儿童下肢截肢及其功能康复的流行病学与临床特征

doi:10.3969/j.issn.1006-9771.2022.07.002

摘要/Abstract

摘要：

目的分析儿童下肢截肢及其康复的流行病学特点与临床特征,阐述儿童截肢的原因及截肢后并发症的情况。

方法选择2016年1月至2021年3月北京博爱医院收治的下肢截肢儿童51例,分析截肢原因与截肢后并发症的相关性。

结果创伤性截肢占58.82%,主要原因为交通事故(70%);疾病性截肢占41.18%,主要原因为先天性肢体畸形(80.95%)。创伤性截肢后发生残端并发症的可能性较预期更高(P < 0.05);疾病性截肢后发生残端并发症的可能性较预期更低(P < 0.05)。

结论交通事故是儿童创伤性截肢的主要原因,其临床特征是不良残端发生率高,主要原因是软组织异常,大部分病例需要通过残端修整术改善不良残端而达到装配假肢恢复行走的目的。先天性胫骨假关节是儿童疾病性截肢的主要原因,往往经历长期的保肢治疗后仍不能避免截肢的结局。

关键词: 截肢, 儿童, 康复, 流行病学, 非理想残肢

Abstract:

Objective To analyze the epidemiological and clinical characteristics of children's lower extremity amputation and amputation rehabilitation, and to explain the causes of children's amputation and the complications after amputation.

Methods From January, 2016 to March, 2021, 51 amputation related children were retrospectively analyzed. The correlation between the cause of amputation and complications post amputation were analyzed.

Results Traumatic amputations accounted for 58.82%, and the main cause was traffic accidents (70%). Amputations caused by diseases accounted for 41.18%, and the main cause was congenital limb deformities (80.95%). Traumatic amputation was more likely to have stump complications than expected (P< 0.05). The possibility of stump complications after disease-specific amputation was lower than expected (P< 0.05).

Conclusion Traffic trauma is the main cause of amputation in children and is characterized clinically by a high incidence of unsatisfactory stumps, mainly due to soft tissue abnormalities, and most cases require stump revision to improve the poor residuals for prosthetic restoration of ambulation. Congenital pseudarthrosis of the tibia is the main cause of disease-specific amputation, and the outcome of amputation often cannot be definitely avoided even after long-term limb preservation treatment.

Key words: amputation, children, rehabilitation, epidemiology, unsatisfactory stumps

中图分类号:

R687.5

顾蕊,田罡,黄秋晨,刘克敏,闵红巍,冯建璞,王安庆. 儿童下肢截肢及其功能康复的流行病学与临床特征[J]. 《中国康复理论与实践》, 2022, 28(7): 753-758.

GU Rui,TIAN Gang,HUANG Qiuchen,LIU Kemin,MIN Hongwei,FENG Jianpu,WANG Anqing. Epidemiological and clinical characteristics of pediatric lower extremity amputation and functional rehabilitation[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(7): 753-758.

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项目	值	项目	值
性别/n		截肢部位/n
男	32	单侧下肢截肢	49
女	19	经前中足截肢	1
年龄/岁	1.8~17	经后足部截肢	7
截肢时年龄/岁	8.1±1.6	经小腿截肢	30
因先天性畸形截肢时年龄/岁	8.06±4.64	膝离断	3
单侧截肢/n	49	经大腿截肢	7
左侧	17	半骨盆截肢	1
右侧	32	双侧下肢截肢	2
双侧截肢/n	2	双大腿截肢	1
截肢原因/n		双侧髋部离断	1
创伤性截肢	30	截肢后并发症/n	33
交通相关因素	21	1种并发症	19
看护不当	9	2种并发症	12
疾病性截肢	21	3种及以上并发症	2
先天性肢体畸形	17	软组织并发症	16
血管性截肢	1	骨性并发症	12
肿瘤性截肢	1	残端神经瘤	7
脂肪异常增生	1	感染性并发症	5
后天性畸形并发感染	1	幻肢痛	1
平均住院时间/d	33.92±31.20	无法分类及其他复杂并发症	21
初次截肢时住院时间/d	34.00±24.95	平均住院费用/元	24 191.34±16 341.22
残端修整时住院时间/d	31.33±35.90	截肢时住院费用/元	25 119.48±18 685.43
残端修整时住院费用/元	18 993.48±17 081.53