目的:大多数患者在胫骨截肢后使用传统的接受腔假体(TSP)独立行走。然而,这些患者通常需要每年两次以上的假体修复,每两年需要一个全新的假体修复。此外,胫骨截肢患者的皮肤溃疡率是股骨截肢患者的四倍,促使更频繁的假体改装和减少使用。胫骨骨整合(TTOI)是解决TSP局限性的一种有前途的技术,但仍未得到充分研究,只有4个队列,总共41个程序之前报告。对感染风险的持续关注以及术后功能能力的问题减缓了TTOI在全球的采用。
目的:本研究报告了流动性的变化,生活质量(QOL),以及最大的描述的创伤性截肢后单侧TTOI患者队列的安全性。
方法:回顾性观察性队列研究。该队列由骨整合干预前后收集的患者数据组成。
方法:大型,三级转诊,主要的大都市中心。
方法:21名骨骼成熟的成年人接受腔窝假体康复失败,至少有两年的骨整合后随访。
方法:流动性由K级评估,定时和去(TUG),六分钟步行测试(6MWT)。通过调查评估QOL:每日假肢磨损小时数,假肢问题的经验,对假肢的一般满意,和简短表格36(SF36)。不良事件包括任何相关的计划外手术,例如感染,骨折,植入物松动,或植入失败。
结果:所有患者在骨整合手术后K水平方面均表现出统计学上的显着改善,TUG,6MWT,假肢磨损小时数,假肢问题的经验,一般假体满意度评分,和SF36物理分量得分(全部p<0.01)。三名患者进行了四次计划外手术:两次软组织翻新,和一个软组织清创术,然后最终移除植入物。没有死亡,术后全身并发症,更多的近端截肢,或发生假体周围骨折。
结论:TTOI可能会改善单侧创伤性胫骨截肢后对TSP康复不满意的患者的活动能力和生活质量。不良事件相对罕见,不会进一步致残。对于正确选择的患者,正确使用TTOI似乎是合理的。
方法:2(治疗性调查,具有戏剧性效果的观察性研究)。
OBJECTIVE: Most patients use a traditional socket prosthesis (TSP) to ambulate independently following transtibial amputation. However, these patients generally require prosthesis repairs more than twice annually and an entirely new prosthesis every two years. Furthermore, transtibial amputation patients have four times the skin ulceration rate of transfemoral patients, prompting more frequent prosthesis refitting and diminished use. Trans-Tibial osseointegration (TTOI) is a promising technique to address the limitations of TSP, but remains understudied with only four cohorts totaling 41 total procedures reported previously. Continued concerns regarding the risk of infection and questions as to functional capacity postoperatively have slowed adoption of TTOI worldwide.
OBJECTIVE: This
study reports the changes in mobility, quality of life (QOL), and the safety profile of the largest described cohort of patients with unilateral TTOI following traumatic amputation.
METHODS: Retrospective observational cohort
study. The cohort consisted of patients with data outcomes collected before and after osseointegration intervention.
METHODS: A large, tertiary referral, major metropolitan center.
METHODS: Twenty-one skeletally mature adults who had failed socket prosthesis rehabilitation, with at least two years of post-osseointegration follow-up.
METHODS: Mobility was evaluated by K-level, Timed Up and Go (TUG), and Six Minute Walk Test (6MWT). QOL was assessed by survey: daily prosthesis wear hours, prosthesis problem experience, general contentment with prosthesis, and Short Form 36 (SF36). Adverse events included any relevant unplanned surgery such as for infection, fracture, implant loosening, or implant failure.
RESULTS: All patients demonstrated statistically significant improvement post osseointegration surgery with respect to K-level, TUG, 6MWT, prosthesis wear hours, prosthesis problem experience, general prosthesis contentment score, and SF36 Physical Component Score (p < 0.01 for all). Three patients had four unplanned surgeries: two soft tissue refashionings, and one soft tissue debridement followed eventually by implant removal. No deaths, postoperative systemic complications, more proximal amputations, or periprosthetic fractures occurred.
CONCLUSIONS: TTOI is likely to confer mobility and QOL improvements to patients dissatisfied with TSP rehabilitation following unilateral traumatic transtibial amputation. Adverse events are relatively infrequent and not further disabling. Judicious use of TTOI seems reasonable for properly selected patients.
METHODS: 2 (Therapeutic investigation, Observational
study with dramatic effect).