Centre for Blast Injury Studies, Bessemer Building, Imperial College London, South Kensington Campus, Exhibition Road, London, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, ICT Centre, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK.
Defence Medical Rehabilitation Centre, Stanford Hall, Stanford on Soar, Loughborough LE12 5QW, UK.
Injury. 2020 Mar;51(3):735-743. doi: 10.1016/j.injury.2020.01.006. Epub 2020 Jan 7.
The aim of the study is to evaluate the clinical outcome and complications from the initial cohort of blast injured bilateral lower limb, above knee amputees who underwent Direct Skeletal Fixation (DSF).
We undertook a retrospective analysis of a prospective data base identifying patients who had undergone implantation with the Australian Osseointegration Group of Australia-Osseointegration Prosthetic Limb (OGAP-OPL) prosthesis, with minimum 24 months follow up. Patient demographics, injury profile, and polymicrobial colonisation status were recorded. Physical functional performance measures recorded were the 6 minute Walk Test (6-MWT) and patient reported outcome measures were the Short Form Health Survey-36 (SF-36). Post operatively, complications including infection, re-operation, and fracture were recorded.
7 patients (14 femora) were identified (mean age 29.8yrs), all injured by dismounted blast. Mean follow up was 46 months. All were polytrauma patients and all had previous polymicrobial colonisation. Following surgery, all patients mobilised with significant improvement in 6-minute walk time, with a mean improvement of 154 m (248 m vs 402 m, p = 0.018). The physical component score for the SF-36 demonstrated a statistically significant improvement from 34.65 to 54.5 (p = 0.018) and the mental component score demonstrated a similar improvement (41.55-58.19 p = 0.018). At follow up, no patient required explantation of the implant. Each had been prescribed a minimum of 1 course of antibiotics with no evidence of deep infection.
DSF is an option for amputees who, due to the nature of their injuries, may not be able to tolerate traditional suspension socket prostheses and have exhausted all other treatment options. At a minimum of 2 year follow up, the absence of significant infective complications suggests DSF may be utilised in the blast injured despite chronic polymicrobial colonisation. Longer term surveillance of these patients is required to assess the long-term suitability of this technique in this cohort of patients.
本研究旨在评估直接骨骼固定（DSF）治疗双侧下肢膝关节以上截肢的爆炸伤初始队列的临床结果和并发症。
我们对前瞻性数据库进行了回顾性分析，确定了接受澳大利亚骨整合组澳大利亚骨整合假肢（OGAP-OPL）植入物治疗、随访至少 24 个月的患者。记录患者的人口统计学资料、损伤情况和多微生物定植状态。记录的身体功能表现测量包括 6 分钟步行测试（6-MWT）和患者报告的结果测量包括简明健康调查问卷 36 项（SF-36）。术后记录并发症，包括感染、再次手术和骨折。
共确定了 7 名患者（14 例股骨）（平均年龄 29.8 岁），均因下车爆炸受伤。平均随访时间为 46 个月。所有患者均为多发伤患者，且均有先前的多微生物定植。手术后，所有患者都能活动，6 分钟步行时间显著改善，平均改善 154 米（248 米对 402 米，p=0.018）。SF-36 的物理成分评分从 34.65 提高到 54.5（p=0.018），精神成分评分也有类似提高（41.55-58.19，p=0.018）。随访时，没有患者需要取出植入物。每位患者都至少开了一个疗程的抗生素，没有深部感染的证据。
对于因受伤性质而无法耐受传统悬挂式假肢且已用尽其他所有治疗方法的截肢患者，DSF 是一种选择。在至少 2 年的随访中，没有明显的感染并发症表明，尽管存在慢性多微生物定植，DSF 仍可用于爆炸伤患者。需要对这些患者进行更长时间的监测，以评估该技术在这组患者中的长期适用性。
