Hebert Jacqueline S, Rehani Mayank, Stiegelmar Robert
Divisions of Physical Medicine & Rehabilitation (J.S.H. and M.R.) and Orthopaedic Surgery (R.S.), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
JBJS Rev. 2017 Oct;5(10):e10. doi: 10.2106/JBJS.RVW.17.00037.
Traditional socket prostheses are not a viable option for all lower-limb prosthetic users. Discomfort, pain in the residual limb, and problems related to the fit of the socket are common and have been shown to negatively impact quality of life and mobility. Osseointegrated or bone-anchored prosthetic implants have evolved over the past 2 decades as a promising alternative for patients who are experiencing substantial issues with socket prostheses.
A review of the literature was performed to identify studies focusing on the evolution, clinical outcomes, success rates, and complications of osseointegrated lower-limb prostheses. Articles were summarized according to the implant type, amputation level, and study characteristics, with rating of the Level of Evidence. Information on patient selection criteria, outcomes, and complications was extracted.
Fourteen articles (with Level-II, III, or IV evidence) met the inclusion criteria. Infection and soft-tissue irritation at the stoma were the most common complications. It is evident that, over the years, changes in implant design, surgical technique, perioperative and postoperative care, and rehabilitation protocols have resulted in improvements in functional outcomes and health-related quality of life, and reduction in rates of complications.
Osseointegration for limb amputation has become an established clinical treatment option for persons with lower-limb amputation not tolerating traditional socket prostheses. Osseointegration could provide substantial benefits regarding function and quality of life for appropriately selected patients who accept the documented risks.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
传统的接受腔假肢并非适用于所有下肢假肢使用者。残肢不适、疼痛以及与接受腔适配相关的问题很常见，并且已被证明会对生活质量和行动能力产生负面影响。在过去20年中，骨整合或骨锚定假肢植入物不断发展，成为那些在接受腔假肢方面存在严重问题的患者的一种有前景的替代方案。
进行文献综述以确定关注骨整合下肢假肢的发展、临床结果、成功率和并发症的研究。根据植入物类型、截肢水平和研究特征对文章进行总结，并对证据水平进行评级。提取有关患者选择标准、结果和并发症的信息。
14篇文章（具有II级、III级或IV级证据）符合纳入标准。造口处的感染和软组织刺激是最常见的并发症。显然，多年来，植入物设计、手术技术以及围手术期和术后护理及康复方案的变化已使功能结果和与健康相关的生活质量得到改善，并发症发生率降低。
对于无法耐受传统接受腔假肢 的下肢截肢者，肢体截肢的骨整合已成为一种既定的临床治疗选择。对于接受记录在案的风险的适当选择的患者，骨整合在功能和生活质量方面可带来显著益处。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
