Outcomes of knee disarticulation and the influence of surgical techniques in dysvascular patients: A systematic review

摘要: Background: Dysvascularity is the main cause of lower limb amputations in Scotland and there an insignificant proportion (1.7%) knee disarticulation (KD), despite benefits amputation. Objectives: The outcomes KD its associated techniques will be evaluated based on quality stump, functional outcomes, prosthetic ambulation gait biomechanics, to determine if a greater rate can justified among dysvascular patients. Methods: Medline, Embase, Cochrane Library Science Direct were searched for relevant literature pre-specified eligibility criteria. Studies critically appraised data extraction/synthesis carried out. Results/ Quality appraisal: SIGN 50 Grade Recommendation, C. 17 studies reported stump. Healing rates are comparible trans-femoral levels other studies. However, risks reamputations method amputation level selection inappropriate. key have ancillary physiologoical tests supplement clinical judgements during selection. Functional Outcomes: Four which pooere with more proximal amputations. Trans-femoral patients had poorer maintenance preoperative independent status than patients, however results only from 1-year follow-up periosd. Prosthetic Ambulation: Nine ambulation. Ambulation vary largely across studies, most limited mobility it would accurate indicate ambulatory multi-disciplinary involvement research teams. Gait Biomechanics: two biomechanics walking capacity decreased levels. One study indicated that provided stabilioty trans-tibial but evidence was insubstantial. Overview Surgical Techniques: anterior flap unsuitable Theoretically, posterior allow3s better vascularisation padding sagittal flaps, no direct comparisons between both techniques. Mazet technique potentially propitious stump ambulation, robust designs required justify suitable Gritti-Stokes low re-amputation rates, controversial may non-ambulatory Recommendations: overall strength current further creditable KD’s different inclusion long-term periods. Variable fully identified accounted multivariate analyses as rehabilitation multifactorial. If measured, prosthetists physiotherapists use validated scales necessary.