Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Disabil Rehabil. 2022 Jul;44(15):3749-3759. doi: 10.1080/09638288.2021.1893393. Epub 2021 Mar 8.
In persons with a hip or knee flexion contracture ≥25°, fitting a prosthesis is said to be difficult. This systematic review aims to assess the evidence for fitting of a prosthesis in persons with a severe contracture (≥25°) after a lower limb amputation.
PubMed, Embase, Scopus, CINAHL, and Orthotics & Prosthetics Virtual Library databases were searched from inception to December 2019, using database specific search terms related to amputation, prosthesis, and contracture. Reference lists of included studies were checked for relevant studies. Quality of the included studies was assessed using the critical appraisal checklist for case reports (Joanna Briggs Institute).
In total, 13 case studies provided evidence for fitting of a prosthesis in more than 63 persons with a transtibial amputation and three with a transfemoral amputation, all of whom had a hip or knee flexion contracture ≥25°. Some studies found a reduction in contractures after prosthesis use.
Several techniques for fitting a prosthesis in case of a flexion contracture ≥25° were found. Contracture reduction occurred in some cases and was possibly related to prosthesis use. Fitting a transtibial or transfemoral prosthesis in persons with a lower limb amputation with a severe flexion contracture is possible.IMPLICATIONS FOR REHABILITATIONThis study provides information on prosthesis prescriptions and adaptations for persons with a transfemoral and transtibial amputation with a flexion contracture ≥25°.The fitting of bent prostheses is not limited by prosthetic components and techniques.Parallel to the use of bent prostheses, it is also important to treat the contracture.
在髋或膝关节屈曲挛缩≥25°的患者中，适配假肢被认为较为困难。本系统评价旨在评估下肢截肢后严重挛缩（≥25°）患者适配假肢的证据。
从建库至 2019 年 12 月，我们在 PubMed、Embase、Scopus、CINAHL 和 Orthotics & Prosthetics Virtual Library 数据库中使用与截肢、假肢和挛缩相关的特定数据库检索词进行检索，并对纳入研究的参考文献列表进行检索以查找相关研究。我们使用病例报告的 Joanna Briggs 循证医学中心评价标准（critical appraisal checklist for case reports）评估纳入研究的质量。
共有 13 项病例研究为 63 例以上胫骨截肢和 3 例股骨截肢患者适配假肢提供了证据，所有患者的髋或膝关节屈曲挛缩≥25°。一些研究发现使用假肢后挛缩减少。
我们发现了几种针对≥25°屈曲挛缩适配假肢的技术。在一些病例中发生了挛缩的减少，可能与使用假肢有关。在下肢截肢伴有严重屈曲挛缩的患者中，适配胫骨或股骨假肢是可行的。
本研究为股骨和胫骨截肢伴有屈曲挛缩≥25°的患者提供了假肢处方和适应的信息。弯曲假肢的适配并不受假肢组件和技术的限制。与使用弯曲假肢平行的是，治疗挛缩也很重要。
