Desteli E E, İmren Y, Erdoğan M, Sarısoy G, Coşgun S
Üsküdar State Hospital, Istanbul, Turkey.
Ondokuzmayis University Hospital, Samsun, Turkey.
Eur J Trauma Emerg Surg. 2014 Dec;40(6):735-9. doi: 10.1007/s00068-014-0418-3. Epub 2014 Jun 21.
Amputation of limb is essential in certain conditions; however, it may have significant impact on the patient's psychological condition. The present study investigates psychological responses of upper limb (UL) amputees versus lower limb (LL) amputees regarding prosthetic adjustment, social discomfort, depression, and body image anxiety.
Traumatic major amputations of 20 upper and 38 lower extremities of 58 patients who were currently using prosthesis were included. 12 of UL amputations were of dominantly used limb. Seven of the UL amputations, and nine of the LL amputations were female. The Trinity Amputation and Prosthesis Experience Scales was used for adjustment, restriction, and satisfaction. Anxiety and depression levels were assessed using Hospital Anxiety and Depression Scale (HADS). Body image disturbance and social discomfort were assessed with Amputation Body Image Scale-Revised (ABIS-R) and Social Discomfort Score, respectively.
58 individuals with 20 UL and 38 LL amputations were included. Mean age of UL amputees was 44.76 ± 12.26 and 49.1 ± 14.3 years for LL amputees. Mean time of daily prosthesis use was 11.35 ± 4.8 and 11.52 ± 4.7 h, respectively. Mean time since amputation was 35.4 ± 14.3 and 36.05 ± 13.6 months; length of prosthesis use time was 24.8 ± 13.4 and 23.9 ± 15.12 months, respectively. Social adjustment and adjustment to limitation subscales had significantly higher scores in LL amputees (p < 0.001). There was statistically significant difference between mean HADS depression and anxiety scores (p < 0.001). Mean total ABIS-R score indicated significantly greater body image disturbance for UL amputees (p < 0.001).
Well-adjusted LL prosthesis probably has better cosmetic appearance compared to that of UL prosthesis and perception of cosmetic appearance may be the key factor that leads to increased levels of body image anxiety and social discomfort.
Epidemiologic and prognostic study, level III.
在某些情况下，肢体截肢是必要的；然而，这可能会对患者的心理状况产生重大影响。本研究调查了上肢截肢者与下肢截肢者在假肢适应、社交不适、抑郁和身体形象焦虑方面的心理反应。
纳入了58例目前正在使用假肢的患者，其中20例上肢和38例下肢进行了创伤性大截肢。12例上肢截肢是优势肢体。上肢截肢者中有7例女性，下肢截肢者中有9例女性。使用三位一体截肢与假肢体验量表评估适应、限制和满意度。使用医院焦虑与抑郁量表（HADS）评估焦虑和抑郁水平。分别使用截肢身体形象量表修订版（ABIS-R）和社交不适评分评估身体形象障碍和社交不适。
纳入了58例截肢患者，其中20例上肢截肢和38例下肢截肢。上肢截肢者的平均年龄为44.76±12.26岁，下肢截肢者为49.1±14.3岁。每天使用假肢的平均时间分别为11.35±4.8小时和11.52±4.7小时。截肢后的平均时间分别为35.4±14.3个月和36.05±13.6个月；假肢使用时间分别为24.8±13.4个月和23.9±15.12个月。下肢截肢者在社会适应和对限制的适应子量表上的得分显著更高（p<0.001）。HADS抑郁和焦虑平均得分之间存在统计学显著差异（p<0.001）。ABIS-R总平均得分表明上肢截肢者的身体形象障碍明显更大（p<0.001）。
与上肢假肢相比，调整良好的下肢假肢可能具有更好的外观，而对外观的认知可能是导致身体形象焦虑和社交不适水平增加的关键因素。
流行病学和预后研究，三级。
