创伤后标准化假肢治疗下的早期与晚期膝下截肢比较。

Comparison of Early versus Late Below Knee Amputation After Trauma With Standardized Prosthetic Care.

机构信息

Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

American Prosthetics and Orthotics, Muscatine, Iowa. USA.

出版信息

Iowa Orthop J. 2022 Jun;42(1):89-96.

PMID:35821918

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9210393/

Abstract

BACKGROUND

High energy, lower extremity trauma is associated with longstanding pain and functional limitations. The clinical decision to proceed with early amputation or limb salvage is often controversial. This study was designed to compare differences in complications, costs, and clinical outcomes of below knee amputation (BKA) performed early after injury or after attempted limb salvage in a hospital with standardized prosthetic care following amputation.

METHODS

This is a retrospective comparative study of subjects who underwent BKA for a traumatic injury at a single level 1 trauma center and received standardized prosthetic care from a single manufacturer from 1999-2016 with minimum 2-year post-amputation follow up. Outcomes collected included demographics, surgical management, unplanned re-operations, and hospital and prosthetic cost data 2 years from time of injury.

RESULTS

Overall, 79 subjects met criteria. Early amputation (EA) was defined by median duration between injury and amputation (6 weeks) with 41 subjects in the EA group and 38 subjects in the late amputation (LA) group. Subjects in the EA group were more likely to have open fractures, high energy mechanism, and less likely to have medical comorbidities. Post-amputation infection was common in both groups (17/41 (42%) vs 17/38 (45%), p=0.77). Subjects undergoing EA were more likely to require unplanned post-amputation revision, 22/41 (54%) versus 10/38 (27%), p=0.017. Hospital costs and prosthetics/orthotics costs from the time of injury to two years following amputation were comparable, with mean hospital EA costs $136,044 versus LA costs $125,065, p=0.38. Mean prosthetics/orthotics costs of EA subjects were $33,252 versus LA costs $37,684, p=0.59.

CONCLUSION

Unplanned post-amputation revision surgeries were more common when BKA was performed early after trauma. Otherwise, outcomes and cost were comparable when amputation was performed early versus late. .

摘要

背景

高能、下肢创伤与长期疼痛和功能障碍有关。是否进行早期截肢或保肢的临床决策常常存在争议。本研究旨在比较在具有标准化假体护理的医院中，受伤后早期进行膝关节以下截肢（BKA）与尝试保肢后进行 BKA 的并发症、成本和临床结果差异。

方法

这是一项回顾性比较研究，研究对象为在一家一级创伤中心因创伤而接受 BKA 的患者，并在 1999 年至 2016 年期间接受同一家制造商的标准化假体护理，随访时间至少为截肢后 2 年。收集的结果包括人口统计学数据、手术管理、非计划再手术以及受伤后 2 年内的医院和假体成本数据。

结果

总体而言，有 79 名患者符合标准。早期截肢（EA）定义为受伤和截肢之间的中位数时间（6 周），EA 组有 41 名患者，LA 组有 38 名患者。EA 组患者更可能患有开放性骨折、高能量机制，而更不可能患有合并症。两组患者截肢后感染均常见（41/41（42%）vs 38/38（45%），p=0.77）。EA 组患者更可能需要非计划的截肢后修正，22/41（54%）vs 10/38（27%），p=0.017。从受伤到截肢后 2 年的时间内，医院费用和假体/矫形器费用相当，EA 组的平均医院费用为 136044 美元，LA 组为 125065 美元，p=0.38。EA 组患者的假体/矫形器平均费用为 33252 美元，LA 组为 37684 美元，p=0.59。