CAJ | 학술논문

目的探讨下肢创伤性截肢后残端问题的影响因素及其手术治疗.方法 1992年11月至2008年8月共收治72例(80侧)下肢踝关节以上创伤性截肢后因残端问题而进行手术治疗的患者,其中男47例,女25例;年龄9～60岁,平均(28.8±12.4)岁.小腿截肢48侧,大腿截肢32侧.从受伤截肢到因残端问题接受手术治疗的时间平均为32.7个月.对患者残端问题进行评价,将性别、单双侧截肢、截肢部位(大腿与小腿)、致伤原因作为因素,截肢到首次残端修整术时间、软组织多余臃肿、皮肤明显瘢痕、皮肤溃疡、神经瘤、骨刺作为水平,统计分析每一因素与各水平间的关系.通过ADL评分评价手术后的效果.结果 14侧行胫腓骨融合术,12侧残端修整术≥2次,双侧截肢者13例21侧(8例双侧残端同时修整),再截肢5侧.80侧残端问题中有53侧(66.3%)原始截肢时未行残端肌肉固定成形术,瘢痕多者42侧(52.5%),神经瘤38侧(47.5%),软组织过多臃肿皱褶24侧(30.0%),皮肤溃疡14侧(17.5%).原始截肢到首次残端修整术的时间小腿截肢比大腿截肢长,差异存统计学意义(P=0.030);大腿截肢软组织臃肿多于小腿截肢,差异有统计学意义(P=0.007);单侧截肢患者骨刺发生率高于舣侧截肢患者,差异有统计学意义(P=0.018).41例患者入院时ADL评分平均为(85.31±7.24)分,出院时为(95.40±3.92)分,差异有统计学意义(t=-11.536,P=0.000).结论单双侧截肢、截肢部位是影响下肢创伤性截肢后残端问题的重要因素.选择适当的患者进行残端修整术及胫腓骨融合术可获得良好疗效.
목적 탐토하지창상성절지후잔단문제적영향인소급기수술치료.방법 1992년11월지2008년8월공수치72례(80측)하지과관절이상창상성절지후인잔단문제이진행수술치료적환자,기중남47례,녀25례;년령9～60세,평균(28.8±12.4)세.소퇴절지48측,대퇴절지32측.종수상절지도인잔단문제접수수술치료적시간평균위32.7개월.대환자잔단문제진행평개,장성별、단쌍측절지、절지부위(대퇴여소퇴)、치상원인작위인소,절지도수차잔단수정술시간、연조직다여옹종、피부명현반흔、피부궤양、신경류、골자작위수평,통계분석매일인소여각수평간적관계.통과ADL평분평개수술후적효과.결과 14측행경비골융합술,12측잔단수정술≥2차,쌍측절지자13례21측(8례쌍측잔단동시수정),재절지5측.80측잔단문제중유53측(66.3%)원시절지시미행잔단기육고정성형술,반흔다자42측(52.5%),신경류38측(47.5%),연조직과다옹종추습24측(30.0%),피부궤양14측(17.5%).원시절지도수차잔단수정술적시간소퇴절지비대퇴절지장,차이존통계학의의(P=0.030);대퇴절지연조직옹종다우소퇴절지,차이유통계학의의(P=0.007);단측절지환자골자발생솔고우의측절지환자,차이유통계학의의(P=0.018).41례환자입원시ADL평분평균위(85.31±7.24)분,출원시위(95.40±3.92)분,차이유통계학의의(t=-11.536,P=0.000).결론 단쌍측절지、절지부위시영향하지창상성절지후잔단문제적중요인소.선택괄당적환자진행잔단수정술급경비골융합술가획득량호료효.
Objective To investigate the surgical management strategies for stump problems fol-lowing trauma-related amputation of lower limb. Methods From November 1992 to August 2008, 72 consecutive patients, who had been troubled by stump problems after above-the-ankle amputation due to trauma, underwent revision surgery of the stump. They were 47 men and 25 women, aged from 9 to 60 (average, 28.8±12.4) years old. The stump problems in all these cases were analyzed retrospectively. Gender, unilateral or bilateral amputation, amputation level, trauma cause were hypothesized as group factors; duration between the original amputation and the first revision surgery, soft tissue redundancy, scar, ulcer, neuroma, and exostosis were taken as levels in each group. The correlations between factors and levels were analyzed statistically. Activities of daily living (ADL) scores were also obtained to estimate effectiveness of the management strategies. Results Eighty problem stumps were treated surgically, including 48 above-knee amputations and 32 below-knee amputations. The duration from the original amputation to the first revision surgery in the below-knee amputation cases was longer than that in the above-knee amputation ones( P = 0.030); the soft tissue redundancy in the above-knee amputation cases was higher than in the below-knee amputation ones (P=0.007); the exostosis in the unilateral amputation was higher than in the bilateral one (P=0.018). The differences in the A DL scores in 41 cases between initial hospitalization and discharge were significant (t=-11.536, P=0.000) . Conclusion Since stump problems following trauma-related amputation of lower limb can have crucial influence on living and work of the amputees, appropriate surgical management should be recommended due to its reliable therapeutic effects.