Objective To analyze the major complications and predictive factors of amputees during postoperative hospitalization, and provide a reference for amputees nursing and early rehabilitation. Methods Using the bibliometric method, we searched Embase, Ovid, Medline, PubMed, CINAHL, China National Knowledge Infrastructure, Wanfang and CQVIP databases for the data of postoperative hospitalization of amputees published from January 1st, 2008 to April 5th, 2022. Statistical description and analysis of article types, sample size, reasons for amputation, amputation sites, complications, influencing factors, predictive factors, and treatment recommendations were performed.Results Finally, 19 articles were included, including 16 in English and 3 in Chinese, all of which were quantitative studies. The literature quality scores were greater than or equal to 7 points, which were all good or excellent. The type of articles were mainly retrospective research (n=15), and the research contents were mainly lower limb amputation. The main reasons for amputation were peripheral vascular disease and diabetes mellitus (n=11). Wound infection, anemia, phantom limb pain, and psychological problems were common complications after amputation. Predictors of complications, secondary operations, and death included age, gender, smoking, drinking, obesity, preoperative comorbidities, level of amputation, anesthesia methods and other factors. Conclusions The focus of acute care after amputation should be wound healing, pain control, proximal physical movement and emotional support, especially for amputees who have prominent postoperative psychological problems. These patients need early psychological disease screening and mental support. After amputation, multi-disciplinary and multi-team coordinated care are needed to achieve both physical and psychological healing of the patient and promote early recovery.
ObjectiveTo carry out an investigation on the life quality of amputees in the “5·12” Wenchuan earthquake before and after rehabilitation of one year (short term), three year (intermediate term) and five year (long term) and find out the best program of recovery. MethodsIn September 2008, 52 patients who were treated in the higher-level hospital and came back to the Second People’s Hospital of Mianzhu City for rehabilitation were divided into two groups: group A and B with 26 patients in each. Phased rehabilitation program was adopted for group A while traditional program was chosen for patients in group B. “The Personal Information Table of Amputees of Deyang City” and The Life Quality Measurement Table of World Health Organization were chosen as the research tools before the program and one year, three years and five years after the program. ResultScores of the life quality of both groups showed a general rising tendency, while group A was higher than group B in each single phase, especially in the longterm one. For positive feeling, group A got a score of 193.0±12.3 and group B got 126.0±11.2; for ability to work, group A had a score of 62.0±5.2 and group B had 41.0±2.3; for life satisfaction, group A achieved 150.0±2.1 and group B achieved 101.0±6.2; for ability of action, the score of group A was 17.0±2.6 and group B was 11.0±5.2. The differences were statistically significant (P ＜ 0.05) . ConclusionCompared with conventional rehabilitation program, phased rehabilitation program can better enhance and consolidate the amputees’ quality of life and promote their returning to family and society, which can make up for the deficiency of the existing rehabilitation programs and is worth popularization and application.
