闭髓腔恢复骨内压，并通过腓骨与胫骨远端之间的骨桥扩大末端支撑面积。本研究的目的是探讨对原始厄特尔技术进行改良的有效性，即在成人经胫骨截肢术中，利用从胫骨创建的皮质骨膜瓣形成骨桥。9例患者接受了采用胫骨皮质骨膜瓣技术进行的腿部截肢手术以重建残端。平均随访时间为30.8（范围18 - 41）个月。术后检查包括临床检查和影像学检查。截肢后第32周进行了6分钟步行试验（恩赖特，《呼吸护理》48(8):783 - 785，2003年）。术后第24周时，所有患者的残端均无痛，且能够完全负重。在经胫骨截肢术中从胫骨到腓骨创建皮质骨膜瓣是一种安全有效的技术，可提供一个坚固且无痛的末端负重残端。这对于年轻患者、运动员以及对身体要求较高的患者而言是一个有用的选择。
