Tennent David J, Polfer Elizabeth M, Sgromolo Nicole M, Krueger Chad A, Potter Benjamin K
San Antonio Military Medical Center, Department of Orthopaedics, 3855 Roger Brooke Drive, Fort Sam Houston, TX 78234, United States.
William Beaumont Army Medical Center, Department of Orthopaedics, 5005 N Piedras St., El Paso, TX, 79920, United States.
Injury. 2018 Jun;49(6):1193-1196. doi: 10.1016/j.injury.2018.03.029. Epub 2018 Mar 27.
The purpose of this study is to characterize through knee and transfemoral amputations following severe traumatic injuries.
A retrospective review of all transfemoral and through knee amputations sustained by United States military service members from 1 October 2001 to 30 July 2011 was conducted. Data from the Department of Defense Trauma Registry, the Armed Forces Health Longitudinal Technology Application, inpatient medical records and the Physical Evaluation Board Liaison Offices were queried in order to obtain characteristics related to injury sustained, demographics, treatment, and disability/mental health outcome data.
A total of 1631 amputations in 1315 patients were identified. Of these there were 37 through knee and 296 were transfemoral amputations. Adequate records for detailed analysis were available on 140 and 25 transfemoral and through knee amputations respectively. There were no significant differences in demographic information, injury mechanism, initial injury severity score, or associated injuries, to include contralateral amputations. There was no significant difference in average disability rating (67.9% vs 78.3%, p = 0.46) or number of service members determined to be fully disabled (42.2% vs 28.6% p = 0.33) between the transfemoral and through knee amputation groups. Whereas there was no difference between groups preoperatively, the knee disarticulation group displayed a higher rate of mental health diagnoses post-amputation (96% vs 72%, p < 0.001) and a higher preponderance of anxiety related disorders than the transfemoral amputees (26.92% vs 12.96%, p = 0.0129).
DISCUSSION/CONCLUSION: Among this military amputee through knee and transfemoral amputees displayed similar physical disability profiles. However, the through knee amputees displayed a higher level of anxiety related disorders and mental health diagnosis overall. While we don't believe this relationship to be causal in nature, this finding reflects the importance of paying particular attention to mental health in the final disposition of traumatic lower extremity amputees.
本研究的目的是通过严重创伤后的膝关节离断和经股骨截肢来进行特征描述。
对2001年10月1日至2011年7月31日期间美国军人所遭受的所有经股骨和膝关节离断截肢进行回顾性研究。查询了国防部创伤登记处、武装部队健康纵向技术应用、住院病历和体格评估委员会联络办公室的数据，以获取与受伤情况、人口统计学、治疗以及残疾/心理健康结果数据相关的特征。
共识别出1315例患者的1631例截肢。其中有37例膝关节离断和296例经股骨截肢。分别有140例经股骨截肢和25例膝关节离断截肢有可供详细分析的充分记录。在人口统计学信息、损伤机制、初始损伤严重程度评分或相关损伤（包括对侧截肢）方面没有显著差异。经股骨截肢组和膝关节离断截肢组之间的平均残疾评级（67.9%对78.3%，p = 0.46）或被确定为完全残疾的军人数量（42.2%对28.6%，p = 0.33）没有显著差异。虽然术前两组之间没有差异，但膝关节离断组截肢后心理健康诊断率较高（96%对72%，p < 0.001），且与经股骨截肢者相比，焦虑相关障碍的比例更高（26.92%对12.96%，p = 0.0129）。
讨论/结论：在这群军事截肢者中，膝关节离断截肢者和经股骨截肢者表现出相似的身体残疾状况。然而，膝关节离断截肢者总体上表现出更高水平的焦虑相关障碍和心理健康诊断。虽然我们不认为这种关系本质上是因果关系，但这一发现反映了在创伤性下肢截肢者的最终处置中特别关注心理健康的重要性。
