Spruit M, Bosman C H
Department of Orthopaedic Surgery, St. Maartenskliniek Nijmegen, The Netherlands.
Eur J Surg. 1994 May;160(5):267-70.
To describe our results with a new technique of revision of failed below knee amputation stumps using gentamicin impregnated collagen sponge.
Open study.
District hospital.
31 patients who underwent below knee amputations between 1988 and 1992, compared with 31 historical controls who were operated on between 1984 and 1988.
Two thirds of the stumps that failed to heal underwent excision of necrotic and devitalised tissue; half had shortening of tibia and fibula and a gentamicin impregnated collagen sponge was left in the wound, which was then closed.
Successful wound healing and rehabilitation.
12 Stumps failed to heal, 8 of which were suitable for local treatment with the gentamicin sponge. All 8 healed satisfactorily, though one required revision of the scar 6 months later. Of the remainder, the stumps were converted to above knee amputations (n = 3) and one was disarticulated at the knee. In the control group 5 of the 7 stumps in which healing failed, were converted to above knee amputations and the other two healed after split skin grafting.
We think that local treatment with the collagen sponge with gentamicin offers a viable alternative to conversion to above knee amputation for below knee amputation stumps that fail to heal. The treatment should now be subjected to a randomised controlled trial.
描述我们使用庆大霉素浸渍胶原海绵对失败的膝下截肢残端进行翻修的新技术的结果。
开放性研究。
地区医院。
1988年至1992年间接受膝下截肢的31例患者，与1984年至1988年间接受手术的31例历史对照患者进行比较。
三分之二愈合失败的残端进行坏死和失活组织切除；一半患者进行胫腓骨缩短术，并在伤口内留置庆大霉素浸渍胶原海绵，然后缝合伤口。
伤口成功愈合及康复情况。
12个残端愈合失败，其中8个适合用庆大霉素海绵进行局部治疗。所有8个均愈合良好，尽管有1个在6个月后需要对瘢痕进行翻修。其余患者中，残端改为膝上截肢（n = 3），1个在膝关节处离断。在对照组中，7个愈合失败的残端中有5个改为膝上截肢，另外2个在植皮后愈合。
我们认为，对于愈合失败的膝下截肢残端，用含庆大霉素的胶原海绵进行局部治疗为改为膝上截肢提供了一种可行的替代方法。现在应对该治疗方法进行随机对照试验。
