Cumming Jane, Barr Steve, Howe Tracey E
Teesside Centre for Rehabilitation Sciences, University of Teesside,Middlesbrough, UK.
Cochrane Database Syst Rev. 2015 Jan 25;1:CD005260. doi: 10.1002/14651858.CD005260.pub3.
Dysvascularity accounts for 75% of all lower limb amputations in the UK. Around 37% of these are at transfemoral level (mid-thigh), with the majority of people being over the age of 60 and having existing co-morbidities. A significant number of these amputees will be prescribed a lower limb prosthesis for walking. However, many amputees do not achieve a high level of function following prosthetic rehabilitation. This is the second update of the review first published in 2005.
We aimed to identify and summarise the evidence from randomised controlled trials evaluating rehabilitation interventions for prosthetic ambulation following unilateral transfemoral amputation in older dysvascular people, whether community dwelling or institutionalised.
For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched July 2014) and Cochrane Register of Studies (CRS) (last searched 2014 Issue 6). No language restrictions were applied.
Randomised and quasi-randomised controlled trials testing prosthetic rehabilitation interventions following a unilateral transfemoral or transgenicular amputation in older (aged 60 years or above) dysvascular people.
Two authors independently scanned the search results for potentially eligible studies and on obtaining full reports of these, selected studies for inclusion and exclusion. Two authors independently assessed methodological quality and extracted data. No data pooling was possible.
No new studies were identified for inclusion in this update. Of the full reports obtained for consideration, one trial was included and four excluded. The included trial was a short-term crossover randomised trial which tested the effects of adding three seemingly identical prosthetic weights (150 g versus 770 g versus 1625 g) to the prostheses of 10 participants with unilateral dysvascular transfemoral amputation. Eight participants were over 60 years of age. The trial found that four participants preferred the lightest weight (150 g), five preferred the middle weight (770 g) and one preferred the addition of the heaviest weight (1625 g).
AUTHORS' CONCLUSIONS: There is a lack of evidence from randomised controlled trials to inform the choice of prosthetic rehabilitation, including the optimum weight of prosthesis, after unilateral transfemoral amputation in older dysvascular people. A programme of research, including randomised controlled trials to examine key interventions, is urgently required in this area.
在英国，血管性疾病导致的截肢占所有下肢截肢病例的75%。其中约37%为经股截肢（大腿中部），大多数患者年龄在60岁以上且伴有其他疾病。这些截肢患者中有相当一部分会被配备下肢假肢用于行走。然而，许多截肢患者在假肢康复后并未达到较高的功能水平。这是该综述的第二次更新，首次发表于2005年。
我们旨在识别和总结随机对照试验的证据，以评估针对老年血管性疾病患者单侧经股截肢后假肢行走康复干预措施，无论患者是居住在社区还是机构中。
本次更新中，Cochrane外周血管疾病组试验检索协调员（TSC）检索了专业注册库（最后检索时间为2014年7月）和Cochrane研究注册库（CRS）（最后检索时间为2014年第6期）。未设语言限制。
针对老年（60岁及以上）血管性疾病患者单侧经股或经膝截肢后进行假肢康复干预的随机和半随机对照试验。
两位作者独立浏览检索结果，查找可能符合条件的研究，并在获取这些研究的完整报告后，选择纳入和排除的研究。两位作者独立评估方法学质量并提取数据。无法进行数据合并。
本次更新未发现新的纳入研究。在获取的供考虑的完整报告中，纳入了1项试验，排除了4项。纳入的试验是一项短期交叉随机试验，该试验测试了给10名单侧血管性经股截肢患者的假肢增加三种看似相同的假肢重量（150克、770克和1625克）的效果。8名参与者年龄超过60岁。试验发现，4名参与者更喜欢最轻的重量（150克），5名更喜欢中等重量（770克），1名更喜欢增加最重的重量（1625克）。
缺乏随机对照试验的证据来指导老年血管性疾病患者单侧经股截肢后假肢康复的选择，包括假肢的最佳重量。该领域迫切需要开展一系列研究，包括随机对照试验以检验关键干预措施。
