现代截肢观念

近十多年来 ,随着生物力学基础理论研究 ,新材料、新工艺、装配技术、截肢者康复等的发展 ,假肢新型接受腔的应用 ,改变传统的末端开放式接受为闭合的全面接触、全面承重式接受腔。传统的截肢方法所造成的圆锥状残肢显然已不适合现代假肢接受腔的装配 ,就要求残肢要有合理的长度 ,圆柱状的外形 ,良好的肌力和功能。因此 ,截肢技术也相应的有了很大发展。本文就现代截肢观念的一些问题进行讨论。1　理想残肢的概念[1]　　作者单位 :5 70 10 2海口 ,海南省人民医院复康中心假肢科　　残肢要安装良好的假肢才能发挥最佳的代偿功能 ,这就要求残…     

对影响假肢穿戴的非理想残肢康复问题的探讨

截肢患者穿戴假肢才能发挥代偿功能 ,假肢代偿功能的水平与残肢条件密切相关 ,一些残肢由于并发症等原因而影响假肢穿戴。本文就我院 8年来收住院的 16 4例截肢患者中 81例影响假肢穿戴的非理想残肢康复问题进行讨论。提出影响假肢穿戴的非理想残肢的概念 ;非理想残肢的种类及对假肢穿戴的主要影响 ;康复的原则和方法 ,假肢制作技术的改进和主要的手术方法 ,以达到改善非理想残肢条件 ,使其可以穿戴良好的假肢 ,发挥满意的代偿功能的目的。     

对截肢问题的探讨

近年来 ,随着生物力学基础理论研究和生物工程学的发展 ,新材料、新工艺的应用 ,假肢制作技术水平的提高 ,尤其是假肢新型接受腔的应用 ,传统的末端开放式接受腔改变成为闭合的、全面接触、全面承重式接受腔 ,并具有残肢承重合理、穿戴舒适、假肢悬吊能力强、不影响残肢血液循环等优点。为了适合现代假肢的良好配戴和发挥最佳代偿功能 ,残肢应具备如下条件 :残肢外形为圆柱状 ,有适当的长度 ,良好的皮肤和软组织条件 ,皮肤感觉正常、无畸形 ,关节活动不受限 ,肌肉力量正常 ,无残肢痛或幻肢痛等。这就要求在截肢部位的选择、截肢手术方法、截…     

对下肢截肢非理想残肢假肢装配问题的探讨

本文就六年来住院下肢截肢患者的非理想残肢91例，对其中未经手术矫治的48例假肢装配问题进行讨论，认为硅橡胶袜套、辅助悬吊带、假肢与矫形器的组合应用及调整好对线等，为某些非理想残肢患者的假肢安装提供了值得推广的好方法，使其穿戴上良好的假肢，充分发挥代偿功能。     

释放接受腔股三角区的挤压力对大腿截肢者残肢肌肉萎缩的影响

目的:通过对两组不同类型的接受腔使用试验,观察不同接受腔对残肢肌肉萎缩速度的影响。方法:选取30例大腿截肢后首次安装假肢的患者,随机分为试验组和对照组,观察截肢者使用两种接受腔后6个月、12个月后的残肢肌肉萎缩情况,分析引起肌肉萎缩的原因。结果:试验组15例使用坐骨包容接受腔,6个月后残肢萎缩约2.0%—3.0%,12个月后残肢围长变化为5.0%—7.0%;对照组13例使用坐骨承重接受腔,6个月后残肢萎缩约4.0%—6.0%,12个月后萎缩约8.0%—9.2%。结论:假肢的接受腔部件是连接假肢与残肢的主要载体,不同形式的接受腔设计可明显影响残肢肌肉萎缩的速度。坐骨包容接受腔是目前最为先进的设计,它能实现残肢与接受腔全接触,通过对股三角区的释放,残肢表面均匀的分布负荷等设计有效减缓残肢在使用假肢过程中的肌肉萎缩速度。     

现代截肢观念及现代截肢术后康复

截肢康复是指从截肢手术到术后处理，康复训练，临时与正式假肢的安装和使用，直到重返家庭与社会的全过程。文章重点论述了截肢部位的选择，现代截肢手术的改进，儿童截肢的特点，大腿截肢手术特点以及影响假肢穿载的非理想残肢的康复。     

假肢发展对截肢观念的影响

随着科学技术的发展和对假肢研究的深入 ,现代技术条件已允许假肢达到很高的对症性 ,从而满足各种各样的残肢条件和对假肢不同的功能要求。从普及型下肢假肢到全电脑控制智能仿生腿 ,从普通的美容上肢假肢到带感应控制的肌电控制假手 ,假肢技术发展的同时又促进了截肢手术的发展 ,对原来的截肢观念产生了影响 ,从而最大限度地保留了残肢的功能 ,使截肢后的患者能更好地发挥假肢的代偿功能。1　现代假肢的发展现代假肢的发展主要集中在两个方面 ,一是假肢接受腔 ,二是假肢零部件 ,特别是功能性部件 ,如膝关节、假脚。接受腔作为患者和假肢之…     

