Duerksen F, Rogalsky R J, Cochrane I W
University of Manitoba, Winnipeg, Canada.
Clin Orthop Relat Res. 1990 Jul(256):50-7.
As compared to an above-knee amputation, the knee disarticulation has several marked advantages that are well known and accepted by most surgeons. However, it has not gained popularity because it leaves a double condylar, bulbous, uneven stump, which is difficult to fit into the base of the socket. In ten patients, a modified surgical technique included moderate trimming of the femoral condylar prominences and patellofemoral arthrodesis in the intercondylar notch. This produces a conical stump with a large area for end bearing, and at the same time allows the standard suction-socket fitting without ischial weight bearing. The average age was 33.1 years (range, ten to 75 years). The indication for amputation was trauma in four cases, tumor in three cases, chronic osteomyelitis in one, ischemia of the leg in one, and congenital malformation in one. Average length of follow-up study was four years (range, one to 9.8 years). Complications were stump ulceration in one case and fistula formation in two cases. Nine patients achieved full weight-bearing ambulation with an end-bearing type of prosthesis. The remaining patient was not fitted with a prosthesis prior to his death from a systemic medical illness. Union of the patellofemoral arthrodesis was achieved in all ten cases. This procedure is recommended whenever knee disarticulation is indicated and ambulation expected. Significant improvement over standard knee disarticulation or distal above-knee amputation can be achieved.
与膝上截肢相比，膝关节离断术有几个显著优点，这是大多数外科医生所熟知并认可的。然而，它并未得到广泛应用，因为它会留下一个双髁、球根状、不平整的残端，很难适配到接受腔底部。在10例患者中，一种改良手术技术包括适度修整股骨髁突出部，并在髁间切迹进行髌股关节固定术。这会产生一个用于末端负重的大面积圆锥形残端，同时允许使用标准的吸着式接受腔，无需坐骨负重。平均年龄为33.1岁（范围为10至75岁）。截肢指征为创伤4例、肿瘤3例、慢性骨髓炎1例、腿部缺血1例、先天性畸形1例。平均随访时间为4年（范围为1至9.8年）。并发症包括1例残端溃疡和2例瘘管形成。9例患者使用末端负重型假体实现了完全负重行走。其余1例患者在因全身性疾病死亡前未安装假体。所有10例患者的髌股关节固定术均获愈合。只要有膝关节离断术指征且预期能行走，就建议采用该手术方法。与标准膝关节离断术或膝上远端截肢相比，可取得显著改善。
