Hertel R, Strebel N, Ganz R
Department of Orthopaedic Surgery, Inselspital University of Berne, Switzerland.
J Orthop Trauma. 1996;10(4):223-9. doi: 10.1097/00005131-199605000-00001.
This retrospective review covers global aspects of reconstructive efforts to salvage severely injured legs. Eighteen patients with traumatic lower leg amputation were compared to 21 patients who underwent complex microvascular reconstruction. The mean number of interventions was 3.5 for amputation and 8 for reconstruction (p < 0.009). Total rehabilitation time was 12 months for amputation and 30 months for reconstruction (p < 0.009). Changes in lifestyle were consistently more important in the amputee group. The mean annual hospital costs for amputated patients were 15,112 Swiss Francs (SD 7,094 SF) for the first 4 years. The mean annual hospital costs for reconstructed patients were 17,365 Swiss Francs (SD 8,702 SF) for the first 4 years. Fifty-six percent of the amputees and 19% of the reconstructed patients were retrained to a different profession (p < 0.025). Fifty-four percent of the amputees and 16% of the reconstructed patients were drawing an extremely costly and life long invalidity pension (p < 0.02). We conclude that for potentially salvageable legs reconstruction is advisable because the functional outcome was better than for amputation and there was no permanent social disintegration due to the long treatment. Total costs (including pensions) for reconstruction were far lower than for amputation.
本回顾性研究涵盖了挽救严重受伤腿部的重建努力的全球情况。将18例创伤性小腿截肢患者与21例接受复杂微血管重建的患者进行了比较。截肢组的平均干预次数为3.5次，重建组为8次（p<0.009）。截肢组的总康复时间为12个月，重建组为30个月（p<0.009）。截肢组患者生活方式的改变一直更为显著。截肢患者头4年的平均每年住院费用为15,112瑞士法郎（标准差7,094瑞士法郎）。重建患者头4年的平均每年住院费用为17,365瑞士法郎（标准差8,702瑞士法郎）。56%的截肢患者和19%的重建患者接受了不同职业的再培训（p<0.025）。54%的截肢患者和16%的重建患者领取极其昂贵且终身的残疾抚恤金（p<0.02）。我们得出结论，对于有可能挽救的腿部，重建是可取的，因为其功能结果优于截肢，且由于治疗时间长不会导致永久性的社会解体。重建的总成本（包括抚恤金）远低于截肢。
