AMPUTATION VS RECONSTRUCTION FOLLOWING LIMB INJURY

对威胁肢体的下肢损伤的适当处理是 这是骨科和创伤文献中广泛争论的主题。 虽然保肢手术现在在技术上是可行的，但很少 越来越明显的是，保肢手术并不 总是等同于良好的功能和病人的福祉。 的确存在 有证据表明，对于某些类型的损伤和患者， 截肢的结果比长时间的，昂贵的 重建 然而，目前，截肢的决定与 重建通常基于主观参数，因为真实性 保肢的限制尚未确定，也没有具体的适应症， 原发性截肢已经阐明。 本研究的目的是 建立一个科学合理的知识库， 临床医生与患者和家属一起决定 适当的治疗选择。 具体目标是：（l）确定 临床和功能结局（包括与健康相关的 生活）后严重，高能量，下肢创伤。(2)到 估计与这些伤害相关的直接和间接费用。 (3)确定成功保肢的早期临床预测因素， 良好的功能结果。 (4)为了确定急性 解释临床和功能结局变化的治疗， (5)识别患者及其环境的特征， 调节功能成果和总体福祉的质量 截肢和重建的区别 主要关注的是 3个主要患者亚组的成本和结局比较：（A）早期 截肢（B）延迟截肢和（C）成功保肢。 该研究将包括一项前瞻性纵向研究， 约700名18-54岁的患者，在12个I级创伤中接受治疗 全国各地的中心。 研究患者将在 首次住院，在术后第一年内间隔3个月， 受伤，并在第二年后的6个月间隔。的一半 研究人群将在36个月时再次接受采访。 患者 也将由骨科医生和体检医生进行临床评估。 出院时以及3、6、12、18、24和36岁时的治疗师 个月 这些数据将用于实现研究目标， 制定一套治疗巨大下肢的初步指南 外伤

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.