Cutson T M, Bongiorni D R
Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina, USA.
J Am Geriatr Soc. 1996 Nov;44(11):1388-93. doi: 10.1111/j.1532-5415.1996.tb01415.x.
To review outcomes, over the last 25 to 30 years, of prosthetic rehabilitation in the older patient with a major lower limb amputation.
Literature review of articles and reports about lower limb amputation, using key words elderly amputee rehabilitation, and lower limb amputation, through a computerized Medline Search.
Age alone should not determine prosthetic rehabilitation. Comorbidities and general health are important determinants. The more proximal the amputation, the more energy is demanded from the cardiovascular and pulmonary systems for prosthetic gait. Changes in surgical technique and revascularization procedures have allowed preservation of the knee, which decreases energy demands and allows more older patients a chance to undergo rehabilitation for ambulation. Although the ratio of below knee (transtibial) amputations to above knee (transfemoral) amputations has increased, overall postsurgical mortality (10-30%), long term survival (40-50%@2 years, 30-40%@5 years), and risk of loss of the contralateral leg (15-20%@2 years) has not changed significantly since the 1960s. Despite the lack of improvement in survival as a result of the systemic vascular disease, the older patient can benefit from rehabilitation efforts with goals of prosthetic ambulation or simply cosmesis. The shortened longevity emphasizes the need for timely rehabilitation to enhance the quality of the remaining years. The geriatrician can add to the presurgical care and preprosthetic phase of rehabilitation by attention to the problems common to the older patient, i.e., multiple comorbidities, polypharmacy, immobility, and depression. Postoperatively, early mobilization is crucial to avoid the deleterious effects of immobility in the older person. Further investigations into the psychosocial issues and cost benefits of limb loss and prosthetic rehabilitation are needed. In addition, comparison of the various rehabilitation protocols and the impact of cardiac resting before rehabilitation are needed.
回顾过去25至30年中，老年患者下肢大截肢后假体康复的结果。
通过计算机化的医学文献数据库检索，使用关键词“老年截肢者康复”和“下肢截肢”，对有关下肢截肢的文章和报告进行文献综述。
年龄本身不应决定假体康复。合并症和总体健康状况是重要的决定因素。截肢部位越靠近近端，假肢步态对心血管和肺部系统的能量需求就越大。手术技术和血管重建程序的改变使得膝关节得以保留，这降低了能量需求，并使更多老年患者有机会接受步行康复治疗。尽管膝下（经胫骨）截肢与膝上（经股骨）截肢的比例有所增加，但自20世纪60年代以来，总体手术死亡率（10 - 30%）、长期生存率（2年时为40 - 50%，5年时为30 - 40%）以及对侧腿丧失的风险（2年时为15 - 20%）并未显著改变。尽管由于全身性血管疾病生存率没有提高，但老年患者仍可从以假肢步行或单纯美容为目标的康复努力中受益。寿命缩短强调了及时康复以提高剩余岁月质量的必要性。老年病医生可以通过关注老年患者常见的问题，即多种合并症、多种药物治疗、行动不便和抑郁，来加强术前护理和康复的术前阶段。术后，早期活动对于避免老年人因行动不便产生的有害影响至关重要。需要进一步研究心理社会问题以及肢体缺失和假体康复的成本效益。此外，还需要比较各种康复方案以及康复前心脏静息的影响。