Objective To observe the effectiveness of vacuum seal ing drainage (VSD) combined with anti-takenskin graft on open amputation wound by comparing with direct anti-taken skin graft. Methods Between March 2005 andJune 2010, 60 cases of amputation wounds for limbs open fractures were selected by using the random single-blind method.The amputation wounds were treated with VSD combined with anti-taken skin graft (test group, n=30) and direct anti-takenskin graft (control group, n=30). No significant difference was found in age, gender, injury cause, amputation level, defect size,preoperative albumin index, or injury time between 2 groups (P gt; 0.05). In test group, the redundant stump skin was usedto prepare reattached staggered-meshed middle-thickness skin flap by using a drum dermatome deal ing after amputation,which was transplanted amputation wounds, and then the skin surface was covered with VSD for continuous negative pressuredrainage for 7-10 days. In control group, wounds were covered by anti-taken thickness skin flap directly after amputation, andconventional dress changing was given. Results To observe the survival condition of the skin graft in test group, the VSDdevice was removed at 8 days after operation. The skin graft survival rate, wound infection rate, reamputation rate, times ofdressing change, and the hospital ization days in test group were significantly better than those in control group [ 90.0% vs.63.3%, 3.3% vs. 20.0%, 0 vs. 13.3%, (2.0 ± 0.5) times vs. (8.0 ± 1.5) times, and (12.0 ± 2.6) days vs. (18.0 ± 3.2) days, respectively](P lt; 0.05). The patients were followed up 1-3 years with an average of 2 years. At last follow-up, the scar area and grading, and twopointdiscrimination of wound in test group were better than those in control group, showing significant differences (P lt; 0.05).No obvious swelling occurred at the residual limbs in 2 groups. The limb pain incidence and the residual limb length were betterin test group than those in control group (P lt; 0.05). Whereas, no significant difference was found in the shape of the residual limbs between 2 groups (P gt; 0.05). In comparison with the contralateral limbs, the muscle had disuse atrophy and decreasedstrength in residual limbs of 2 groups. There was significant difference in the muscle strength between normal and affected limbs(P lt; 0.05), but no significant difference was found in affected limbs between 2 groups (P gt; 0.05). Conclusion Comparedwith direct anti-taken skin graft on amputation wound, the wound could be closed primarily by using the VSD combined withanti-taken skin graft. At the same time it could achieve better wound drainage, reduce infection rate, promote good adhesion ofwound, improve skin survival rate, and are beneficial to lower the amputation level, so it is an ideal way to deal with amputationwound in the phase I.
Objective To provide a clinical basis for the prevention of diabetic foot ulcers by analyzing the clinical data and prognosis of high-risk diabetic foot patients. Methods A retrospective analysis was performed on high-risk diabetic foot patients who were hospitalized in West China Hospital of Sichuan University between January 1, 2012 and December 31, 2018. Patients were divided into high-risk group and low-risk group according to whether they hada history of foot ulcer or amputation. The clinical characteristics of the two groups of patients were compared. The patients were followed up from hospital discharge to January 31, 2021, and their survival and ulcer recurrence or new-onset status were evaluated. Results Finally, 123 patients were included, including 29 patients in the high-risk group and 94 patients in the low-risk group. There was no statistical difference in the duration of diabetes, smoking history, drinking history, education level, proportion of receiving regular treatment, proportion of regular blood glucose monitoring, body mass index, proportion of diabetic peripheral neuropathy, callus, foot deformity, diabetic nephropathy, diabetic retinopathy, diabetic cardiac autonomic neuropathy, diabetic gastrointestinal autonomic neuropathy, hypertension, coronary heart disease and laboratory test results between the two groups (P>0.05). The proportion of women (51.7% vs. 29.8%), age [(69.8±10.3) vs. (64.4±11.3) years], proportion of lower extremity arterial disease (62.1% vs. 34.4%), proportion of hyperuricemia (27.6% vs. 10.6%) in the high-risk group were higher than the low-risk group (P<0.05). After follow-up (67±20) months, 25.8% of the patients had ulcer recurrence or new onset, and 24.2% of the patients died. The most common cause of death was diabetes complications (43.8%). The overall 1-, 3-, and 5-year cumulative mortality rates of the patients were 4.5%, 12.7%, and 20.6%, respectively. The 3- and 5-year recurrence or new ulcer rates were 8.3% and 18.2%, respectively. The 5-year recurrence or new ulcer rates in the low-risk group and high-risk group were 10.3% and 40.3%, respectively, and there was a difference in ulcer recurrence between the two groups (P=0.004). Conclusions Compared with high-risk diabetic foot patients without ulcer or amputation, patients with a history of ulcer or amputation have higher rates of lower extremity arterial disease and hyperuricemia. Patients with a history of ulceration or amputation have a higher risk of recurrent or new ulceration than patients without a history of ulceration or amputation.
