Campbell W B, Ridler B M
Department of Surgery, Royal Devon and Exeter Hospital, U.K.
Eur J Vasc Endovasc Surg. 1996 Oct;12(3):342-5. doi: 10.1016/s1078-5884(96)80254-1.
To evaluate our accuracy in predicting the use of prostheses by patients undergoing major lower limb amputation.
Prospective study, with multiple assessors, "blind" to the predictions made by each other.
Sixty-one patients (35 male: age 51-91, median 79) having their first major lower limb amputation.
Five members of the rehabilitation team (surgeon, specialist in prosthetics, nurse, physiotherapist and occupational therapist) each recorded predictions of prosthetic use and mobility before amputation and during the first 2 weeks thereafter. Patients were followed up 6-24 months later.
At follow-up 17 patients had died. Of the remaining 44 (25 below-knee and 19 above-knee amputees), 23 of 27 (85%) who had been predicted as using prostheses were doing so, while only 11 of 17 (65%) had been correctly predicted as non-users. Nevertheless, only two of the patients not using prostheses contrary to prediction had ever had prostheses made for them, and both had developed problems with the other leg at a later date. Different members of the rehabilitation team were similar in their ability to predict outcome.
Inappropriate fitting of prostheses can be kept to a minimum by a team approach to rehabilitation, but amputees may defy careful prediction by the development of new medical problems.
评估我们预测接受下肢大截肢手术患者使用假肢情况的准确性。
前瞻性研究，由多名评估人员进行，相互对各自的预测“不知情”。
61例首次接受下肢大截肢手术的患者（35例男性，年龄51 - 91岁，中位数79岁）。
康复团队的五名成员（外科医生、假肢专家、护士、物理治疗师和职业治疗师）分别记录截肢前及术后前两周的假肢使用和活动能力预测情况。对患者进行6 - 24个月的随访。
随访时17例患者死亡。其余44例（25例膝下截肢和19例膝上截肢）中，预测会使用假肢的27例中有23例（85%）确实在使用，而预测为不使用者的17例中只有11例（65%）预测正确。然而，与预测相反未使用假肢的患者中只有两例曾制作过假肢，且这两例后来另一条腿都出现了问题。康复团队的不同成员在预测结果的能力方面相似。
通过团队康复方法可将假肢不合适的情况降至最低，但截肢患者可能会因出现新的医疗问题而违背仔细的预测。