全面承重小腿假肢对小腿截肢后残肢肌肉萎缩速度的影响研究

目的:观察全面承重小腿假肢(TSB)对残肢肌肉萎缩速度的影响。方法:选取65例首次装配小腿假肢的患者,分为观察组30例和对照组35例,观察组采用TSB接受腔,对照组采用小腿假肢(PTK)接受腔。结果:2组使用假肢随访2年,观察组12及24个月残肢围长明显高于对照组(P0.05)。结论:全接触负重技术可有效减小残肢缓萎缩速度,提高接受腔适配性,是现代假肢接受腔适配技术的重要理念和新技术要求。     

小腿假肢接受腔计算机三维模型的构建

背景:假肢接受腔作为截肢患者肢体残端和假肢之间载荷传递的惟一通道,是影响假肢适配性的重要部件.假肢接受腔的三维建模是接受腔实用性的关键,可以在测量时得到更准确的数据.目的:建立假肢接受腔计算机三维模型,为接受腔有限元分析提供数据基础,为加工制造接受腔提供可靠的参数.方法:选择1例32岁右侧小腿截肢的男性患者,髋关节各肌力正常,髋18°屈曲挛缩,其他关节活动度正常.根据患者CT和核磁共振扫描图像,采用Mimics10.0软件处理数据,构建假肢接受腔计算机三维模型,准确模拟残肢和接受腔的结构.结果与结论:建立的小腿残肢和接受腔计算机三维模型比较准确地反映了接受腔和残肢的几何特征和外部轮廓.假肢接受腔三维模型的建立有助于提高制作的成功率,从根本上改变传统依靠手工设计、测量、取型、修型等落后的生产模式.     

现代截肢观念及现代截肢术后康复

截肢康复是指从截肢手术到术后处理、康复训练、临时与正式假肢的安装和使用,直到重返家庭与社会的全过程。文章重点论述了截肢部位的选择,现代截肢手术的改进,儿童截肢的特点,大腿截肢手术特点以及影响假肢穿戴的非理想残肢的康复。     

Lecture 19: Lower-Extremity Amputations and Prosthetics

Before leaving the hospital, amputees must be taught to care for their stump and to handle their prosthesis. They also must learn how to place their stump in the device, to control their body to best advantage, and to check the mechanical parts of the prosthesis.     

下肢截肢后不良残肢的临床评估和处理

目的分析下肢截肢后不良残肢发生的原因，并介绍其临床处理方法。方法对109例下肢截肢者(共计110个残肢)进行评定，评定内容包括：残肢皮肤软组织状况、长度、形状、关节活动度、肌力、幻肢痛、残肢痛等，然后对不良残肢进行相应的理疗、体疗或手术处理。结果本组合格残肢64肢(占58％)，不合格残肢46肢(占42％)。不合格残肢主要表现为：残端形状不规则20肢，短残肢18肢，残端不稳定瘢痕伴感染13肢，残端肿胀及臃肿14肢，关节屈曲挛缩畸形18肢，神经瘤2肢，经理疗、体疗或手术处理后，均达到装配假肢的条件。结论对不良残肢要进行对症处理，使之能装配或穿戴假肢。由于假肢技术的不断改进，现在残肢的长度不再是影响假肢装配的主要原因，而残端皮肤软组织的条件已成为影响假肢装配的主要因素。     

Neurology (48)

Phantom pain and phantom sensations in upper limb amputees: an epidemiological study. (University Hospital Groningen, Groningen, The Netherlands) Pain 2000;87:33–41.
This study determined the prevalence and factors associated with phantom pain and phantom sensations in upper limb amputees in The Netherlands. Additionally, the relationship between phantom pain, phantom sensations, and prosthesis use in upper limb amputees was investigated. One hundred twenty-four upper limb amputees participated in the study. Subjects were asked to fill out a self-developed questionnaire scoring the following items: date, side, level, and reason of amputation, duration of experienced pain before amputation, frequencies with which phantom sensations, phantom pain, and stump pain are experienced, amount of trouble and suffering experienced, respectively, related to these sensations, type of phantom sensations, medical treatment received for phantom pain and/or stump pain, and the effects of the treatment, self medication, and prosthesis use. The response rate was 80%. The prevalence of phantom pain was 51%, of phantom sensations 76%, and of stump pain 49%; 48% of the subjects experienced phantom pain a few times per day or more. Moderate to severe suffering from phantom pain was experienced by 64% of the respondents. A significant association was found between phantom pain and phantom sensations (relative risk 11.3) and between phantom pain and stump pain (relative risk 1.9). No other factors associated with phantom pain or phantom sensations could be determined. Only 4 patients received medical treatment for their phantom pain. Phantom pain is a common problem in upper limb amputees that causes considerable suffering for the subjects involved. Only a small number of subjects are treated for phantom pain. Conclude that further research is needed to determine factors associated with phantom pain.     

