Andronic Octavian, Boeni Thomas, Burkhard Marco D, Kaiser Dominik, Berli Martin C, Waibel Felix W A
Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
J Orthop. 2019 Nov 1;18:5-12. doi: 10.1016/j.jor.2019.10.008. eCollection 2020 Mar-Apr.
The Pirogoff amputation (1854) was initially developed to provide full-weight-bearing stumps and therefore allow a short ambulation without prosthesis. Modifications of the original technique including Boyd (1939) and the "Modified Pirogoff" were developed, which further reduced complications and improved the outcome. However, the current evidence regarding the techniques is scarce. The functional outcome, survivorship and complication rates are unknown. It was the purpose of this study to expand the knowledge with a retrospective case series and ultimately summarize and analyze the data with a systematic review.
A retrospective study of the Boyd procedures from our institution between 1999 and 2018 was performed. Outcome was determined based on the PLUS-M Score (Prosthetic Limb Users Survey of Mobility). Survivorship (absence of more proximal amputation), postoperative leg-length discrepancy, time to early fusion and time to mobilization were also evaluated. Finally, in the second part of the study, the results were integrated in a systematic review, which followed the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) guidelines. The quality of all the studies were then assessed using the Joanna Briggs Institute Critical Appraisal Checklist (JBI CAC).
A total of 123 procedures including 115 patients, with an average follow-up of 45 months (range, 10-300 months) could be included. A very good or good function could be achieved in 85 (69%) patients. The mean survivorship was 82.1% (range 46%-100%). In four studies, including our series, all patients remained with a functional stump at the latest follow-up. The calculated average leg-length discrepancy was 2.5 cm.
The "Modified Pirogoff" and Boyd amputation techniques can achieve favourable long-term functional outcome in cases of irreparable foot conditions such as osteomyelitis or trauma. Patency of the posterior tibial artery is an indispensable condition to elect for these surgical techniques. Presence of neuropathy does not preclude this amputation level. With proper patient selection, a maximal survivorship of the stump with treatable minor complications can be achieved.Level of Evidence: IV.
皮罗戈夫截肢术（1854年）最初是为了提供能完全负重的残端，从而实现无需假肢的短距离行走而开发的。对原始技术进行了改进，包括博伊德（1939年）和“改良皮罗戈夫”技术，这些改进进一步降低了并发症并改善了治疗效果。然而，目前关于这些技术的证据很少。其功能结局、生存率和并发症发生率尚不清楚。本研究的目的是通过回顾性病例系列来扩展相关知识，并最终通过系统评价对数据进行总结和分析。
对1999年至2018年间我们机构进行的博伊德手术进行回顾性研究。结局根据PLUS-M评分（假肢使用者活动能力调查）确定。还评估了生存率（无更高平面的截肢）、术后腿长差异、早期融合时间和活动时间。最后，在研究的第二部分，将结果纳入系统评价，该评价遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。然后使用乔安娜·布里格斯研究所批判性评价清单（JBI CAC）评估所有研究的质量。
总共纳入了123例手术，涉及115名患者，平均随访45个月（范围为10 - 300个月）。85例（69%）患者获得了非常好或良好的功能。平均生存率为82.1%（范围为46% - 100%）。在包括我们系列的四项研究中，所有患者在最近一次随访时均保留了功能良好的残端。计算得出的平均腿长差异为2.5厘米。
“改良皮罗戈夫”和博伊德截肢技术在诸如骨髓炎或创伤等无法修复的足部疾病病例中可实现良好的长期功能结局。胫后动脉通畅是选择这些手术技术的不可或缺的条件。存在神经病变并不排除该截肢平面。通过适当的患者选择，可以实现残端的最大生存率，并伴有可治疗的轻微并发症。证据级别：IV级。
