火器伤害导致的早期与延迟下肢截肢:至少两年的随访。

Mustafa Aydın, Ali Murat Başak, Ömer Levent Karadamar, Begüm Aslantaş, Ali Aydilek, Tolga Ege, Deniz Cankaya
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引用次数: 0

摘要

背景:火器伤等高能量伤亡可能导致下肢软组织和骨骼的大面积缺损。虽然这类损伤的主要目的是保留肢体,但反复进行肢体抢救和随后的功能恢复手术可能会对患者的身体和心理造成不利影响。本研究的主要目的是评估枪伤后早期接受下肢截肢手术的患者与晚期接受截肢手术的患者的生理和心理结果比较。我们还评估了影响晚期膝下截肢(BKA)患者预后的因素:这项回顾性研究纳入了 2016 年 3 月至 2022 年 3 月间因枪支造成下肢损伤而接受 BKA 的患者。在受伤后立即被送往的第一个中心接受急诊下肢截肢手术的患者构成早期截肢(EA)组。在其他中心接受首次干预后转到我们的三级转诊中心继续治疗并随后接受 BKA 的患者构成晚期截肢(LA)组。我们对患者的年龄、性别、截肢侧、幻肢痛(PLP)和创伤后应激障碍(PTSD)进行了评估:共有 35 名患者的医院病历资料,其中 EA 组 16 人,LA 组 19 人。所有患者均为男性。受伤时的平均年龄为(25.5±5.3)岁(20-45 岁),平均随访时间为(37±17)个月(25-84 个月)。在PLP经历的比较中,组间差异具有统计学意义,EA组有1名(10%)患者经历过PLP,而LA组有9名(90%)患者经历过PLP(P=0.010)。EA组有3名(23%)患者被诊断出创伤后应激障碍,LA组有10名(77%)患者被诊断出创伤后应激障碍(P=0.039):结论:晚期接受 BKA 的患者受 PLP 和创伤后应激障碍影响的比例较高。在决定为下肢严重开放性损伤患者实施保肢手术时,考虑到晚期 BKA 的不良预后至关重要。患者应充分了解这些不良后果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Early versus delayed lower extremity amputations caused by firearm injury: A minimum 2-year follow-up.

Background: High-energy casualties such as firearm injuries may result in extensive loss of soft tissue and bone in the lower extremities. Although the primary aim in these types of injuries is the preservation of the extremity, repeated surgical procedures for extremity salvage and subsequent restoration of function could have detrimental effects on the patient both physically and psychologically. The main aim of this study is to evaluate the physical and psychological outcomes of patients who underwent lower extremity amputation in the early period after a firearm injury compared with the results of patients who underwent amputation in the late period. We also evaluated the factors affecting the prognosis in patients undergoing late below-knee amputation (BKA).

Methods: This retrospective study included patients who underwent BKA following a lower extremity injury caused by firearms between March 2016 and March 2022. Patients who underwent emergency BKA at the first center they were taken to immediately after the injury constituted the early amputation (EA) group. Patients who were transferred to our tertiary-level referral center for continuation of treatment after the first intervention at another center and later underwent BKA constituted the late amputation (LA) group. The patients were evaluated regarding age, gender, amputation side, presence of phantom limb pain (PLP), and post-traumatic stress disorder (PTSD).

Results: Information was available from hospital records for a total of 35 patients; 16 in the EA group and 19 in the LA group. All patients were male. The mean age at the time of injury was 25.5±5.3 years (range, 20-45 years), and the mean follow-up period was 37±17 months (range, 25-84 months). In the comparison of PLP experienced, the difference between the groups was statistically significant, with PLP experienced by 1 (10%) patient in the EA group and by 9 (90%) in the LA group (p=0.010). PTSD was diagnosed in 3 (23%) patients in the EA group and 10 (77%) patients in the LA group (p=0.039).

Conclusion: Patients who underwent late BKA were found to be affected by PLP and PTSD at a higher rate. When deciding on extremity-preserving surgery for patients with severe open injuries to the lower extremity, it is crucial to consider the poor outcomes associated with late BKA. Patients should be thoroughly informed about these negative outcomes.

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