Churilov Irina, Churilov Leonid, Murphy David
St Vincent's Health, Department of Rehabilitation - Melbourne, Fitzroy, Australia.
The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.
Ann Vasc Surg. 2014 Oct;28(7):1801-8. doi: 10.1016/j.avsg.2014.05.002. Epub 2014 Jun 6.
To investigate whether application of a rigid dressing (RD) to the residual limb soon after transtibial amputation reduces the time from amputation to the first prosthetic casting/fitting compared with the residual limb managed with a soft dressing (SD).
Studies in humans were identified by a systematic search of MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials to December 2013. Search terms were based on appropriate medical subject headings and other free-text headings combining the following key words: "amputation," "amputation stumps," "transtibial," "lower limb," "post operative dressing," "removable rigid dressing," "rigid dressing," "wound healing," "rehabilitation," and "prosthetic." Reference lists of the relevant retrieved studies were checked for further studies. Papers could be published in English or other languages.
Randomized controlled trials (RCT) and cross-sectional studies that included adults who had an amputation of the lower limb were included. Initial literature search identified 356 potentially relevant articles. Review of abstracts and subsequently full text identified 6 studies included in the meta-analysis. Of these studies, 2 were RCT and 4 were retrospective cross-sectional studies.
Data were extracted by one reviewer and then checked by another reviewer.
The use of RD resulted in significantly shorter time from amputation to casting or fitting of the prosthesis. Pooled standardized mean difference (SMD) from meta-analysis using DerSimonian and Laird random effect model was 0.46 (95% confidence interval: 0.19-0.73; P = 0.001), with 54% variation in SMD attributable to heterogeneity (I(2) = 0.539, P = 0.06). No evidence of small study effect has been found. The quality of reporting of the results varied, with some important elements omitted in the publications.
Patients who are fitted with RD post transtibial amputation commence prosthetic management sooner than those managed with SD.
探讨与采用软敷料（SD）处理残肢相比，经胫截肢术后立即对残肢应用硬敷料（RD）是否能缩短从截肢到首次进行假肢石膏固定/装配的时间。
通过系统检索MEDLINE、EMBASE、CINAHL和Cochrane对照试验中心注册库，查找截至2013年12月的人体研究。检索词基于适当的医学主题词和其他自由文本词，组合了以下关键词：“截肢”、“截肢残端”、“经胫”、“下肢”、“术后敷料”、“可移除硬敷料”、“硬敷料”、“伤口愈合”、“康复”和“假肢”。检查检索到的相关研究的参考文献列表以查找更多研究。论文可以用英文或其他语言发表。
纳入包括下肢截肢成人的随机对照试验（RCT）和横断面研究。初步文献检索确定了356篇可能相关的文章。对摘要及随后的全文进行审查后，确定了6项纳入荟萃分析的研究。其中，2项为RCT，4项为回顾性横断面研究。
由一名审阅者提取数据，然后由另一名审阅者进行核对。
使用RD可显著缩短从截肢到假肢石膏固定或装配的时间。采用DerSimonian和Laird随机效应模型进行荟萃分析得出的合并标准化均数差（SMD）为0.46（95%置信区间：0.19 - 0.73；P = 0.001），SMD的54%变异归因于异质性（I² = 0.539，P = 0.06）。未发现小研究效应的证据。结果报告的质量各不相同，出版物中遗漏了一些重要内容。
经胫截肢后使用RD的患者比使用SD的患者更早开始假肢处理。
