A 15-year follow-up of transfemoral amputees with bone-anchored transcutaneous prostheses MECHANICAL COMPLICATIONS AND PATIENT-REPORTED OUTCOMES
A 15-year follow-up of transfemoral amputees with bone-anchored transcutaneous prostheses MECHANICAL COMPLICATIONS AND PATIENT-REPORTED OUTCOMES
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DOI：
10.1302/0301-620x.102b1.bjj-2019-0611.r1
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发表时间：
2020-01-01
影响因子：
4.6
通讯作者：
Reinholdt, C.
中科院分区：
文献类型：
--
作者：
Hagberg, K.;Jahani, S-A Ghassemi;Reinholdt, C.
目的本研究的目的是描述单侧经股截肢（TFA）患者使用骨锚定经皮假体治疗的植入物和患者报告的结局。患者和方法在这项队列研究中，纳入了1999年1月至2017年12月期间在瑞典哥德堡Sahlliska大学医院接受截肢者康复骨整合假体（OPRA）植入系统治疗的所有单侧TFA患者。该队列包括111例患者（78例男性（70%）），平均年龄45岁（17至70岁）。截肢的主要原因是75人（68%）的创伤和23人（21%）的肿瘤。患者在治疗前和2年、5年、7年、10年和15年随访时回答了经股动脉截肢患者问卷（Q-TFA）。在每个时间点为每例患者分配假体活动等级。所有的机械并发症，定义为骨折，弯曲，或磨损的任何一部分的植入物系统，导致删除或更改，recorded.ResultsThe Q-TFA评分在两个，五，七，十年显示显着更多的假体使用，更好的流动性，更少的问题，并改善全球的情况，与基线相比。7年和15年后，骨结合种植体部分（固定装置）的存活率分别为89%和72%。共有61名患者（55%）发生机械并发症（平均3.3（SD 5.76）），导致经皮植入物部件的更换。有一个较高的活动等级和机械并发症的数量之间的正相关。ConclusionComparison与治疗前相比，患者报告的结果是显着更好，并保持随着时间的推移。尽管在15年的时间里已经证明了骨整合和转移载荷的能力，但在外部种植体部件中发现了大量的机械失效。由于这些与较高的活动有关，因此需要限制活动并改善种植体系统的机械性能。
AimsThe aim of this study was to describe implant and patient-reported outcome in patients with a unilateral transfemoral amputation (TFA) treated with a bone-anchored, transcutaneous prosthesis. Patients andMethodsIn this cohort study, all patients with a unilateral TFA treated with the Osseointegrated Prostheses for the Rehabilitation of Amputees (OPRA) implant system in Sahlgrenska University Hospital, Gothenburg, Sweden, between January 1999 and December 2017 were included. The cohort comprised 111 patients (78 male (70%)), with a mean age 45 years (17 to 70). The main reason for amputation was trauma in 75 (68%) and tumours in 23 (21%). Patients answered the Questionnaire for Persons with Transfemoral Amputation (Q-TFA) before treatment and at two, five, seven, ten, and 15 years' follow-up. A prosthetic activity grade was assigned to each patient at each timepoint. All mechanical complications, defined as fracture, bending, or wear to any part of the implant system resulting in removal or change, were recorded.ResultsThe Q-TFA scores at two, five, seven, and ten years showed significantly more prosthetic use, better mobility, fewer problems, and an improved global situation, compared with baseline. The survival rate of the osseointegrated implant part (the fixture) was 89% and 72% after seven and 15 years, respectively. A total of 61 patients (55%) had mechanical complications (mean 3.3 (SD 5.76)), resulting in exchange of the percutaneous implant parts. There was a positive relationship between a higher activity grade and the number of mechanical complications.ConclusionCompared with before treatment, the patient-reported outcome was significantly better and remained so over time. Although osseointegration and the ability to transfer loads over a 15-year period have been demonstrated, a large number of mechanical failures in the external implant parts were found. Since these were related to higher activity, restrictions in activity and improvements to the mechanical properties of the implant system are required.