مقایسه کیفیت زندگی در بیماران با ترومای ماژور اندام تحتانی تحت آمپوتاسیون و تحت درمان حفظ اندام یا کانسرواتیو

نوع مقاله : مقاله پژوهشی

نویسندگان

1 مرکز تحقیقات ارتوپدی،دانشگاه علوم پزشکی مازندران،ساری،ایران

2 دانشکده پزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران

3 مرکز تحقیقات روانپزشکی و علوم رفتاری، انستیتو اعتیاد، دانشگاه علوم پزشکی مازندران، مازندران، ایران

چکیده
چکیده:
مقدمه: در برخی موارد ترومای ماژور اندام تحتانی، قطع عضو یا حفظ اندام صورت می‌گیرد. هدف از انجام این مطالعه مقایسه کیفیت زندگی در بیماران تحت آمپوتاسیون با حفظ اندام می‌باشد.
مواد و روش‌ها: مطالعه حاضر مقایسه‌ای مقطعی بوده و بیماران مبتلا به ترومای ماژور اندام تحتانی که تحت آمپوتاسیون اندام تحتانی یا حفظ اندام قرار گرفته بودند پس از گذشت حداقل 6 ماه از درمان آسیب اولیه از نظر کیفیت زندگی با استفاده از پرسشنامه SF-36 مورد مقایسه قرار گرفتند.
نتایج و بحث: 94 بیمار وارد مطالعه شدند که 9/80 درصد از بیماران در این مطالعه مرد بودند. میانه سنی 5/41 سال (18 تا 64) بود. همچنین اختلاف آماری معناداری از نظر سن، جنسیت، وضعیت تأهل، تعداد فرزند، سطح تحصیلات، سیگار کشیدن و سوءمصرف مواد و یا الکل بین گروه‌های مطالعه وجود نداشت. زیر مقیاس سلامت عمومی (001/0= P) و سرزندگی (انرژی) (002/= P) به طور معناداری 6 ماه پس از آسیب اولیه در گروه آمپوتاسیون نمرات بالاتری داشتند.
نتیجه‌گیری: در بیماران مبتلا به ترومای ماژور، تلاش جهت حفظ اندام در مقابل آمپوتاسیون منجر به افزایش طول مدت بستری، تعداد موارد عفونت و جراحی مجدد می‌گردد. آمپوتاسیون پس از حداقل 6 ماه منجر به بهبود کیفیت زندگی به ویژه در زمینه سلامت عمومی و احساس سرزندگی می‌گردد.

کلیدواژه‌ها

موضوعات

عنوان مقاله English

Comparison of Quality of Life in Patients with Major Lower Limb Trauma Undergoing Amputation Versus Limb Salvage or Conservative Treatment

نویسندگان English

Salman Ghaffari 1
, Shiva Aghatabay 2
Mehran Razavipour 1
Maryam Rezapour 3
1 Department of Orthopedics, School of Medicine, Orthopedic Research Center, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
2 School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
3 Department of Psychiatry, School of Medicine, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
چکیده English

Abstract
Introduction: In some cases of major lower limb trauma, either amputation or limb preservation is performed. The aim of this study was to compare the quality of life in patients undergoing amputation versus limb preservation.
Materials & Methods: In a cross-sectional comparative study, patients with major lower limb trauma who underwent either lower limb amputation or limb preservation were evaluated at least six months post injury. Quality of life was assessed and compared between the two groups using SF-36 questionnaire.
Results & Discussion: A total of 94 patients, including 80.9% male and 0.9% female, with mean age of 41.5 years (range 18 to 64), with the mean study period of 6 months, were included in the study. There was no statistically significant difference between the two study groups regarding age, gender, marital status, number of children, education level, smoking, or substance and alcohol abuse. The sub-scales of general health (P = 0.001) and vitality (energy) (P = 0.002) were significantly higher in the amputation group in comparison with the limb-preservation group within the six- months post injury.
Conclusion: In patients with major trauma, attempts to preserve the limb, instead of immediate amputation results into longer hospital stays, increased incidence of infections, and higher rates of re-operation. Amputation, within a minimum of six months, leads to improved quality of life, particularly in the domains of general health and vitality.

