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Amputees in Limburg: incidence, morbidity and mortality, prosthetic supply, care utilisation and functional level after one year

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PROSTHETICS AND ORTHOTICS INTERNATIONAL 2000年第2期24卷 90-96页

作者： Pernot, HFM Winnubst, GMM Cluitmans, JJM de Witte, LP Laurentius Ziekenhuis Dept Rehabil Roermond Netherlands

Objectives: To describe for the province of Limburg, the Netherlands, the incidence of lower limb amputation (LLA), the demographic characteristics of the amputees, reason and level of amputation, care the amputees receive, prosthetic supply and functional level after one year. Design: A prospective descriptive cohort study. Methods: Anonymized data on all amputees in all nine hospitals were collected during 1994. Follow-up was one year. Results: 191 major lower limb amputations in 164 patients. Incidence was 17.1 per 100,000, Amputation levels: 77 trans-tibial, 52 transfemoral and 43 knee disarticulation. Twenty (20) patients died during hospitalisation. Eighty-seven (87) amputees gave permission for followup, 60 could be actually followed. Twenty-two (22) patients received in-patient rehabilitation, 16 primary day-care, 21 went to a nursing home and one went home without rehabilitation. The mean duration of rehabilitation was 35 weeks. In 53 patients a functional prosthesis was indicated. Forty-three (43) of these patients walked with the prosthesis after one year, 7 of whom more than 500 metres. Nineteen (19) amputees performed the Get Up and Go Test (GUGT) safely. Amputees on average have a low level of functioning, as indicated by SIP68 and Barthel Index Scores. The ability to walk is closely related to this daily function and quality of life. Conclusion: After one year the majority of amputees have low walking skills and the walking distance is limited. They are often ADL-dependent and their amputation greatly limits their daily function.

关键词：日常生活活动年龄分布截肢术/死亡率截肢术/康复截肢术/统计学和数值数据人工四肢/统计学和数值数据人工四肢/供应和分配设备和供应随访研究发病率腿年患病率/发展趋势荷兰/流行病学物理治疗技术/方法人群监测功能恢复性别分布疾病影响状态调查存活率分析时间因素老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Lower limb deficient children in the Netherlands: epidemiological aspects

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PROSTHETICS AND ORTHOTICS INTERNATIONAL 2000年第1期24卷 13-18页

作者： Rijnders, LJM Boonstra, AM Groothoff, JW Cornel, MC Eisma, WH Univ Groningen Hosp Dept Rehabil Groningen Netherlands

information on the characteristics of children with limb deficiencies and amputations in the Netherlands is largely lacking. The present study aimed to collect data about the prevalence of congenital deficiencies, the ratio of congenital to acquired limb deficiencies, types of lower leg deficiency or amputation and male/female ratios. Data were obtained from a regional birth defects registry for the northern parr. of the Netherlands (EUROCAT-NNL) and from a national survey, inclusion criteria for the selection of the EUROCAT data were: children/foetuses with lower leg deficiencies born in 1981-1986. Inclusion criteria for the survey data were: children aged 1-18 years with congenital deficiencies or acquired amputations of the leg, excluding toe deficiencies/amputations. Both the regional birth defects registry and the national survey only yielded small numbers of children, which limits the validity of the authors' findings. The Eurocat data show a prevalence of lower leg deficiencies at birth Of 2.07/10,000. Fifty-five (55) children/foetuses were included in the present study. The male/female ratio was 1:1. Of the live-burn children, 30% also had defects of the upper limbs, while 38% had bilateral lower limb deficiencies. The national survey included 89 children, of whom 73% had congenital deficiencies, while the others had undergone amputations: of which 37% were due to malignancies, 29% to traumata, 13% to infections and 21% to other pathology. The male/female ratio was 7:3 for the children with congenital deficiencies. versus 6:4 for the children with acquired amputations. In the group of congenital deficiencies, fibula deficiency was most frequently seen (36%), while in the group with acquired amputations trans-femoral amputation, knee disarticulation and trans-tibial amputation were seen with equal frequency (21%). In 40% of the children with congenital deficiency and in 8% of the children with acquired amputations the arm was also affected. Both legs were aff

关键词：畸形/流行病学截肢术/统计学和数值数据腿/畸形荷兰/流行病学登记青少年儿童儿童学龄前女(雌)性人类婴儿男(雄)性

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Arterial intervention and reduction in amputation for chronic critical leg ischaemia

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BRITISH JOURNAL OF SURGERY 2000年第4期87卷 454-458页

作者： Luther, M Kantonen, I Lepäntalo, M Salenius, JP Vasa Cent Hosp Dept Surg Cardiovasc Unit Vasa 65130 Finland

