Pinzur M S, Smith D, Osterman H
Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Foot Ankle Int. 1995 Mar;16(3):124-7. doi: 10.1177/107110079501600303.
A prospective randomized trial compared performing a Syme ankle disarticulation using a one-stage versus Wagner's two-stage technique. Surgery was performed at two University Medical Centers where patients underwent amputation surgery for gangrene or nonsalvageable diabetic foot infection. Those undergoing surgery subsequent to trauma or congenital anomaly were eliminated. Initially, 21 patients were randomized into one-stage and two-stage surgery. The randomization was stopped for ethical reasons when the results of both procedures appeared to be similar. The next 22 consecutive patients underwent 23 Syme ankle disarticulations in one-stage surgery. Selection of amputation level was based on clinical examination, transcutaneous oximetry as a measure of vascular inflow, serum albumin as a measure of tissue nutrition, and total lymphocyte count as a measure of immunocompetence. As a total group, 31 of 44 amputations progressed to amputation wound healing and prosthetic limb fitting. In the randomized group, 9 of 13 one-stage and 5 of 8 two-stage surgeries healed. In the subsequent consecutive group, 17 of 23 healed. In all, 26 of 36 one-stage and 5 of 8 two-stage surgeries healed successfully. We concluded from this study that Syme ankle disarticulation may be performed as safely in one stage as in two stages in properly selected patients and, therefore, recommend the one-stage Syme ankle disarticulation in those patients suitable for this level amputation.
一项前瞻性随机试验比较了采用一期手术与瓦格纳二期手术技术进行Syme踝关节离断术的效果。手术在两家大学医学中心进行，患者因坏疽或不可挽救的糖尿病足感染接受截肢手术。排除因创伤或先天性畸形而接受手术的患者。最初，21例患者被随机分为一期手术组和二期手术组。当两种手术的结果似乎相似时，出于伦理原因停止了随机分组。接下来的22例连续患者接受了23例一期Syme踝关节离断术。截肢水平的选择基于临床检查、经皮血氧测定作为血管流入的指标、血清白蛋白作为组织营养的指标以及总淋巴细胞计数作为免疫能力的指标。作为一个整体组，44例截肢中有31例实现了截肢伤口愈合和假肢安装。在随机分组的患者中，13例一期手术中有9例愈合，8例二期手术中有5例愈合。在随后的连续患者组中，23例中有17例愈合。总体而言，36例一期手术中有26例成功愈合，8例二期手术中有5例成功愈合。我们从这项研究中得出结论，在适当选择的患者中，一期进行Syme踝关节离断术与二期手术一样安全，因此，建议在适合该截肢水平的患者中采用一期Syme踝关节离断术。
