Krueger Chad A, Wenke Joseph C, Cho Mickey S, Hsu Joseph R
*Department of Orthopaedic Surgery, San Antonio Military Medical Center, Ft Sam Houston, TX; †United States Army Institute of Surgical Research, Department of Extremity Trauma and Regenerative Medicine, Ft Sam Houston, TX; and ‡Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC.
J Orthop Trauma. 2014 Apr;28(4):227-31. doi: 10.1097/BOT.0b013e3182a665f5.
Much attention has been given to lower extremity amputations that occur more than 90 days after injury, but little focus has been given to analogous upper extremity amputations. The purpose of this study was to determine the reason(s) for desired amputation and the common complications after amputation for those combat-wounded service members who underwent late upper extremity amputation.
Retrospective case series.
Tertiary trauma center.
PATIENTS/PARTICIPANTS: All US service members who sustained major extremity amputations from September 2001 to July 2011 were analyzed.
Late (>90 days after injury) upper extremity amputations.
Amputation level(s), time to amputation, age, number of operations, pre/postoperative complications, reason(s) for desiring amputation, and disability outcomes were analyzed.
Seven of 218 (3.2%) upper extremity amputees had a late upper extremity amputation (>90 days from injury to amputation). The mean and median number of days from injury to amputation was 689 and 678, respectively. The most common preamputation complications were loss of wrist or finger motion (7, 100%), neurogenic pain (4, 57%), and heterotopic ossification (4, 57%). Three (43%) patients (2 persistent and 1 new onset) had neurogenic pain and 2 (29%) had heterotopic ossification after amputation. Only 57% (4 of 7) of amputees used their prostheses regularly.
Service members undergoing late upper extremity amputation seem to have different pre- and postoperative complications than those patients undergoing late lower extremity amputations. It was common for the amputee to not wear their prostheses and to experience similar complications after amputation, albeit in a less severe form.
下肢截肢发生在受伤90天之后的情况已受到广泛关注，但类似的上肢截肢却很少受到关注。本研究的目的是确定那些接受晚期上肢截肢的受伤军人进行截肢的原因以及截肢后的常见并发症。
回顾性病例系列研究。
三级创伤中心。
患者/参与者：分析了2001年9月至2011年7月期间所有遭受严重肢体截肢的美国军人。
晚期（受伤90天之后）上肢截肢。
分析截肢水平、截肢时间、年龄、手术次数、术前/术后并发症、截肢原因以及残疾结果。
218例上肢截肢患者中有7例（3.2%）进行了晚期上肢截肢（从受伤到截肢超过90天）。从受伤到截肢的平均天数和中位数分别为689天和678天。截肢前最常见的并发症是手腕或手指活动丧失（7例，100%）、神经源性疼痛（4例，57%）和异位骨化（4例，57%）。3例（43%）患者（2例持续性和1例新发）截肢后出现神经源性疼痛，2例（29%）出现异位骨化。只有57%（7例中的4例）的截肢者经常使用假肢。
接受晚期上肢截肢的军人似乎与接受晚期下肢截肢的患者有不同的术前和术后并发症。截肢者不佩戴假肢且截肢后出现类似并发症的情况很常见，尽管程度较轻。