Objective To explore the feasibility of using biomechanical indicators as supplementary evaluation to the Musculoskeletal Tumor Society Scoring System (MSTS) for amputee patients. Methods Twenty-four patients who underwent hemipelvectomy between September 2018 and January 2025 were enrolled. There were 15 males and 9 females with an average age of 61.4 years (range, 45-76 years). Participants performed gait tests at self-selected speeds using three assistive devices (prosthesis, single crutch, and double crutches). Motion data were analyzed using a customized OpenSim model. Biomechanical indicators of the intact limb exhibiting common characteristics were screened through correlation and sensitivity analyses. Test-retest reliability [interclass correlation coefficient (ICC)] of selected parameters was assessed to evaluate their potential as MSTS score supplements. Results All biomechanical indicators showed significant positive correlations with MSTS scores across assistive devices (P<0.05). Seven indicators demonstrated |Pearson correlation coefficients|>0.8, including walking speed, maximum hip angle, maximum hip moment, peak hip flexion moment, peak hip extension moment, hip flexion impulse, and hip extension impulse. Among these, maximum hip moment, hip flexion impulse, and hip extension impulse exhibited significant between-group differences in adjacent MSTS levels (P<0.05), indicating high sensitivity, along with excellent test-retest reliability (ICC>0.74, P<0.01). Conclusion Biomechanical indicators statistically qualify as potential supplements to MSTS scoring. Maximum hip moment, hip flexion impulse, and hip extension impulse demonstrate particularly high sensitivity to MSTS score variations.
【摘要】 目的 观察综合康复治疗对汶川地震截肢伤员功能障碍的临床疗效。 方法 对5•12汶川大地震22例挤压伤截肢患者的24条截肢残端实施护理、摆放良肢位、运动治疗、残端塑形、紫外线疗法、红外线疗法、石蜡疗法、音频电疗法、经皮电刺激神经疗法、关节松动、按摩和拍打、超短波治疗、作业疗法和心理治疗等综合康复治疗，直至截肢伤员出院为止。视觉模拟评分法量表评定幻肢痛疼痛强度、测定膝关节和髋关节活动范围、Barthel指数评定日常活动。 结果 治疗前幻肢痛疼痛强度为2.95±1.33，治疗后为0.50±0.96；治疗前肘关节活动范围为（90.0±28.3）º，治疗后为（135.0±7.1）º；治疗前肩关节屈伸活动范围为（68.8±27.8）º，治疗后为（137.5±9.6）º；治疗前肩关节收展活动范围为（53.8±7.5）º，治疗后为（96.3±4.8）º；治疗前膝关节活动范围为（91.0±23.0）º，治疗后为（123.0±6.7）º；治疗前髋关节屈伸活动范围为（86.9±25.9）º，治疗后为（132.3±13.8）º；治疗前髋关节收展活动范围为（46.9±10.9）º，治疗后为（64.6±8.7）º；治疗前Barthel指数为57.05±18.69，治疗后为78.18±13.85，康复治疗前后均有统计学意义（Plt;0.05）。 结论 地震后截肢不良残肢发生率高，综合康复治疗能促进截肢残端伤口愈合和消除残肢疼痛，可明显改善残肢条件，有利于地震截肢患者功能恢复和日常生活能力的提高，为后期的假肢安装及步态训练创造了条件。【Abstract】 Objective To observe the efficiency of comprehensive rehabilitation therapy on amputation patients after Wenchuan earthquake. Methods Twenty-two amputation patients after Wenchuan earthquake with 24 stumps were treated with postoperative wound care, maintaining the correct position of the limbs, exercise therapy, stump shaping, ultraviolet therapy, infrared therapy, paraffin therapy, audio electrotherapy, transcutaneous electrical nerve stimulation therapy, joint mobilization, massage, beat, ultrashort wave therapy, occupational therapy and psychotherapy and so on until discharged. The results were measured from the following aspects: pain intensity using VAS, rangement of knee joint and hip joint, Barthel index of ADL before and after rehabilitation. Results Pain intensity of phantom limb pain were (2.94±1.53) before rehabilitation,and (0.44±1.03) after; the movement range of elbow was (90.0±28.3)º before and(135.0±7.1)º after; the movement range of shoulder flexion and extension was (68.8±27.8)º before and (137.5±9.6)º after; the movement range of shoulder abduction and adduction was (53.8±7.5)º before and (96.3±4.8)º after rehabilitation; the movement range of knee was (91.0±23.0)º before and (123.0±6.7)º after rahabiliation; the movement range of hip flexion and extension was (86.9±25.9)º before and (132.3±13.8)º after; the movement range of hip abduction and adduction was (46.9±10.9)º before and (64.6±8.7)º after; the score of Barthel index was 57.05±18.69 before and 78.18±13.85 after. The difference between before and after rehabilitation were statistically significant (Plt;0.05). Conclusion The incidence of adverse amputation stumps after the earthquake was high. Integrative rehabilitation has an positive effect on promoting wound healing, by eliminating stump pain and recovering lower limb function, improving daily living function and social ability, and creating conditions for installing prosthesis limbs and gait training in later period.
