University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center of Rehabilitation, The Netherlands.
University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, The Netherlands.
Medicine (Baltimore). 2023 Mar 10;102(10):e33188. doi: 10.1097/MD.0000000000033188.
Lisfranc and Chopart amputations are historically controversial procedures. To obtain evidence for the pros and cons we performed a systematic review to analyze wound healing, the need for re-amputation at a higher level, and ambulation after a Lisfranc or Chopart amputation.
A literature search was performed in 4 databases (Cochrane, Embase, Medline, and PsycInfo), using database-specific search strategies. Reference lists were studied to include relevant studies that were missed in the search. Of the 2881 publications found, 16 studies could be included in this review. Excluded publications concerned editorials, reviews, letters to the editor, no full text available, case reports, not meeting the topic, and written in a language other than English, German, or Dutch.
Failed wound healing occurred in 20% after Lisfranc amputation, in 28% after modified Chopart amputation, and 46% after conventional Chopart amputation. After Lisfranc amputation, 85% of patients were able to ambulate without prosthesis for short distances, and after modified Chopart 74%. After a conventional Chopart amputation, 26% (10/38) had unlimited household ambulation.
The need for re-amputation because wound healing problems occurred most frequently after conventional Chopart amputation. All 3 types of amputation levels do, however, provide a functional residual limb, with the remaining ability to ambulate without prosthesis for short distances. Lisfranc and modified Chopart amputations should be considered before proceeding to a more proximal level of amputation. Further studies are needed to identify patient characteristics to predict favorable outcomes of Lisfranc and Chopart amputations.
跖跗关节离断和跗跖关节离断术在历史上一直存在争议。为了获得支持和反对的证据，我们进行了系统评价，以分析伤口愈合、需要更高水平再截肢以及跖跗关节离断或跗跖关节离断后的步行能力。
我们在 4 个数据库（Cochrane、Embase、Medline 和 PsycInfo）中进行了文献检索，使用了数据库特定的检索策略。研究了参考文献列表，以纳入在检索中遗漏的相关研究。在 2881 篇出版物中，有 16 项研究可纳入本综述。排除的出版物涉及社论、综述、给编辑的信、无法获得全文、病例报告、不符合主题以及用英语、德语或荷兰语以外的语言撰写。
跖跗关节离断术后伤口愈合失败的发生率为 20%，改良跖跗关节离断术为 28%，传统跖跗关节离断术为 46%。跖跗关节离断术后，85%的患者无需假体即可短距离行走，改良跖跗关节离断术后为 74%。传统跖跗关节离断术后，26%（10/38）的患者可进行无限制的家庭步行。
由于伤口愈合问题需要再次截肢的情况最常发生在传统跖跗关节离断术后。然而，所有 3 种截肢水平都提供了一个功能性残肢，仍然可以无需假体短距离行走。在进行更高水平的截肢之前，应考虑跖跗关节离断和改良跖跗关节离断术。需要进一步的研究来确定患者特征，以预测跖跗关节离断和跗跖关节离断术的良好结果。
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