Squires J W, Johnson W C, Widrich W C, Nabseth D C
Am J Surg. 1982 Apr;143(4):523-7. doi: 10.1016/0002-9610(82)90207-0.
Seventy-six above-knee amputations performed on elderly debilitated patients were reviewed. Fifty-one wounds healed without complications; 25 amputation wounds developed postoperative complications. The quality of the femoral pulse has a significant effect on wound healing after an above-knee amputation. Other significant conditions that appear to influence the frequency of wound complications are hypertension, a failed bypass procedure to the groin, and angiographic evidence of stenosis or occlusion of the common femoral or the profunda femoral artery. Multiple variable analysis suggests a beneficial effect of antibiotics in patients with a diminished or absent femoral pulse. Age, presence of cardiac disease, diabetes, associated diseases and the use of drains have no significant effect on the outcome. Before an above-knee amputation, patients with a diminished femoral pulse should undergo arteriography and perhaps reconstructive surgery. Primary hip disarticulation may be the initial procedure of choice in the presence of multiple risk factors.
对76例老年体弱患者行膝上截肢术的情况进行了回顾。51例伤口愈合且无并发症；25例截肢伤口出现术后并发症。股动脉搏动情况对膝上截肢术后伤口愈合有显著影响。其他似乎影响伤口并发症发生率的重要情况包括高血压、腹股沟旁路手术失败以及股总动脉或股深动脉狭窄或闭塞的血管造影证据。多变量分析表明，对于股动脉搏动减弱或消失的患者，抗生素有有益作用。年龄、心脏病、糖尿病、相关疾病及引流管的使用对结果无显著影响。在进行膝上截肢术前，股动脉搏动减弱的患者应接受动脉造影检查，可能还需进行重建手术。在存在多种危险因素时，一期髋关节离断术可能是首选的初始手术。
