OUTCOMES FOLLOWING LIMB RECONSTRUCTION VS AMPUTATION

这是一项继续和延长正在进行的结果前瞻性研究的建议 在高能量的下肢创伤之后。下层的主要目标 肢体评估项目或‘LEAP’研究是(1)比较临床和 截肢者与成功截肢者的功能结局 重建，(2)确定成功保肢的早期临床预测因素和 良好的功能结果，以及(3)确定患者和他的特征 调节功能结果质量和油井质量的环境 是存在的。研究人员建议将随访期延长至受伤后5年。 两年随访的初步结果显示， 身体机能随着时间的推移。然而，两年的结果远远不是最佳的。 只有50%的患者回到了他们的主要角色活动； 分数是严重残疾的标志。此外，几乎没有区别 在接受截肢的患者中观察到的结果与 重建。如果不对这些人进行更长期的跟踪， 调查人员表示，他们的康复情况并不完整，预计 所有患者的永久性损伤和残疾水平，以及 治疗。尽管患者在以下方面似乎已经达到了平台期 临床恢复，有理由相信功能恢复可能 对于一些患者来说，继续改善；对于另一些患者，功能可能会恶化。 为期5年的跟踪调查将针对以下具体目标：(1)确定 高能量低能量后的长期(5年)结局和生活质量 四肢创伤和比较截肢者的预后 最初住院，出院后截肢， 和成功重建；(2)估算5年和生命周期成本 与高能低能量后截肢和重建相关 四肢创伤；以及(3)在5岁时确定良好结果的相关因素 截肢和重建术患者受伤后数年。此外, 他们建议扩展对两年数据的分析，以解决几个重要的问题 临床和方法学问题。

This is a proposal to continue and extend an ongoing prospective study of outcomes following high energy lower extremity trauma. The principal objectives of the Lower Extremity Assessment Project or 'LEAP' study were to (1) compare clinical and functional outcomes for those undergoing amputation versus successful reconstruction, (2) identify early clinical predictors of successful limb salvage and good functional outcomes, and (3) identify characteristics of the patient and his environment that mediate the quality of functional outcomes and quality of well being. The investigators propose to extend the followup to 5 years post-injury. Preliminary results of the 2 year follow-up indicate substantial improvement in physical function over time. However, 2 year outcomes are far from optimal. Only 50 percent of all patients are back to their major role activity; SIP scores are indicative of significant disability. Furthermore, little difference in outcomes was observed among those undergoing amputation versus reconstruction. Without longer term follow-up of these individuals, the investigators state they have an incomplete picture of recovery and expected levels of permanent impairment and disability over all patients, and by treatment. Although patients appear to have achieved a plateau in terms of clinical recovery, there is reason to believe that functional recovery may continue to improve for some patients; for others, function may deteriorate. The 5-year followup will address the following specific aims: (1) to determine the long term (5 year) outcomes and quality of life following high energy lower extremity trauma and to compare outcomes of those undergoing amputation during the initial hospitalization, amputation following discharge from the hospital, and successful reconstruction; (2) to estimate 5 year and lifetime costs associated with amputation versus reconstruction following high energy lower extremity trauma; and (3) to determine the correlates of good outcome at 5 years post injury for both amputation and reconstruction patients. In addition, they propose to extend analysis of the 2-year data to address several important clinical and methodological issues.