AMPUTATION VS RECONSTRUCTION FOLLOWING LIMB INJURY

四肢威胁肢体损伤的适当处理是 这是矫形外科和创伤文献中广泛争论的主题。 虽然肢体保留术现在在技术上是可行的，但只有极少数人 然而，越来越明显的是，保肢手术并不 总是等同于良好的功能和耐心的幸福。确实存在这样的情况 有证据表明，对于某些类型的损伤和患者，早期 截肢比长时间、代价高昂的截肢效果更好 重建。然而，目前截肢的决定与 重建通常基于主观参数，因为现实 肢体保留术的范围尚未确定，也没有具体的适应症 一次截肢已阐明。这项研究的目的是 开发科学合理的知识库，可供 临床医生与患者和家属共同决定一种 选择合适的治疗方法。具体目标是：(L)确定 临床和功能结果(包括与健康相关的质量 生命)，在严重的，高能量，腿部创伤之后。(2)至 估计与这些伤害相关的直接和间接成本。 (3)找出保肢成功的早期临床预测因素 良好的功能结果。(4)识别急性呼吸道感染的特征 解释临床和功能结果差异的治疗和 (5)确定患者及其环境的特征 调节功能结果和总体幸福感的质量 截肢后和重建后。最感兴趣的是一个 3个主要患者亚组的成本和结果比较：(A)早期 截肢(B)延迟截肢和(C)成功保肢。 这项研究将包括一项前瞻性的纵向研究 大约700名年龄在18-54岁之间的患者，在12个I级创伤中接受治疗 全国各地的中心。研究中的患者将在 首次住院，在术后第一年每隔3个月住院 受伤，在第二年期间每隔6个月治疗一次。一半 研究人群将在36个月后再次接受采访。病人 也将由骨科医生和体检人员进行临床评估 出院时及3、6、12、18、24及36岁的治疗师 月份。这些数据将用于解决研究的目标和 制定一套治疗巨大下肢的初步指南 精神创伤。

The appropriate management of limb threatening lower extremity injuries is the subject of extensive debate in the orthopedic and trauma literatures. Although limb salvage is now technically feasible in all but very few cases, it is becoming increasingly apparent that limb salvage does not always equate with good function and patient well-being. Indeed there is evidence to suggest that for some types of injuries and patients, an early amputation results in better outcome than does a long, costly reconstruction. At present, however, the decision to amputate versus reconstruct is most often based on subjective parameters because realistic limits of limb salvage have not been defined nor specific indications for primary amputation been elucidated. The objective of this study is to develop a scientifically sound knowledge base which can be used by clinicians together with patients and families in deciding on an appropriate choice of therapy. The specific aims are: (l) to determine the clinical and functional outcomes (including health-related quality of life) following severe, high energy, lower extremity trauma. (2) To estimate the direct and indirect costs associated with these injuries. (3) To identify early clinical predictors of successful limb salvage and good functional outcomes. (4) To identify characteristics of the acute treatment that explain variations in clinical and functional outcomes and (5) to identify characteristics of the patient and his environment that mediate the quality of functional outcomes and general well-being following amputation versus reconstruction. Of primary interest is a comparison of costs and outcomes for 3 major patient subgroups: (A) early amputation (B) delayed amputation and (C) successful limb salvage. The study will consist of a prospective, longitudinal study of approximately 700 patients aged 18-54, treated at 12 level I trauma centers across the Country. Study patients will be interviewed during the initial hospitalization, at 3 month intervals during the first year post- injury and at 6 month intervals during the second year post. One half of the study population will be interviewed again at 36 months. Patients will also be clinically assessed by an orthopedist and a physical therapist at discharge from the hospital and at 3, 6, 12, 18, 24 and 36 months. These data will be used to address the study's aims and to develop an initial set of guidelines for treating massive lower extremity trauma.