Surgical experience and supervision may influence the quality of lower limb amputation
Surgical experience and supervision may influence the quality of lower limb amputation
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DOI：
10.1308/003588402760452691
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发表时间：
2002-09-01
影响因子：
1.4
通讯作者：
Ashley, S
中科院分区：
文献类型：
--
作者：
Cosgrove, CM;Thornberry, DJ;Ashley, S
目的：在因周围血管疾病（PVD）而接受下肢大截肢的患者中，只有一半可能使用假体活动。本研究的目的是确定是否外科医生的经验影响残肢的质量，从而适合于一个prosthes.Methods的残端的可能性：所有患者接受主要下肢截肢PVD前瞻性招募，1992年8月和1996年7月之间。手术后，由康复医学顾问将患者分类为可能适合（I组）或不适合（II组）进行康复。I组中的患者进行了进一步的评估，由假肢fitting.Results：共217例患者进行了260截肢PVD之间1992年和1996年：经股骨（TFA）131，经胫骨（TTA）127，并通过膝关节（TKA）在2。30天死亡率为12%（n = 27）。手术后，109例患者被分配到I组（51%），81例患者被分配到II组（37%）。两组患者中进行手术的初级外科医生的比例相似。23例截肢残端（9%）需要在30天内翻修或转换为更高水平。翻修或转换显着更频繁的原始操作已经完成了一个无人监督的初级外科医生，而不是一个资深外科医生（P = 0.009）。有缺陷的截肢损害肢体拟合率也达到了显着性时，无人监督的初级和高级外科医生进行了比较（P = 0.04）。结论：康复的相对较少的截肢者谁达到阶段的肢体拟合是阻碍了不良的手术技术在很大比例的情况下。由更有经验的外科医生进行手术的患者有更好的机会活动而无需翻修或转换手术。
Aim: Only half of those patients undergoing major lower limb amputations for peripheral vascular disease (PVD) are likely to mobilise on a prosthesis. This study aimed to determine whether a surgeon's experience influenced the quality of the residual limb and thus the likelihood of the stump being suitable for a prosthesis.Methods: All patients undergoing major lower limb amputations for PVD were recruited prospectively, between August 1992 and July 1996. Following surgery, patients were categorised, by a consultant in rehabilitation medicine, as potentially suitable (group I) or unsuitable (group II) for rehabilitation. Patients in group I were further assessed by prosthetists for limb fitting.Results: A total of 217 patients underwent 260 amputations for PVD between 1992 and 1996: transfemoral (TFA) 131, trans-tibial (TTA) 127, and through-knee (TKA) in 2. The 30-day mortality was 12% (n = 27). Following surgery, 109 patients were assigned to group I (51%), and 81 patients to group II (37%). The proportion of junior surgeons performing surgery was similar for patients in both groups. Twenty-three amputation stumps (9%) required revision or conversion to a higher level within 30 days. Revisions or conversions were significantly more frequent where the original operation had been performed by an unsupervised junior surgeon rather than a senior surgeon (P = 0.009). The rate of defective amputations compromising limb fitting also reached significance when unsupervised junior and senior surgeons were compared (P = 0.04).Conclusions: Rehabilitation of the relatively few amputees who reach the stage of limb fitting is hindered by poor surgical technique in a large proportion of cases. Patients operated on by a more experienced surgeon had a better chance of mobilising without revision or conversion surgery.