AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,re...AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC展开更多
<b>Introduction:</b> Transfemoral amputation results in a prosthesis<span "=""> </span>which bears weight on the ischium. Gait disturbance,<span "=""> </s...<b>Introduction:</b> Transfemoral amputation results in a prosthesis<span "=""> </span>which bears weight on the ischium. Gait disturbance,<span "=""> </span>lack of an end-bearing<span "=""> </span><span "="">stump and discomfort in the groin from the socket even while sitting, are important issues. <b>Methods:</b> This is a pilot report of an ongoing randomized blind clinical trial of a new intramedullary implant post transfemoral amputation. Here</span>, we describe<span "=""> </span>a single case illustrating the surgical technique and clinical outcome of a dysfunctional post-traumatic transfemoral amputation addressed with this implant.<span "=""> </span>Clinical gait analysis, SF-12 and VAS were assessed pre- and post-intervention <span "="">at 6 months of follow-up. <b>Results:</b> An improved stump control is accomplished by means of myoplasty and myodesis through an end-cap. Stride width improved from 0.21</span><span "=""> </span>m pre-op to<span "=""> </span>0.13<span "=""> </span>m post-op, and more symmetrical stride length (<span style="white-space:nowrap;"><span style="white-space:nowrap;">△</span></span>0.21<span "=""> </span>m pre-op vs. <span style="white-space:nowrap;"><span style="white-space:nowrap;">△</span></span>0.06<span "=""> </span>m post-op) was noted, indicating improved gait quality and stability. Gait velocity increased (0.51 ± 0.04 m/s pre-op<span "=""> </span><span "="">vs. 0.64 ± 0.02 m/s post-op). <b>Conclusion:</b> This technique reveals improvements in gait parameters in</span><span "=""> </span>a transfemoral amputee treated with a new procedure. Improved prosthesis control, sitting comfort, greater hip range of motion, better gait stability, and enhanced walking abilities were noted.展开更多
目的探讨穿戴坐骨包容接受腔与四边形接受腔大腿假肢的单侧大腿截肢者在日常生活中行走时的步态差异,为临床制定大腿假肢使用处方提供指导。方法选取7位大腿截肢患者作为试验组,为患者分别适配四边形和坐骨包容接受腔大腿假肢。同时选取...目的探讨穿戴坐骨包容接受腔与四边形接受腔大腿假肢的单侧大腿截肢者在日常生活中行走时的步态差异,为临床制定大腿假肢使用处方提供指导。方法选取7位大腿截肢患者作为试验组,为患者分别适配四边形和坐骨包容接受腔大腿假肢。同时选取7位年龄、性别、身高和体质量相匹配的健康受试者作为对照组。所有受试者以舒适的步速在室外平路上行走240 m,应用便携式步态测试仪(intelligent device for energy expenditure and activity,IDEEA)采集步态数据,包括7个时空参数和4个加速度参数,通过IBM SPSS Statistics 23对数据进行处理。对比患者穿戴两种假肢与健康受试者之间、患者分别穿戴同种假肢时患侧与健侧之间、患者穿戴两种假肢时患侧之间、健侧之间的参数差异。结果与健康受试者相比,患者分别穿戴两种假肢行走时,两种假肢健侧和患侧的站立时间和步态周期增大(P<0.05),步速、步频、跨步长减小(P<0.05);两种假肢患侧的摆动时间延长(P<0.05),地面冲击和足落地控制减小(P<0.05);四边形接受腔假肢双侧和坐骨包容接受腔假肢健侧的单步时间延长(P<0.05)。四边形接受腔假肢患侧摆动时间长于健侧(P=0.03);坐骨包容接受腔假肢患侧摆动时间长于健侧(P=0.02),地面冲击小于健侧(P=0.04)。四边形接受腔假肢患侧的步态周期长于坐骨包容接受腔假肢(P=0.01);四边形接受腔假肢健侧的步态周期长于坐骨包容接受腔假肢(P=0.03)。结论患者穿戴两种假肢在室外行走时,步行速度均明显慢于健康受试者;患者步行过程中健侧均有代偿;患者穿戴坐骨包容接受腔假肢行走时的速度快于穿戴四边形接受腔假肢时的速度;患者穿戴坐骨包容接受腔假肢行走时假肢侧在支撑期的稳定性比穿四边形接受腔假肢更好。展开更多
