Anderson L, Westin G W, Oppenheim W L
J Pediatr Orthop. 1984 Sep;4(5):550-4.
Syme amputations are not always effective. Heel pad migration, skin sloughs, and problems with prosthetic fitting may complicate a seemingly simple procedure. We reviewed 69 Syme amputations performed in 62 children at the Los Angeles Shriners Hospital between 1956 and 1980. The major indication was leg length discrepancy, due to either paraxial fibula hemimelia (33 cases) or proximal focal femoral deficiency (19 cases). The average age at amputation was 5.6 years, with an average follow-up of 10.5 years (range 1-25 years). The results were assessed by a combination of chart review, patient recall examinations, and questionnaires. Satisfaction in adulthood was high. Early complications included three skin sloughs and one infection. Late complications included 2 retained os calcis apophyses, 1 exostosis, and 16 cases of heel pad migration. Only one of the heel pad group required revision; prosthetic adjustment resolved the others. Prosthetic knees were often too low because of failure to limit the length of the stump appropriately. Syme amputation should be considered a primary reconstructive procedure, rather than a last resort, in fibula hemimelia and proximal femoral focal deficiency.
赛姆截肢术并不总是有效的。足跟垫移位、皮肤坏死以及假肢适配问题可能会使这个看似简单的手术变得复杂。我们回顾了1956年至1980年间在洛杉矶施莱宁儿童医院为62名儿童实施的69例赛姆截肢术。主要指征是肢体长度不等，原因是近轴腓骨半侧发育不全（33例）或近端局灶性股骨缺如（19例）。截肢时的平均年龄为5.6岁，平均随访10.5年（范围1 - 25年）。通过病历审查、患者回忆检查和问卷调查相结合的方式评估结果。成年后的满意度较高。早期并发症包括3例皮肤坏死和1例感染。晚期并发症包括2例跟骨骨骺残留、1例骨疣和16例足跟垫移位。足跟垫移位组中只有1例需要翻修；其他病例通过假肢调整得以解决。由于未能适当限制残端长度，假肢膝关节往往过低。在腓骨半侧发育不全和近端股骨局灶性缺如的情况下，赛姆截肢术应被视为一种主要的重建手术，而非最后的手段。
