Örgel Marcus, Ranker Alexander, Harb Afif, Krettek Christian, Aschoff Horst-Heinrich
Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
Orthopade. 2021 Jan;50(1):4-13. doi: 10.1007/s00132-020-04031-2.
Transcutaneous osseointegrated prosthetic systems (TOPS) are an established optional procedure for the prosthetic treatment of amputations. Under the term endo-exo-prosthesis (EEP), the endosteal adapted exo-prosthesis (Dr. Grundei®) is currently used as the only standard prosthesis for clinical application in Germany. The prosthetic treatment with EEP involves a two-stage surgical procedure. In a first surgical step, the endo-fixed stem is implanted into the bone; in a second operation, approx. 2-6 weeks later, the skin/soft tissue stoma is created, through which the exoprosthetic components can be coupled transcutaneously.
The aim of this manuscript was to retrospectively collect descriptive 3‑year statistics (2017-2019) from clinical follow-ups and to analyze them with regard to possible effects of TOPS on the mobility level measured by k‑levels. In addition, a brief description of the current standard of care in Germany regarding TOPS will be given.
All patients who underwent EEP after major amputation from February 2017 to December 2019 (n = 72, with 76 implants) were included in this study. The data of the EEP patients were collected in standardized follow-ups. K‑levels were compared preoperatively to 6 months postoperatively.
A total of N = 72 patients (N = 76 implantations) was analyzed in the described period. The main cause of amputations was trauma (68.9%). Main complications were myofascial complaints. Implant loosening and deep infections were observed in two cases (2.7%) during this period. Stoma problems occurred with a 3-year average of 25.7%. In terms of K‑levels, there was a high significant increase from preoperative 1.8 ± 0.8 to 3.0 ± 0.4 after a 6-month period.
TOPS is an established optional procedure for the treatment of limb loss. In Germany, only one implant is currently regularly implanted (endo-exo prosthesis), and the restoration is currently focused on the lower limb. The restoration of patients with major amputation of the lower extremity by means of TOPS can lead to an increase in mobility and, thus, to an increase in daily activities and participation in daily living.
经皮骨整合假体系统（TOPS）是一种既定的截肢修复治疗可选方法。在“内外侧假体”（EEP）这一术语下，骨内适配型外侧假体（格伦德伊博士®）目前是德国临床应用中唯一的标准假体。EEP修复治疗涉及两阶段手术过程。在第一步手术中，将骨内固定柄植入骨内；在第二步手术中，大约2至6周后，创建皮肤/软组织造口，通过该造口可经皮连接外部假体组件。
本手稿的目的是回顾性收集临床随访的3年描述性统计数据（2017 - 2019年），并就TOPS对通过k级衡量的活动水平可能产生的影响进行分析。此外，还将简要介绍德国目前关于TOPS的护理标准。
本研究纳入了2017年2月至2019年12月期间接受重大截肢后接受EEP治疗的所有患者（n = 72，植入76个假体）。EEP患者的数据在标准化随访中收集。将术前k级与术后6个月的k级进行比较。
在所描述的时间段内，共分析了N = 72例患者（N = 76次植入）。截肢的主要原因是创伤（68.9%）。主要并发症是肌筋膜不适。在此期间，观察到2例（2.7%）出现植入物松动和深部感染。造口问题3年平均发生率为25.7%。在k级方面，术后6个月时从术前的1.8±0.8显著提高到3.0±0.4。
TOPS是一种既定的肢体缺失治疗可选方法。在德国，目前常规植入的只有一种假体（内外侧假体），且目前修复主要针对下肢。通过TOPS对下肢重大截肢患者进行修复可提高活动能力，从而增加日常活动和参与日常生活的程度。