Objective To explore the effectiveness of QIN Sihe’s surgical strategy combined with Ilizarov technique in treating foot and ankle deformities on the verge of amputation. Methods A retrospective analysis was conducted on the clinical data of 56 patients (62 feet) with foot and ankle deformities on the verge of amputation treated with QIN Sihe’s surgical strategy and Ilizarov technique between May 2010 and December 2020. Among them, there were 39 males and 17 females. The age ranged from 8 to 62 years (median, 27.5 years). QIN Sihe’s surgical strategy: subcutaneous release or open lengthening of contracted Achilles tendons, limited correction of bony deformities through multiple osteotomies during surgery, tendon transfer to balance the power of the foot and ankle, simultaneous percutaneous osteotomy and correction of tibial torsion deformity to restore the weight-bearing line of the lower extremity, and installation of Ilizarov foot and ankle distraction devices for slow distraction and correction of residual foot and ankle deformities. After removal of external fixation, individualized braces were used for protection during exercise and walking. For patients with bilateral deformities, staged surgeries were performed. The effectiveness was evaluated according to the QIN Sihe’s Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction at last follow-up. Results All patients achieved the preoperative expected orthopedic and functional reconstruction goals. The postoperative wearing time of external fixator was 3-7 months, with an average of 5.5 months. The incidence of pin tract infection during the treatment period was 6.5% (4/62). All patients were followed up 25-132 months (median, 42 months). All 56 patients successfully retained their limbs. At last follow-up, foot and ankle deformities were corrected, the weight-bearing line was basically restored, and plantigrade feet were restored. At last follow-up, according to QIN Sihe’s Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction, the effectiveness was rated as excellent in 37 cases (39 feet), good in 18 cases (21 feet), and fair in 1 case (2 feet). The excellent and good rate was 96.8% (60/62). Conclusion The combination of QIN Sihe’s surgical strategy and Ilizarov technique in treating foot and ankle deformities on verge of amputation is minimally invasive, safe, and the therapeutic effect is controllable. This combined approach has unique advantages in preserving limb function and restoring biomechanical balance.
ObjectiveTo systematically evaluate the efficacy of mirror therapy for phantom limb sensation and phantom limb pain in amputee. MethodsDatabases include PubMed, EMbase, The Cochrane Library (Issue 9, 2015), CBM, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about mirror therapy for phantom limb sensation and phantom limb pain in amputee from inception to 1st Sept. 2015. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then metaanalysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs involving 129 patients were included. The results of meta-analysis showed that, there was no significant difference between the mirror therapy group and the control group in relieving the phantom limb sensation and phantom limb pain in amputee (MD=-7.29, 95%CI -27.73 to 13.16, P=0.48). ConclusionMirror therapy could improve the control of phantom limb, however, there is no sufficient evidence to support the effect of mirror therapy on pain management in amputee. The long-term effect of mirror therapy is still under exploration. Due to the limited quantity and quality of the included studies, larger-sample, high quality designed RCTs are needed to verify the above conclusion.