کلیدواژه‌ها English

Amputation
Quality of life
Trauma
1         Johansen K, Daines M, Howey T, Helfet D, Hansen Jr ST. Objective criteria accurately predict amputation following lower extremity trauma. Journal of Trauma and Acute Care Surgery. 1990;30(5):568-573. doi: 10.2331/suisan.32.804.
2         de Mestral C, Sharma S, Haas B, Gomez D, Nathens AB. A contemporary analysis of the management of the mangled lower extremity. Journal of Trauma and Acute Care Surgery. 2013;74(2):597-560. doi: 10.2331/suisan.32.804.
3         Johnson BA, Carmack D, Neary M, Tenuta J, Chen J. Operation Iraqi freedom: the Landstuhl regional medical center experience. The Journal of foot and ankle surgery. 2005;44(3):177-183. https://doi.org/10.1053/j.jfas.2005.02.007.
4         Perkins Z, Yet B, Glasgow S, Cole E, Marsh W, Brohi K, et al. Meta-analysis of prognostic factors for amputation following surgical repair of lower extremity vascular trauma. Journal of British Surgery. 2015;102(5):436-450. https://doi.org/10.1002/bjs.9689.
5         Nance M. National trauma data bank—annual report. NTDB annual report. 2013. https://doi.org/10.1596/978-0-8213-9937-8.
 
