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首页> 外文期刊>Journal of prosthetics and orthotics: JPO >Postoperative Dressing and Management Strategies for Transtibial Amputations: A Critical Review
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Postoperative Dressing and Management Strategies for Transtibial Amputations: A Critical Review

机译：胫骨截肢的术后换药和管理策略：严格审查。

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摘要

Postamputation management is an important determinant of recovery from amputation. However, consensus on the most effective postoperative management strategies for individuals undergoing transtibial amputation (TTA) is lacking. Dressings can include simple soft gauze dressings, thigh-high rigid cast dressings, shorter removable rigid dressings, and prefabricated pneumatic dressings. Postoperative prosthetic attachments can be added to all but simple soft dressings. These dressings address the need to cleanly cover a fresh surgical wound, but not all postoperative dressings are designed to facilitate the strategic goals of preventing knee contractures, reducing edema, protecting against external trauma, or facilitating early weight bearing. The type of dressing and management strategy often overlap and are certainly interrelated. Current protocols and decisions are based on local practice, skill, and intuition. The current available literature is challenging, and difficulties include variations in healing potential, in comorbidity, in surgical-level selection, in techniques and skill, in experience with postoperative strategies, and with poorly defined outcome criteria. This article reviews the published literature and compares measures of safety, efficacy, and clinical outcomes of the various techniques. Analysis of 10 controlled studies supported only 4 of the 14 claims cited in uncontrolled, descriptive studies. The literature supports that rigid plaster cast dressings result in significantly accelerated rehabilitation times and significantly less edema compared with soft gauze dressings, and prefabricated pneumatic prostheses were found to be associated with significantly fewer postoperative complications and required fewer higher-level revisions compared with soft gauze dressings. No studies directly compared pneumatic prostheses with rigid dressings, and no reports compared all types of dressings within one study. In conclusion, the literature and evidence to date are primarily anecdotal and insufficient to support many of the claims. Future randomized trials on TTA dressing and management strategies are clearly needed to collect the evidence needed to best guide clinicians with the decision.
机译：截肢后的管理是截肢恢复的重要决定因素。但是，对于接受胫骨截肢术（TTA）的个体最有效的术后管理策略尚缺乏共识。敷料可以包括简单的柔软纱布敷料，大腿高刚性敷料，较短的可移动刚性敷料和预制气动敷料。可以将术后假体附件添加到所有简单的柔软敷料中。这些敷料满足了清洁覆盖新鲜外科伤口的需要，但并非所有术后敷料都旨在实现预防膝关节挛缩，减轻水肿，防止外部创伤或促进早期负重的战略目标。敷料的类型和管理策略经常重叠，并且肯定是相互关联的。当前的协议和决策基于本地实践，技能和直觉。当前可用的文献具有挑战性，困难包括治愈潜力，合并症，手术水平选择，技术和技能，术后策略经验以及预后标准不明确的差异。本文回顾了已发表的文献，并比较了各种技术的安全性，疗效和临床结果。对10项对照研究的分析仅支持在非对照描述性研究中引用的14项主张中的4项。文献支持与硬质纱布敷料相比，硬质石膏浇注敷料可显着缩短康复时间，并显着减少浮肿;与软质纱布敷料相比，预制的气动假体与术后并发症的发生率显着相关，并且不需要进行更高级别的翻修。没有研究将充气假体与刚性敷料直接进行比较，也没有报告在一项研究中比较所有类型的敷料。总之，迄今为止的文献和证据主要是轶事，不足以支持许多主张。显然需要进行有关TTA敷料和管理策略的未来随机试验，以收集所需的证据，从而最好地指导临床医生做出决定。

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