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【J Vasc Surg】周围动脉疾病患者经膝关节截肢术
Through-knee amputation in patients with peripheral arterial disease: A review of 50 cases
Presented at the Thirty-second Annual Meeting of The Southern Association for Vascular Surgery, Naples, Fla, Jan 16-19, 2008.
Bryan C. Morse, MD, David L. Cull, MD, Corey Kalbaugh, MS, Anna L. Cass, MPH, Spence M. Taylor, MD
Received 21 January 2008; accepted 9 April 2008. published online 01 July 2008.
Background
For good rehabilitation candidates, the biomechanical advantages of the end weight-bearing through-knee amputation (TKAmp) compared with the above knee amputation (AKA) are well established. However, the TKAmp has been abandoned by vascular surgeons because of poor wound healing rates related to long tissue flaps and challenges to prosthetic fitting related to the femoral condyles. Since 1998, we have performed the modified “Mazet” technique TKAmp procedure that creates shorter flaps to close the wound and greatly facilitates prosthesis fitting. The purpose of this study is to review our results with TKAmp in patients with peripheral vascular disease who were not candidates for below-knee amputation.
Methods
The records of all patients who underwent through-knee amputation between 1998 and 2006 were retrospectively reviewed. Mean follow-up was 33 months (range, 38 days to 99 months). Amputations for trauma and malignancy were excluded. Patient survival, maintenance of ambulation, and independent living status were analyzed using Kaplan-Meier survival analysis methods.
Results
Fifty patients underwent TKAmp using a modified Mazet technique. The mean age was 63 years; 50% were men, and 50% had diabetes mellitus. All patients had peripheral arterial disease. Thirty-five patients (70%) had prior revascularization procedures. Those patients averaged 2.2 revascularization procedures prior to amputation. There were three (6%) perioperative deaths. The ipsilateral common femoral artery was patent in 43/50 (86%) of patients at the time of amputation. Forty patients (80%) had open wounds and three patients (6%) had a failed below-knee amputation at the time of TKAmp. Thirty-eight patients (81%) healed their TKAmp wound. Nine patients failed to heal and were revised to an above knee amputation. The cumulative probability of regular prosthetic usage and maintenance of ambulation was estimated to be 0.56 at 3 years and 0.41 at 5 years. The probability of maintaining independent living status at 3 and 5 years was 0.77 and 0.65, respectively. Survival probabilities for patients in this series were 0.60 at 3 years and 0.44 at 5 years.
Conclusion
These data show that the TKAmp is associated with an acceptable primary healing rate and satisfactory functional outcomes in patients with peripheral arterial disease. The advantages of TKAmp over AKA make it the preferred alternative for patients with vascular disease who are candidates for prosthetic rehabilitation. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领
Through-knee amputation in patients with peripheral arterial disease: A review of 50 cases
周围动脉疾病患者经膝关节截肢术：50例报告
Presented at the Thirty-second Annual Meeting of The Southern Association for Vascular Surgery, Naples, Fla, Jan 16-19, 2008.
发表于第32届南方血管外科年会 Naples, Fla, Jan 16-19, 2008.
Bryan C. Morse, MD, David L. Cull, MD, Corey Kalbaugh, MS, Anna L. Cass, MPH, Spence M. Taylor, MD
Received 21 January 2008; accepted 9 April 2008. published online 01 July 2008.
收到 2008-01-21 修回 2008-04-09 在线出版 2008-07-01
Background
For good rehabilitation candidates, the biomechanical advantages of the end weight-bearing through-knee amputation (TKAmp) compared with the above knee amputation (AKA) are well established. However, the TKAmp has been abandoned by vascular surgeons because of poor wound healing rates related to long tissue flaps and challenges to prosthetic fitting related to the femoral condyles. Since 1998, we have performed the modified “Mazet” technique TKAmp procedure that creates shorter flaps to close the wound and greatly facilitates prosthesis fitting. The purpose of this study is to review our results with TKAmp in patients with peripheral vascular disease who were not candidates for below-knee amputation.
背景：对康复顺利的患者，经膝关节截肢术(TKAmp)与膝关节上截肢术相比具有更好的生物力学优点。然而，由于组织皮瓣过长造成的愈合率低和股骨髁造成的假肢装配困难等因素的影响，经膝关节截肢术已被血管外科医师摒弃。自1998年，我们采用改良的“Mazet”经膝关节截肢术，从而缩短创面皮瓣并方便了假肢的装配。本研究的目的是对不适合行膝关节下截肢术的周围血管疾病患者接受经膝关节截肢术的预后进行回顾性分析。
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作者:admin@医学,生命科学 2010-11-04 17:11
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