Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
Arch Orthop Trauma Surg. 2023 Aug;143(8):4943-4949. doi: 10.1007/s00402-023-04783-4. Epub 2023 Feb 1.
Hip disarticulation and hemipelvectomy are defined as major ablative amputations of the lower limb. Due to the small number of patients, little is known about the outcome and follow-up.
We aimed to assess (1) reasons for performed major ablative surgeries such as hip disarticulation and hemipelvectomy in a German center for trauma and orthopedic surgery. (2) In addition, mortality and quality of life after hip disarticulation and hemipelvectomy as well as (3) patient and treatment characteristics should be investigated.
During a period of twelve years, 15 patients underwent hip disarticulation or hemipelvectomy. Mortality, EQ-5D-3L quality of life by EQ-5D-3L and time-trade-off (TTO), VAS, cause of disarticulation, length of hospital stays, revisions, comorbidities, Charlson comorbidity index (CCI), and ASA score were evaluated retrospective for all patients.
The overall mortality rates were 26.7% at 30 days, 60.0% after one year and 66.7% after three years. The five surviving patients reported about moderate problems in the EQ-5D-3L. The average VAS score reached 45 (range 15-65). The mean TTO was 9.8 (range 6-12). Indications for amputation were infection (n = 7), tumor (n = 6), trauma (n = 1) and ischemia (n = 1).
Hip disarticulation and hemipelvectomy are followed by a high postoperative mortality. Quality of life of the affected patients is impaired in long-term follow-up. Especially amputations performed due to infections show high mortality within one month after surgery despite average young age and low CCI. Surgeons should be aware of this devastating outcome and extraordinary vigilant for these vulnerable patient cohorts.
髋关节离断术和半骨盆切除术被定义为下肢的主要破坏性截肢。由于患者数量较少，对于这些手术的结果和随访知之甚少。
我们旨在评估（1）在德国创伤和矫形外科中心进行主要破坏性手术（如髋关节离断术和半骨盆切除术）的原因。（2）此外，还评估了髋关节离断术和半骨盆切除术的死亡率和生活质量，以及（3）患者和治疗特征。
在 12 年期间，有 15 名患者接受了髋关节离断术或半骨盆切除术。对所有患者进行了回顾性评估，包括死亡率、EQ-5D-3L 生活质量（EQ-5D-3L 和时间权衡法[TTO]）、VAS 评分、离断原因、住院时间、翻修、合并症、Charlson 合并症指数（CCI）和美国麻醉师协会（ASA）评分。
术后 30 天、1 年和 3 年的总死亡率分别为 26.7%、60.0%和 66.7%。5 名存活患者报告在 EQ-5D-3L 中有中度问题。平均 VAS 评分为 45（范围 15-65）。平均 TTO 为 9.8（范围 6-12）。截肢的指征包括感染（n=7）、肿瘤（n=6）、创伤（n=1）和缺血（n=1）。
髋关节离断术和半骨盆切除术的术后死亡率较高。受影响患者的生活质量在长期随访中受损。特别是由于感染而进行的截肢，尽管平均年龄较小且 CCI 较低，但在手术后一个月内死亡率很高。外科医生应该意识到这种毁灭性的结果，并对这些脆弱的患者群体保持高度警惕。