6         Scalea TM, DuBose J, Moore EE, West M, Moore FA, McIntyre R, et al. Western Trauma Association critical decisions in trauma: management of the mangled extremity. Journal of Trauma and Acute Care Surgery. 2012;72(1):86-93. https://doi.org/10.1097/ta.0b013e318241ed70 .
7         Chung KC, Saddawi-Konefka D, Haase SC, Kaul G. A cost-utility analysis of amputation versus salvage for Gustilo IIIB and IIIC open tibial fractures. Plastic and reconstructive surgery. 2009; 124(6):1965-1973. https://doi.org/10.1097/prs.0b013e3181bcf156 .
8         Tillmann BW, Guttman MP, Nathens AB, de Mestral C, Kayssi A, Haas B. The timing of amputation of mangled lower extremities does not predict post-injury outcomes and mortality: a retrospective analysis from the ACS TQIP database. Journal of Trauma and Acute Care Surgery. 2021;91(3):447-456. https://doi.org/10.1097/ta.0000000000003302 .
9         Gordon WT, O'Brien FP, Strauss JE, Andersen RC, Potter BK. Outcomes associated with the internal fixation of long-bone fractures proximal to traumatic amputations. JBJS. 2010;92(13):2312-2318. https://doi.org/10.2106/jbjs.j.00138 .
10      Atherton R, Robertson N. Psychological adjustment to lower limb amputation amongst prosthesis users. Disability and rehabilitation. 2006;28(19):1201-1209. https://doi.org/10.1080/09638280600551674 .
11      Quigley M, Dillon MP, Duke EJ. Comparison of quality of life in people with partial foot and transtibial amputation: a pilot study. Prosthetics and Orthotics International. 2016;40(4):467-474. https://doi.org/10.1177/0309364614568414 .
12      Grzebień A, Chabowski M, Malinowski M, Uchmanowicz I, Milan M, Janczak D. Analysis of selected factors determining quality of life in patients after lower limb amputation-a review article. Polish Journal of Surgery. 2017;89(2):57-61. https://doi.org/10.5604/01.3001.0009.8980 .
13      Noszczyk W. Chirurgia tętnic i żył obwodowych: Wydawnictwo Lekarskie PZWL; 1998. https://doi.org/10.5114/nan.2024.147066 .
14      Horgan O, MacLachlan M. Psychosocial adjustment to lower-limb amputation: a review. Disability and rehabilitation. 2004;26(14-15):837-850. https://doi.org/10.1080/09638280410001708869 .
15      Meatherall BL, Garrett MR, Kaufert J, Martin BD, Fricke MW, Arneja AS, et al. Disability and quality of life in Canadian aboriginal and non-aboriginal diabetic lower-extremity amputees. Archives of physical medicine and rehabilitation. 2005;86(8):1594-1602 https://doi.org/10.1016/j.apmr.2004.11.026 ..
16      Frieden RA. The geriatric amputee. Physical Medicine and Rehabilitation Clinics. 2005;16(1):179-195. https://doi.org/10.1016/j.pmr.2004.06.004 .
17      Thompson DM, Haran D. Living with an amputation: What it means for patients and their helpers. International Journal of Rehabilitation Research. 1984;7(3):283-292. https://doi.org/10.1097/00004356-198409000-00003
18      Tekin L, Safaz Ý, Göktepe AS, Yazýcýođlu K. Comparison of quality of life and functionality in patients with traumatic unilateral below knee amputation and salvage surgery. Prosthetics and orthotics international. 2009 Mar;33(1):17-24. https://doi.org/10.1080/03093640802482542
19      Torre F, Martín-Corral J, Callejo A, Gómez-Vega C, La Torre S, Vallejo R, et al. Calidad de vida relacionada con la salud y estrategias de afrontamiento ante el dolor en pacientes atendidos por una unidad de tratamiento del dolor. Revista de la sociedad española del dolor. 2008;15(2):83-93. https://doi.org/10.1016/s1134-8046(10)70025-2 .
20      Vilagut G, Ferrer M, Rajmil L, Rebollo P, Permanyer-Miralda G, Quintana JM, et al. El Cuestionario de Salud SF-36 español: una década de experiencia y nuevos desarrollos. Gaceta sanitaria. 2005;19:135-150. https://doi.org/10.1157/13074369 .
21      Montazeri A, Gashtasebi A, Vahdaninia M. Translation, reliability and validity of Persian tool by SF-36. J Payesh. 2006;5(1):49-56.  https://doi.org/10.1080/09286580600826512
22      Seekamp A, Regel G, Tscherne H. Rehabilitation and reintegration of multiply injured patients: an outcome study with special reference to multiple lower limb fractures. Injury. 1996;27(2):133-138.https://doi.org/10.1016/0020-1383(95)00178-6 .
23      MacKenzie EJ, Bosse MJ, Pollak AN, Webb LX, Swiontkowski MF, Kellam JF, et al. Long-term persistence of disability following severe lower-limb trauma: results of a seven-year follow-up. JBJS. 2005;87(8):1801-1809. https://doi.org/10.2106/00004623-200508000-00020
24      Perkins Z, De'Ath H, Sharp G, Tai N. Factors affecting outcome after traumatic limb amputation. Journal of British Surgery. 2012;99(Supplement_1):75-86. https://doi.org/10.1002/bjs.7766 .
25      Khan F, Amatya B, Hoffman K. Systematic review of multidisciplinary rehabilitation in patients with multiple trauma. Journal of British Surgery. 2012;99(Supplement_1):88-96. https://doi.org/10.1002/bjs.7776
26      Cannada LK, Jones AL. Demographic, social and economic variables that affect lower extremity injury outcomes. Injury. 2006;37(12):1109-1116. https://doi.org/10.1016/j.injury.2006.07.016 .
27      Rozycki GS, Tremblay LN, Feliciano DV, McClelland WB. Blunt vascular trauma in the extremity: diagnosis, management, and outcome. Journal of Trauma and Acute Care Surgery. 2003;55(5):814-824.  https://doi.org/10.1097/01.ta.0000087807.44105.ae
28      Asensio JA, Kuncir EJ, García-Núñez LM, Petrone P. Femoral vessel injuries: analysis of factors predictive of outcomes. Journal of the American College of Surgeons. 2006;203(4):512-520. https://doi.org/10.1016/j.jamcollsurg.2006.06.020 .
29      Scalea JR, Crawford R, Scurci S, Danquah J, Sarkar R, Kufera J, et al. Below-the-knee arterial injury: the type of vessel may be more important than the number of vessels injured. Journal of Trauma and Acute Care Surgery. 2014;77(6):920-925. https://doi.org/10.1097/ta.0000000000000458
30      Helgeson MD, Potter BK, Burns TC, Hayda RA, Gajewski DA. Risk factors for and results of late or delayed amputation following combat-related extremity injuries. Orthopedics. 2010;33(9). https://doi.org/10.3928/01477447-20100722-02 .
