Bosse Michael J, Morshed Saam, Reider Lisa, Ertl William, Toledano James, Firoozabadi Reeza, Seymour Rachel B, Carroll Eben, Scharfstein Daniel O, Steverson Barbara, MacKenzie Ellen J
*Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC; †Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, University of San Francisco; ‡Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; §Department of Orthopaedic Surgery and Rehabilitation, University of Oklahoma; ‖Department of Orthopaedic Surgery, Naval Medical Center San Diego; ¶Harborview Medical Center, University of Washington; **Department of Orthopaedic Surgery, Wake Forest Baptist Health; ††Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health; and ‡‡Orthopaedic Trauma Service, Tampa General Hospital, Florida Orthopaedic Institute.
J Orthop Trauma. 2017 Apr;31 Suppl 1:S63-S69. doi: 10.1097/BOT.0000000000000791.
The optimal technique for a transtibial amputation in a young, active, and healthy patient is controversial. Proponents of the Ertl procedure (in which the cut ends of the tibia and fibula are joined with a bone bridge synostosis) argue that the residual limb is more stable which confers better prosthetic fit and improved function especially among high-performing individuals. At the same time, the Ertl procedure is associated with longer operative and healing time and may be associated with a higher complication rate compared with the standard Burgess procedure. The TAOS is a prospective, multicenter randomized trial comparing 18-month outcomes after transtibial amputation using the Ertl versus Burgess approach among adults aged 18 to 60. The primary outcomes include surgical treatment for a complication and patient-reported function. Secondary outcomes include physical impairment, pain, and treatment cost.
对于年轻、活跃且健康的患者而言，经胫骨截肢的最佳技术存在争议。厄特尔手术（将胫骨和腓骨的断端通过骨桥融合连接在一起）的支持者认为，残肢更稳定，这能带来更好的假肢适配性并改善功能，尤其是在高水平运动者中。与此同时，与标准的伯吉斯手术相比，厄特尔手术的手术时间和愈合时间更长，且可能伴有更高的并发症发生率。TAOS是一项前瞻性、多中心随机试验，比较了18至60岁成年人采用厄特尔手术与伯吉斯手术进行经胫骨截肢术后18个月的结果。主要结局包括并发症的手术治疗和患者报告的功能。次要结局包括身体损伤、疼痛和治疗费用。
