Fifteen years of experience with Integral-Leg-Prosthesis: Cohort study of artificial limb attachment system
Fifteen years of experience with Integral-Leg-Prosthesis: Cohort study of artificial limb attachment system
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DOI：
10.1682/jrrd.2014.11.0280
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发表时间：
2015-01-01
影响因子：
--
通讯作者：
Aschoff, Horst H.
中科院分区：
文献类型：
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作者：
Juhnke, Dora-Lisa;Beck, James P.;Aschoff, Horst H.
整体式假肢是一种较新的附着系统，可实现假肢的直接骨骼对接。在1999年1月至2013年12月期间，69名经股截肢患者由一名德国外科医生安装了ILP。这些年来，器械设计迭代和手术技术不断发展。为了进行比较，将接受前两种设计和手术迭代的患者置于第1组，将符合最终设计的患者置于第2组。使用Fisher精确检验对感染率和计划和非计划手术干预进行统计学比较。数据表明，在第1组中观察到的造口相关感染的高发生率在第2组中显著降低。在第2组的39名患者中，42个种植体，没有继发于感染的手术干预。所有第2组患者通过遵循简单但明确的伤口卫生方案，在不使用抗生素的情况下保持无感染。我们得出的结论是，在软组织和假体界面处具有低能量表面的骨整合髓内器械的最终迭代允许生物稳定的皮肤造口保持无感染，无需长期使用抗生素。感染率的降低归因于基于临床的经验驱动的设计和手术技术变更。
Integral-Leg-Prosthesis (ILP) is a comparatively new attachment system that allows direct skeletal docking of artificial limbs. Between January 1999 and December 2013, 69 patients with transfemoral amputation were fitted with ILPs by a single German surgeon. Device design iterations and surgical techniques evolved during these years. For the purposes of comparison, patients receiving the first two designs and procedure iterations were placed in group 1 and the patients fitted with the final design were placed in group 2. Infection rate and planned and unplanned surgical interventions were statistically compared using Fisher exact test. Data demonstrated that the high rate of stoma-associated infections seen in group 1 was dramatically reduced in group 2. Of the 39 patients with 42 implants in group 2, none had operative interventions secondary to infection. All group 2 patients remained infection-free without the use of antibiotics by following a simple but defined wound-hygiene protocol. We concluded that the final iteration of the osseointegrated intramedullary device with a low energy surface at the soft tissue and prosthesis interface allowed a biologically stable skin stoma that remained infection-free without chronic use of antibiotics. The reduction in the infection rate was attributed to the clinically based, empirically driven changes in design and surgical techniques.