Amputationen am Rückfu?

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• 作者：PD Dr. S. Rammelt (1)
  A. Olbrich (1)
  H. Zwipp (1)
  
• 关键词：Fu? ; Chopart ; Amputation ; Pirogoff ; Amputation ; Syme ; Amputation ; Exartikulation ; Foot ; Chopart amputation ; Pirogoff amputation ; Syme amputation ; Disarticulation
• 刊名：Operative Orthop?die und Traumatologie
• 出版年：2011
• 出版时间：October 2011
• 年：2011
• 卷：23
• 期：4
• 页码：265-279
• 全文大小：1743KB
• 参考文献：1. Baumgartner R, Botta P (2008) Amputationen und Prothesenversorgung, 3. Aufl. Thieme, Stuttgart New York
  2. Baumgartner R (2009) Amputation als Komplikation -Komplikationen bei Amputationen. Med Orth Tech 2:7-8
  3. Bellmann D (2008) Vorfu?prothese nach Bellmann. In: Baumgartner R, Botta P (Hrsg) Amputationen und Prothesenversorgung, 3. Auflage. Thieme, Stuttgart New York, S?293-97
  4. Boyd HB (1939) Amputation of the foot with calcaneo-tibial arthrodesis. J Bone Joint Surg 21:997-000
  5. Dauzac C, Guillon AP, Manager D et al (2002) Arthrodese tibio-calcanéene montee par fixateur externe d’Ilizarov: une technique originale de traitement des maux perforants plantaires compliquees. Maitrise Orthop 116:2-3
  6. Eilert RE, Jayakumar SS (1976) Boyd and Syme ankle amputations in children. J Bone Joint Surg Am 58(8):1138-141
  7. Frykberg RG, Abraham S, Tierney E et al (2007) Syme amputation for limb salvage: early experience with 26 cases. J Foot Ankle Surg 46(2):93-00 CrossRef
  8. Hansen ST Jr (2001) Salvage or amputation after complex foot and ankle trauma. Orthop Clin North Am 32(1):181-86 CrossRef
  9. Harris RI (1956) Syme’s amputation: the technical details essential for success. J Bone Joint Surg Br 38-B(3):614-32
  10. Lafiteau (1792) Observation sur une amputation partielle du pied. In: Fourcroy AF (Hrsg) La médecine éclairée par les sciences physique. Buisson, Paris, S?85-8
  11. Letts M (1996) The augmented Chopart amputation in children. Oper Orthop Traumatol 8:279-86 CrossRef
  12. Lindqvist C, Riska EB (1965) Results after amputations of Chopart, Pirogoff and Syme. Acta Orthop Scand 36:344-45
  13. Lisfranc J (1815) Nouvelle methode operatoire pour l’amputation partielle du pied par son articulation tarso-metatarsienne. L’Imprimerie Feuguery, Paris
  14. Martini M, Benhabiles M, Bouzid A et al (1966) Le calcanéectomie, traitement de choix des ostéites chroniques du calcanéum. Ann Chir 20(25):1484-487
  15. Pinzur MS, Stuck RM, Sage R et al (2003) Syme ankle disarticulation in patients with diabetes. J Bone Joint Surg Am 85-A(9):1667-672
  16. Pirogoff NJ (1854) Kostno-plasticheskoe udlineie kostei goleni pri velushtshenii stopi. Vojenno-med J St Petersburg 63:83-00
  17. Rammelt S, Biewener A, Grass R, Zwipp H (2005) Verletzungen des Fu?es beim polytraumatisierten Patienten. Unfallchirurg 108(10):858-65 CrossRef
  18. Rammelt S, Grass R, Brenner P, Zwipp H (2001) Septische Talusnekrose nach drittgradig offener Talusfraktur im Rahmen eines komplexen Fu?traumas (floating talus). Trauma Berufskrankh 3(Suppl 2):230-35 CrossRef
  19. Syme J (1831) Treatise on the excision of diseased joints. Adam Black, Edinburgh
  20. Syme J (1843) Amputation at the ankle joint. Monthly J Med Science (London, Edinburgh) 3:93-6
  21. Taniguchi A, Tanaka Y, Kadono K et al (2003) Pirogoff ankle disarticulation as an option for ankle disarticulation. Clin Orthop Relat Res 414:322-28 CrossRef
  22. Warren G (1997) Conservative amputation of the neuropathic foot. The Pirogoff procedure. Oper Orthop Traumatol 9:49-8 CrossRef
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  26. Zwipp H, Rammelt S, Grass R (2001) Komplextrauma des Fu?es. Trauma Berufskrankh 3(Suppl 2):S?221–S?229
  
• 作者单位：PD Dr. S. Rammelt (1)
  A. Olbrich (1)
  H. Zwipp (1)
  
  1. Klinik und Poliklinik für Unfall- und Wiederherstellungsschirurgie, Universit?tsklinikum Carl Gustav Carus der TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
  

文摘

Objective Obtaining a durable, weight-bearing stump with minimal or no loss of limb length, and stable soft tissue coverage with preservation of the original sensation of the sole of the foot at the heel. Indications Complex trauma to the foot with devitalized or nonreconstructable forefoot and midfoot, deep bony and soft tissue infection, infected Charcot foot with threatening sepsis, necrosis or gangrene of the forefoot and midfoot with vasculopathy, malignant tumors, certain infections, gigantism of the forefoot. Contraindications Possible reconstruction of the midfoot and forefoot beyond the midtarsal (Chopart) joint, loss or irreversible destruction of the sole of the foot or the distal tibial metaphysis. Surgical technique The skin incision is designed to retain a long plantar flap with a maximum amount of weight-bearing sole 5-?cm below amputation level and a shorter anterior flap 1-?cm below amputation level. Exarticulation or bone resection is performed from anterior to posterior, while preserving the posteromedial vessels to supply the heel flap. The Chopart stump is held in a neutral position avoiding equinus with a tibiotalar external fixator and additional tendon balancing with a noninfected posterior tibialis and one of the peronaeal tendons from medial and lateral through the talar head and Achilles tendon lengthening. Alternatively, a Pirogoff stump with minimal limb length loss (about 2?cm) is achieved with minimal resection at the anterior calcaneal process. The calcaneus is rotated 70-0° and fused to the distal end of the tibia with lag screws or an external frame. Alternatively, a Syme stump is covered with the heel skin after resection of the malleoli flush to the tibial plafond. If anterior wound closure cannot be obtained without tension, temporary vacuum-assisted closure and later definitive coverage with skin grafts, local or free flaps is obtained. In cases of deep infection, the amputation is performed as a staged procedure. Postoperative management Nonweight bearing until stable scar formation, early mobilization in a total contact cast. Interim prosthesis after 2-?weeks, fitting of the definitive prosthesis with special shoewear after 2-?months. Results Over a 12-year period, 15?Chopart, 7?Pirogoff, and 2?Syme amputations were performed. A total of 15?patients had sustained a complex foot trauma, 9?had a deep infection, among them 7 in a diabetic Charcot foot. In 16?patients, among them all with deep infection, 1- planned revisions were performed. In 5?patients (20.8%), the stumps were revised subacutely to a more proximal amputation level. In 2?patients with Chopart amputation, a hindfoot fusion was performed to correct equinus, while 1?Chopart and 1?Pirogoff stump were subjected to resection of a prominent exostosis. Except for 2?patients with Charcot foot, all patients with hindfoot amputation could walk barefoot over short distances.