31      Busse JW, Jacobs CL, Swiontkowski MF, Bosse MJ, Bhandari M, Group E-BOTW. Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies. Journal of orthopaedic trauma. 2007;21(1):70-76. https://doi.org/10.3928/01477447-20100722-02
32      Aydemir Ö. Konsültasyon-Liyezon psikiyatrisinde yaşam kalitesi ölçümü: Kısa Form-36 (SF-36). Psikiyatri Psikoloji Psikofarmakoloji Dergisi. 1999;7(2):14-23. https://doi.org/10.21673/anadoluklin.1419384.
33      Brazier JE, Harper R, Jones N, O'cathain A, Thomas K, Usherwood T, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. British medical journal. 1992;305(6846):160-164. https://doi.org/10.1136/bmj.305.6846.160
34      Fairhurst MJ. The Function of Below-Knee Amputee Versus the Patient With Salvaged Grade I11 Tibia1 Fracture. Clinical Orthopaedics and Related Research (1976-2007). 1994;301:227-232. https://doi.org/10.1097/00003086-199404000-00035
35      Gunawardena NS, de Alwis Seneviratne R, Athauda T. Functional outcomes of unilateral lower limb amputee soldiers in two districts of Sri Lanka. Military Medicine. 2006;171(4):283-287. https://doi.org/10.7205/milmed.171.4.283
36      Gunawardena N, Seneviratne SdA, Atauda T. An approach to validation of a multi-dimensional tool. J Coll Community Physicians Sri Lanka. 2003;8:18-26. https://doi.org/10.4038/jccpsl.v8i1.8302
37      Pezzin LE, Dillingham TR, MacKenzie EJ. Rehabilitation and the long-term outcomes of persons with trauma-related amputations. Archives of physical medicine and rehabilitation. 2000;81(3):292-300. https://doi.org/10.1016/s0003-9993(00)90074-1
38      Dagum AB, Best AK, Schemitsch EH, Mahoney JL, Mahomed MN, Blight KR. Salvage after severe lower-extremity trauma: are the outcomes worth the means? Plastic and reconstructive surgery 1999;103(4): 1212-1220. https://doi.org/10.1097/00006534-199904010-00017
39      Smith DG, Horn P, Malchow D, Boone DA, Reiber GE, Hansen ST. Prosthetic history, prosthetic charges, and functional outcome of the isolated, traumatic below-knee amputee. Journal of Trauma and Acute Care Surgery. 1995;38(1):44-47. https://doi.org/10.1097/00005373-199501000-00013
40      HANSEN JR ST. Overview of the severely traumatized lower limb reconstruction versus amputation. Clinical Orthopaedics and Related Research®. 1989;243:17-19. https://doi.org/10.1097/00003086-198906000-00003
41      Moore T, Green S, Garland D. Severe trauma to the lower extremity: long-term sequelae. Southern medical journal. 1989;82(7):843-844. https://doi.org/10.1097/00007611-198907000-00012
42      Hansen Jr S. The type-IIIC tibial fracture. Salvage or amputation. JBJS. 1987;69(6):799-800. https://doi.org/10.2106/00004623-198769060-00001
43      Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. New England Journal of Medicine. 2002;347(24):1924-1931. https://doi.org/10.1056/nejmoa012604
44      Poutoglidou F, Khan R, Krkovic M. Amputation versus reconstruction in severe lower extremity injury: a systematic review and meta-analysis. Archives of Bone and Joint Surgery. 2023;11(6):378. https://doi.org/10.7759/cureus.29222
45      Edelstein D, Florescu I. Crushing injuries of the foot and ankle, with complex open fractures: result of a prospective study with a 3 year follow-up. Journal of medicine and life. 2016;9(3):255. https://doi.org/10.1177/2473011418s00388
46      Fioravanti M, Maman P, Curvale G, Rochwerger A, Mattei J-C. Amputation versus conservative treatment in severe open lower-limb fracture: A functional and quality-of-life study. Orthopaedics & Traumatology: Surgery & Research. 2018;104(2):277-281. https://doi.org/10.1016/j.otsr.2017.12.013
47      Georgiadis GM, Behrens FF, Joyce MJ, Earle AS, Simmons AL. Open tibial fractures with severe soft-tissue loss. Limb salvage compared with below-the-knee amputation. JBJS. 1993;75(10):1431-1441. https://doi.org/10.2106/00004623-199310000-00003
48      Higgins TF, Klatt JB, Beals TC. Lower Extremity Assessment Project (LEAP)–the best available evidence on limb-threatening lower extremity trauma. Orthopedic Clinics. 2010;41(2):233-239. https://doi.org/10.1016/j.ocl.2009.12.006
49      Frisch HM, Andersen CRC, Mazurek CMT, Ficke CJR, Keeling CJJ, Pasquina CPF, et al. The Military Extremity Trauma Amputation/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma. JBJS. 2013;95(2):138-145. https://doi.org/10.2106/jbjs.k.00734
50      Ellington JK, Bosse MJ, Castillo RC, MacKenzie EJ, Group LS. The mangled foot and ankle: results from a 2-year prospective study. Journal of orthopaedic trauma. 2013;27(1):43-48 https://doi.org/10.1097/bot.0b013e31825121b6.
51      Ladlow P, Phillip R, Coppack R, Etherington J, Bilzon J, McGuigan MP, et al. Influence of immediate and delayed lower-limb amputation compared with lower-limb salvage on functional and mental health outcomes post-rehabilitation in the UK military. JBJS. 2016;98(23):1996-2005. https://doi.org/10.2106/jbjs.15.01210.
52      Barla M, Gavanier B, Mangin M, Parot J, Bauer C, Mainard D. Is amputation a viable treatment option in lower extremity trauma? Orthopaedics & Traumatology: Surgery & Research 2017;103(6):971-975. https://doi.org/10.1016/j.otsr.2017.05.022.
53      Hertel R, Strebel N, Ganz R. Amputation versus reconstruction in traumatic defects of the leg: outcome and costs. Journal of orthopaedic trauma. 1996;10(4):223-229. https://doi.org/10.1097/00005131-199605000-00001
54      Hoogendoorn J, van der Werken C. Grade III open tibial fractures: functional outcome and quality of life in amputees versus patients with successful reconstruction. Injury. 2001;32(4):329-334. https://doi.org/10.1016/s0020-1383(00)00250-3
55      Demiralp B, Ege T, Kose O, Yurttas Y, Basbozkurt M. Amputation versus functional reconstruction in the management of complex hind foot injuries caused by land-mine explosions: a long-term retrospective comparison. European Journal of Orthopaedic Surgery & Traumatology. 2014;24:621-626. https://doi.org/10.1007/s00590-013-1345-4