Department of Orthopaedics, Walter Reed National Military Medical Center, America Building (Bldg. 19), 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
J Bone Joint Surg Am. 2013 May 15;95(10):888-93. doi: 10.2106/JBJS.L.00423.
The prevalence of penetrating wartime trauma to the extremities has increased in recent military conflicts. Substantial controversy remains in the orthopaedic and prosthetic literature regarding which surgical technique should be performed to obtain the most functional transtibial amputation. We compared self-reported functional outcomes associated with two surgical techniques for transtibial amputation: bridge synostosis (modified Ertl) and non-bone-bridging (modified Burgess).
A review of the prospective military amputee database was performed to identify patients who had undergone transtibial amputation between June 2003 and December 2010 at three military institutions receiving the majority of casualties from the most recent military conflicts; two of those institutions, Walter Reed Army Medical Center and National Naval Medical Center, have since been consolidated. Short Form-36, Prosthesis Evaluation Questionnaire, and functional data questions were completed by twenty-seven modified Ertl and thirty-eight modified Burgess isolated transtibial amputees.
The average duration of follow-up after amputation (and standard deviation) was 32 ± 22.7 months, which was similar between groups. Residual limb length was significantly longer in the modified Ertl cohort by 2.5 cm (p < 0.005), and significantly more modified Ertl patients had delayed amputations (p < 0.005). There were no significant differences between groups with regard to any of the Short Form-36 domains or Prosthesis Evaluation Questionnaire subsections.
The modified Ertl and Burgess techniques offer similar functional outcomes in the young, active-duty military population managed with transtibial amputation.
近年来，四肢穿透性战时创伤的患病率在军事冲突中有所增加。在矫形和假肢文献中，对于哪种手术技术更适合获得最功能化的胫骨截肢仍存在很大争议。我们比较了两种胫骨截肢手术技术的术后功能恢复：桥接骨融合（改良 Ertl）和非骨桥接（改良 Burgess）。
对前瞻性军事截肢数据库进行了回顾，以确定 2003 年 6 月至 2010 年 12 月期间在三家接受最近军事冲突中大多数伤员的军事机构接受胫骨截肢的患者，其中两家机构，沃尔特·里德陆军医疗中心和国家海军医疗中心，此后已合并。27 名改良 Ertl 患者和 38 名改良 Burgess 孤立性胫骨截肢患者完成了简短形式 36 项、假肢评估问卷和功能数据问题。
截肢后（和标准差）的平均随访时间为 32 ± 22.7 个月，两组之间相似。改良 Ertl 组的残肢长度明显长 2.5 厘米（p < 0.005），且改良 Ertl 患者的延迟截肢明显更多（p < 0.005）。两组在简短形式 36 项的任何一个领域或假肢评估问卷的任何一个部分都没有显著差异。
改良 Ertl 和 Burgess 技术在接受胫骨截肢的年轻现役军人中提供相似的功能结果。
