Juhnke D-L, Aschoff H-H
Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Martin-Luther-Krankenhaus, Caspar-Theyß-Str. 27-31, 14193, Berlin, Deutschland.
Orthopade. 2015 Jun;44(6):419-25. doi: 10.1007/s00132-015-3117-9.
Rehabilitation of patients having undergone limb amputation is difficult due to problems related to poor socket fit, which often deteriorates comfort, gait and the ability to take part in everyday life and work. The endo-exo prosthesis has been an alternative provision for people having undergone lower limb amputation for reasons other than diabetes or peripheral vascular disease for more than 10 years. The system consists of an intramedullar, osseointegrated and skin perforating prosthesis, which is implanted in the remaining bone and has an abutment to allow the attachment of the external prosthetic part including the knee joint in the case of a trans-femoral amputation. The idea originates in findings of modern tooth-implantology and involves a two-step operation. This study focuses on one centre's experience with the endo-exo prostheses in Lübeck, Germany, to describe and discuss the reliability of this alternative treatment method after lower limb amputation.
This article presents the results of lower limb amputees operated on in Lübeck, Germany between 1999-2013. It focuses on theoretical aspects of osseointegration and different clinically-based findings using the endo-exo technique over the last decade.
74 lower-limb amputees were treated with an endo-exo prosthesis until December 2013. There were only 4 verified intramedullar infections, yet there were many unplanned surgical revisions secondary to soft-tissue infections in the beginning. They were successfully encountered via clinically-based changes that were made concerning implant design, wound treatment and operative technique.
Since 1990 a few groups have developed an innovative method that provides an alternative to traditional socket-type prostheses. This involves a skeletally anchored device that is inserted into the remaining stump and provides osseointegration into the bone. The distal part of the implant protrudes transcutaneously and allows attachment to a prosthetic limb. This creates a hard point where the forces are transmitted through the skeleton with a more physiological pathway because the bone becomes the force carrier again, closer in biomechanics to an able-bodied person. With long-term numbers that show successful osseointegration for more than 10 years it is evident that obligate bacterial colonization does not necessarily lead to an intramedullar infection. Especially short stumps that are difficult to treat with a socket can be successfully fitted with an endo-exo prosthesis. Amputees who would otherwise be bound to a wheelchair due to their challenging situation should specifically be regarded as potential profiteers of this novel treatment option.
由于与接受腔适配性差相关的问题，肢体截肢患者的康复存在困难，这常常会降低舒适度、影响步态以及参与日常生活和工作的能力。内-外骨骼假肢作为糖尿病或外周血管疾病以外原因导致下肢截肢患者的一种替代选择，已应用超过10年。该系统由髓内、骨整合且穿透皮肤的假肢组成，植入剩余骨骼中，并带有一个基台，以便在股骨截肢时连接包括膝关节在内的外部假肢部件。这一理念源于现代牙种植学的研究成果，涉及两步手术。本研究聚焦于德国吕贝克一家中心使用内-外骨骼假肢的经验，以描述和讨论这种下肢截肢替代治疗方法的可靠性。
本文介绍了1999年至2013年在德国吕贝克接受手术的下肢截肢患者的结果。重点关注骨整合的理论方面以及过去十年使用内-外骨骼技术的不同临床研究结果。
截至2013年12月，74名下肢截肢患者接受了内-外骨骼假肢治疗。仅发生4例经证实的髓内感染，但一开始因软组织感染导致许多计划外的手术翻修。通过基于临床的植入物设计、伤口处理和手术技术的改变，成功解决了这些问题。
自1990年以来，一些团队开发了一种创新方法，为传统接受腔式假肢提供了替代方案。这涉及一种骨骼锚固装置，插入剩余残端并实现与骨骼的骨整合。植入物的远端经皮突出，以便连接假肢肢体。这创造了一个硬点，力通过骨骼以更符合生理的途径传递，因为骨骼再次成为力的载体，在生物力学上更接近健全人。长期数据显示骨整合成功超过10年，显然专性细菌定植不一定会导致髓内感染。特别是那些使用接受腔难以治疗的短残端，使用内-外骨骼假肢能够成功适配。因自身情况具有挑战性而原本只能依赖轮椅的截肢患者，应被视为这种新治疗选择的潜在受益者。