Effects of Early Mobilization on Unhealed Dysvascular Transtibial Amputation Stumps: A Clinical Trial

VanRoss ER, Johnson S, Abbott CA. Effects of early mobilization on unhealed dysvascular transtibial amputation stumps: a clinical trial.

Objective

To observe the effects of early mobilization on unhealed transtibial (TT) amputation stump wounds of dysvascular etiology. An “unhealed” stump was defined as having a wound greater than 1cm × 1cm at least 3 weeks after surgery.

Design

An observational cohort study.

Setting

This center receives about 250 new lower-limb amputees a year from over 50 surgeons working in 16 hospitals. Over 35% are unhealed.

Participants

Sixty-six consecutive new TT amputees (age 62.8±10.8y) of dysvascular etiology (diabetes 50%) with unhealed stumps were recruited. Sixty-one percent were current or past smokers. The mean ± SD stump wound size was 7.7±2.7cm × 3.2±2.0cm.

Interventions

The wound size was measured, and stump transcutaneous oxygen (TcpO₂) and transcutaneous carbon dioxide (TcpCO₂) were measured. Wounds were debrided and dressed by using a standard protocol. Mobilization using a Pneumatic Post-Amputation Mobility (PPAM) Aid for approximately 3 weeks was followed by provision of a TT prosthesis. A standard physiotherapy walking training program was performed.

Main Outcome Measures

Stump wound healing, time to achieve healing, and resting transcutaneous oxygen pressure pre- and posttherapy.

Results

Of the 66 amputees, 4 did not start. Sixty-two started; 6 withdrew, and 56 completed the trial. Complete wound healing was achieved in 74% (46/62) over a mean of 141 (87-270) days. The mean ± SD stump TcpO₂ at baseline was 41.3±19.8mmHg and increased significantly to 50.6±21.9mmHg (P<.02) after 97 (34-185) days of mobilization. Nine of 46 required revision plastic surgery. Five subjects, whose wounds were healing, became unwell, dropped out, and later deceased. Five subjects, all current smokers, did not heal and underwent higher amputation.

Conclusions

Patients with large unhealed TT stump wounds can simultaneously undergo walking training by using a prosthesis and can achieve wound healing. Seventy-four percent of subjects achieved full wound healing. The small minority of patients who did not heal were current smokers whose TcpO₂ levels did not improve throughout the trial. Rising levels of stump TcpO₂were associated with wound healing.     

Evaluation of prosthetic usage in upper limb amputees

Purpose: Upper limb amputations cause severe functional disability and lower the patient's self body image, with severe psychological implications. Many parameters are involved in the successful rehabilitation of upper limb amputations. The aim of this study was to investigate whether there are any parameters that might predict the successful prosthetic rehabilitation of upper limb amputees.

Method: The records of 45 patients who had undergone an upper limb amputation were traced. The patients were evaluated according to four parameters: (1) Modified upper extremities amputees' questionnaire; (2) Pain level according to Visual Analog Scale (VAS), range from 1 (lowest) up to 10 (highest); (3) Pain type - phantom or pain in the stump; (4) Functional assessment of prosthetic usage.

Results: Thirty (71.43%) of the patients reported difficulties with prosthesis usage. Twenty-three patients (54.76%) were satisfied with their prosthesis - 19 had cosmetic prosthesis and four had body-powered prosthesis.

Conclusion: No significant affect of the amputation level except for trans-wrist amputation with 100% prosthesis use. No significant difference was found between prosthesis type and the correlation to stump problems.

The above-elbow amputees, with dominant hand amputation, who used functional prosthesis (body-powered), achieved the best functional outcome and result.     

Evaluation of prosthetic usage in upper limb amputees

Purpose:?Upper limb amputations cause severe functional disability and lower the patient's self body image, with severe psychological implications. Many parameters are involved in the successful rehabilitation of upper limb amputations. The aim of this study was to investigate whether there are any parameters that might predict the successful prosthetic rehabilitation of upper limb amputees.

Method:?The records of 45 patients who had undergone an upper limb amputation were traced. The patients were evaluated according to four parameters: (1) Modified upper extremities amputees' questionnaire; (2) Pain level according to Visual Analog Scale (VAS), range from 1 (lowest) up to 10 (highest); (3) Pain type – phantom or pain in the stump; (4) Functional assessment of prosthetic usage.

Results:?Thirty (71.43%) of the patients reported difficulties with prosthesis usage. Twenty-three patients (54.76%) were satisfied with their prosthesis – 19 had cosmetic prosthesis and four had body-powered prosthesis.

Conclusion:?No significant affect of the amputation level except for trans-wrist amputation with 100% prosthesis use. No significant difference was found between prosthesis type and the correlation to stump problems.

The above-elbow amputees, with dominant hand amputation, who used functional prosthesis (body-powered), achieved the best functional outcome and result.