Background: Untreated chronic critical leg ischaemia (CLI) usually leads to an amputation or death of a patient. Surgical and endovascular interventions may improve arterial flow. Long infrainguinal reconstruction may be the most useful method for preventing amputations. The value of different reconstruction methods was assessed by their impact on amputation incidence. Methods: A nationwide 2-year analysis of the incidence of major amputations and reconstructions for CLI was done in Finland (population 5.1 million). Incidences were compared in hospital regions with more than 150 000 inhabitants. Results: The overall amputation incidence was 216 per million inhabitants per year. The corresponding incidence of arterial reconstructions was 203 per million inhabitants per year. There were large variations in the incidence of amputations and reconstructions;20-fold differences in infrapopliteal surgical reconstructions and 30-fold differences in endovascular procedures were found. There was a correlation between a high incidence of infrapopliteal surgical reconstructions and a low incidence of amputations. This correlation was found for below-knee amputations only. Conclusion: These results suggest that long surgical reconstructions improving perfusion directly to the ischaemic tissue can improve leg salvage.

关键词：截肢术/统计学和数值数据慢性病芬兰发病率缺血/外科学腿/血液供给腿/外科学登记血管外科手术/统计学和数值数据人类

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Major amputations in Nigeria: a plea to educate traditional bone setters

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TROPICAL DOCTOR 2000年第3期30卷 133-135页

作者： Onuminya, JE Obekpa, PO Ihezue, HC Ukegbu, ND Onabowale, BO Univ Jos Teaching Hosp Orthopaed Unit Dept Surg Jos Plateau Nigeria

A study was made of 100 major amputations performed on 96 patients in two regional hospitals in a 10-year period in Nigeria. The objective of the study was to evaluate the outcome of major amputations in Nigeria. The median age of patients was 30 years with male to female ratio 3:1. Ninety of the 100 major amputations involved the lower limbs with the above-the-knee/elbow-the-knee ratio of *** was the leading indication for 70 amputations, of these 60 were iatrogenic resulting from mismanaged fractures by the traditional bone setters. The non-traumatic indications were: diabetic limb gangrene (20);bone malignancies (9);and vascular insufficiency (1). Provisional amputation was offered in 60 cases, of these 10 had reamputation. There were eight (8.5%) mortalities. The functional outcome for this group was discouraging. Only 25 amputees affording successful prosthetic fitting and social rehabilitation. Major amputation in Nigeria foreshadows a dismal existence and emphasizes the need for health policies which are effective in controlling the risk factors.

关键词：截肢术/死亡率截肢术/统计学和数值数据截肢创伤性/病因学截肢创伤性/死亡率文化特征骨折/并发症骨折/治疗医原性疾病医学非洲传统尼日利亚/流行病学危险因素青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类男(雄)性中年人

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Analyses of prosthetic episodes in trans-tibial amputees

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PROSTHETICS AND ORTHOTICS INTERNATIONAL 1999年第1期23卷 9-12页

作者： Datta, D Vaidya, SP Alsindi, Z No Gen Hosp NHS Trust Mobil & Specialised Rehabil Ctr Sheffield S5 7AT S Yorkshire England

The prosthetic episodes, i.e. actual processes of provision, identifying number of prostheses, their maintenance, repairs and replacements were analysed for 104 trans-tibial amputees aged 16 and over, over a 10 year period. The purpose of this investigation was to identify how frequently a new prosthesis is actually required for this group of amputees and what are their maintenance requirements. Variations of requirement between the amputee groups of aged 16-60 and over 60 years are also addressed. In the 10 years period of the study the amputees needed an average of 5.04 new prostheses, 6.25 refits, 2.28 major repairs and 17.04 day repairs. The younger amputees, i.e. below the age of 60 years, required significantly more new prostheses (p=0.003), more refit of sockets (p=0.0012) and more day repairs (p=0.01). Traumatic amputees below the age of 60 years needed significantly more day repairs compared to the non-traumatic amputees in the older age group (p=0.003).

关键词：年龄分布截肢术/康复截肢术/统计学和数值数据人工四肢数据收集大不列颠/流行病学发病率腿维修/统计学和数值数据假体失效假体安装/统计学和数值数据康复中心回顾性研究性别分布胫骨/外科学青少年成年人老年人女(雌)性人类男(雄)性中年人

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Lower limb amputations during 3 years in Hungary

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ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY 1999年第1-2期119卷 94-97页

作者： Lázló, G Belicza, É Kullmann, L Natl Inst Med Rehabil H-1528 Budapest 123 Hungary Debrecen Univ Med Sch Med Dept Social Med H-4012 Debrecen Hungary

We reviewed nationwide hospital data of amputations during 3 years to provide a comparison with similar data gathered about 20 years ago, Data were provided by the National Medical Records Centre and processed by our personally developed programmes. The cause of amputation was most often vascular disease, amputees were usually elderly, and the large majority of amputation surgery was carried out on the lower limb. The rate of transtibial amputation has increased favourably in the last 2 decades, but there are large regional differences within the country. Mortality parameters remarkably exceed those of foreign countries. Although the data accuracy is compromised, there are still ways of exploiting the data in favour of qualify improvement of care, e.g. improve transtibial amputation rate, reduce mortality. The publication of data can be of benchmarking importance for hospitals by enabling them to compare their own results with those of other hospitals, as well as to develop and improve performance.