文摘AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC
文摘<b>Introduction:</b> Transfemoral amputation results in a prosthesis<span "=""> </span>which bears weight on the ischium. Gait disturbance,<span "=""> </span>lack of an end-bearing<span "=""> </span><span "="">stump and discomfort in the groin from the socket even while sitting, are important issues. <b>Methods:</b> This is a pilot report of an ongoing randomized blind clinical trial of a new intramedullary implant post transfemoral amputation. Here</span>, we describe<span "=""> </span>a single case illustrating the surgical technique and clinical outcome of a dysfunctional post-traumatic transfemoral amputation addressed with this implant.<span "=""> </span>Clinical gait analysis, SF-12 and VAS were assessed pre- and post-intervention <span "="">at 6 months of follow-up. <b>Results:</b> An improved stump control is accomplished by means of myoplasty and myodesis through an end-cap. Stride width improved from 0.21</span><span "=""> </span>m pre-op to<span "=""> </span>0.13<span "=""> </span>m post-op, and more symmetrical stride length (<span style="white-space:nowrap;"><span style="white-space:nowrap;">△</span></span>0.21<span "=""> </span>m pre-op vs. <span style="white-space:nowrap;"><span style="white-space:nowrap;">△</span></span>0.06<span "=""> </span>m post-op) was noted, indicating improved gait quality and stability. Gait velocity increased (0.51 ± 0.04 m/s pre-op<span "=""> </span><span "="">vs. 0.64 ± 0.02 m/s post-op). <b>Conclusion:</b> This technique reveals improvements in gait parameters in</span><span "=""> </span>a transfemoral amputee treated with a new procedure. Improved prosthesis control, sitting comfort, greater hip range of motion, better gait stability, and enhanced walking abilities were noted.
文摘目的探讨穿戴坐骨包容接受腔与四边形接受腔大腿假肢的单侧大腿截肢者在日常生活中行走时的步态差异,为临床制定大腿假肢使用处方提供指导。方法选取7位大腿截肢患者作为试验组,为患者分别适配四边形和坐骨包容接受腔大腿假肢。同时选取7位年龄、性别、身高和体质量相匹配的健康受试者作为对照组。所有受试者以舒适的步速在室外平路上行走240 m,应用便携式步态测试仪(intelligent device for energy expenditure and activity,IDEEA)采集步态数据,包括7个时空参数和4个加速度参数,通过IBM SPSS Statistics 23对数据进行处理。对比患者穿戴两种假肢与健康受试者之间、患者分别穿戴同种假肢时患侧与健侧之间、患者穿戴两种假肢时患侧之间、健侧之间的参数差异。结果与健康受试者相比,患者分别穿戴两种假肢行走时,两种假肢健侧和患侧的站立时间和步态周期增大(P<0.05),步速、步频、跨步长减小(P<0.05);两种假肢患侧的摆动时间延长(P<0.05),地面冲击和足落地控制减小(P<0.05);四边形接受腔假肢双侧和坐骨包容接受腔假肢健侧的单步时间延长(P<0.05)。四边形接受腔假肢患侧摆动时间长于健侧(P=0.03);坐骨包容接受腔假肢患侧摆动时间长于健侧(P=0.02),地面冲击小于健侧(P=0.04)。四边形接受腔假肢患侧的步态周期长于坐骨包容接受腔假肢(P=0.01);四边形接受腔假肢健侧的步态周期长于坐骨包容接受腔假肢(P=0.03)。结论患者穿戴两种假肢在室外行走时,步行速度均明显慢于健康受试者;患者步行过程中健侧均有代偿;患者穿戴坐骨包容接受腔假肢行走时的速度快于穿戴四边形接受腔假肢时的速度;患者穿戴坐骨包容接受腔假肢行走时假肢侧在支撑期的稳定性比穿四边形接受腔假肢更好。
