Nijmeijer Rachelle, Voesten Henricus G J M, Geertzen Joannes H B, Dijkstra Pieter U
Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Vascular Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands.
J Vasc Surg. 2017 Sep;66(3):866-874. doi: 10.1016/j.jvs.2017.04.052.
This study analyzed survival of the amputee patients, wound healing, and ambulation after knee disarticulation (KD).
Between July 1989 and October 2015, 153 KDs in 138 patients were performed at Nij Smellinghe Hospital, Drachten. Data were retrieved from hospital medical records. Wound healing was analyzed using nonparametric tests. Ambulation was recorded according to the Special Interest Group Amputation Medicine Workgroup Amputation and Prosthetics mobility scale.
Survival at 1, 6, and 12 months was 86%, 65%, and 55%, respectively. Wounds healed in 91% of patients. Wounds healed primarily in 57% of residual limbs, and healing was delayed in 33%. A transfemoral amputation (TFA) was performed in 10%. Patients with sagittal flaps had significantly poorer primary wound healing and delayed wound healing more often than patients with a dorsal-myocutaneous (dorsomyocutaneous) flap (P < .027). In total, 62% of patients were provided with a prosthesis. Preoperatively, 71% of the patients had intention to ambulate with prosthesis, of which 91% received prosthesis. Of these, 35% walked without the help of others. KD amputee patients who underwent a reamputation at the transfemoral level were significantly less ambulant than amputee patients who did not (P < .021).
If feasible, the dorsomyocutaneous flap technique seems to be the treatment of choice in KD. Because the wound complication rate of the group with a dorsomyocutaneous flap and the percentage of amputee patients who received prosthesis after KD fell within the same range as TFA amputee patients, KD may be an appropriate alternative when surgeons consider a TFA.
本研究分析了膝关节离断术（KD）后截肢患者的生存率、伤口愈合情况及行走能力。
1989年7月至2015年10月期间，在德伦特省德拉赫滕的奈斯梅林赫医院对138例患者进行了153例膝关节离断术。数据从医院病历中获取。使用非参数检验分析伤口愈合情况。根据截肢医学特别兴趣小组工作组的截肢与假肢活动量表记录行走能力。
1个月、6个月和12个月时的生存率分别为86%、65%和55%。91%的患者伤口愈合。57%的残肢伤口一期愈合，33%的伤口愈合延迟。10%的患者进行了经股骨截肢术（TFA）。与采用背阔肌皮瓣的患者相比，采用矢状皮瓣的患者一期伤口愈合明显较差，伤口愈合延迟的情况更常见（P <.027）。共有62%的患者安装了假肢。术前，71%的患者打算使用假肢行走，其中91%的患者安装了假肢。在这些患者中，35%的人无需他人帮助即可行走。在经股骨水平进行再次截肢的KD截肢患者的行走能力明显低于未进行再次截肢的截肢患者（P <.021）。
如果可行，背阔肌皮瓣技术似乎是KD的首选治疗方法。由于背阔肌皮瓣组的伤口并发症发生率和KD后安装假肢的截肢患者百分比与TFA截肢患者处于同一范围内，当外科医生考虑进行TFA时，KD可能是一种合适的替代方法。