关键词：年龄分布截肢术/统计学和数值数据臂匈牙利/流行病学发病率腿登记危险因素性别分布成年人老年人女(雌)性人类男(雄)性中年人

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Influence of patient characteristics and treatment options on outcome of patients with prosthetic aortic graft infection

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ANNALS OF VASCULAR SURGERY 1999年第4期13卷 413-420页

作者： Seeger, JM Back, MR Albright, JL Carlton, LM Harward, TRS Kubulis, PS Flynn, TC Huber, TS Univ Florida Coll Med Dept Surg Vasc Surg Sect Gainesville FL 32610 USA Univ Florida Coll Med Dept Biostat Gainesville FL 32610 USA

This study was undertaken to determine the influence of patient characteristics and treatment options on survival and limb loss after treatment of prosthetic aortic graft infection. Fifty-three patients treated for prosthetic aortic graft infection were reviewed.. Twenty-three presented with groin infection, 12 with sepsis, 10 with aortoenteric fistula, 4 with limb ischemia, and 4 with pseudoaneurysm. Treatment included staged extraanatomic bypass (EAB) plus graft excision in 23 patients, simultaneous EAB and graft excision in 18, in situ graft replacement in 5, and local therapy only in 7. Axillofemoral bypass was done for revascularization in 53 limbs and axillopopliteal bypass in 16 limbs. The results of this study showed that morbidity and mortality of prosthetic aortic graft infection is influenced by the presentation and type of treatment of the infected graft. Staged axillofemoral bypass (when possible) plus graft excision appears to be associated with acceptable outcome (survival with limb salvage in 74%).

关键词：截肢术/统计学和数值数据主动脉腹/外科学腿/血液供给寿命表假体相关感染/流行病学假体相关感染/治疗再手术危险因素治疗结果女(雌)性人类男(雄)性中年人

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Prevalence and causal conditions for amputation surgery in the third world: ten years experience at Dodoma Regional Hospital, Tanzania

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PROSTHETICS AND ORTHOTICS INTERNATIONAL 1999年第3期23卷 217-224页

作者： Loro, A Franceschi, F Dodoma Reg Hosp Dept Orthopaed Dodoma Tanzania

This is a partly retrospective study of 252 major limb amputations carried out in regional hospital in Tanzania over a period of ten years mostly by the authors. The paper reports on the aetiology and levels of amputation and identifies prevalence and sex of the amputees. The causes of amputation classified under tumours, vascular diseases, trauma, infections, burns, animal bites, iatrogenic causes, maduromycosis and miscellanea - are discussed with particular reference to the influence of the environment, cultural habits and local customs.

关键词：截肢术/统计学和数值数据四肢/外科学回顾性研究坦桑尼亚青少年成年人老年人儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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Epidemiology of lower limb amputees in Southern Finland in 1995 and trends since 1984

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PROSTHETICS AND ORTHOTICS INTERNATIONAL 1999年第2期23卷 88-92页

作者： Pohjolainen, T Alaranta, H Jorvi Hosp Rehabil Unit FIN-02740 Espoo Finland

The purpose of this study was to look at the current epidemiological trends of lower limb amputees in 1995 and the trends since 1984 in the area of Southern Finland with 1.3 million inhabitants. During the one-year period, the lower limb amputation was performed on 366 patients. The overall amputation rate has been unchanged since 1984 being 28.0 per 100,000 inhabitants in 1995. The mean age was 71.4 years. The overall amputation rate was 28.0 per 100,000 inhabitants. Of the 366 patients in the study 30% had arteriosclerosis without diabetes mellitus and 49% had diabetes. Diabetes mellitus has become the most common cause of amputation since 1985. Tumours were the cause in 2% and trauma in 4%. The most common unilateral amputations were trans-femoral amputations (29%) followed by trans-tibial amputations (28%) and toe amputations (24%). The unilateral trans-tibial/trans-femoral ratio was 0.54 in 1984 and 0.95 in 1995. The one-year mortality rate was 39% in 1984 and 40% in 1995. The rate of amputation has been relatively constant over the last ten years. The age related incidence in the older age groups has also been unchanged over the last ten years. Better control of diabetes and prophylactic foot care of diabetics can have a positive contribution in preventation of lower limb amputations. The current rehabilitation and prosthetic services of the lower limb amputees can be planned in the south of Finland on the basis of the incidence of 28 per 100,000 inhabitants.

关键词：截肢术/统计学和数值数据截肢者/统计学和数值数据芬兰发病率存活率分析老年人女(雌)性人类男(雄)性

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