Requirements of amputation for assembling lower limb prosthesis
1. General requirements for prosthesis assembly
(1) The length of the residual limb should be appropriate to ensure sufficient leverage, but it is better to leave some space in the joint of the prosthesis;
(2) The remaining joint should retain its original physiological function as much as possible without contracture;
(3) The stump should be covered with appropriate soft tissue, without tenderness, spur or neuroma;
(4) The residual limbs should have good skin conditions, healthy, smooth, less scar adhesion, no sinus ulcer.
In the above four aspects, except that the length of the stump depends on the amputation site, and generally will not change after the operation, the other three aspects are related to the operation technology of the hand, the postoperative nursing treatment, training and other factors. In order to ensure a good condition for the amputee to assemble the prosthesis with good function, the medical community and the prosthesis community should be closely combined. According to statistics, due to improper amputation and lack of understanding of prosthetics by surgeons, about 10% of amputees in China need to repair the stumps when they are installed for the first time. In addition, many amputees did not receive timely care of the disabled limbs after operation, and the swelling of the disabled limbs before the assembly has not been eliminated. When they come to the prosthetic factory to assemble the prosthesis, they need to re bandage the disabled limbs so as to promote the finalization of the disabled limbs, which not only wastes the time of the patients, but also affects the function of the disabled limbs.
2. Selection of amputation position of lower limbs: in principle, the length of stump should be kept as much as possible.
The following three situations should be noted:
(1) If the knee is amputated from the attachment part of patellar ligament near tibia, it will not only lose the flexion and extension function of knee joint, but also bring disadvantage to the bearing of residual end after the prosthesis is is installed. Therefore, the knee joint should be amputated.
(2) In order to reduce the appearance defect caused by the expansion of the stump, it is better to remove the extra part of the medial and lateral malleolus.
(3) After partial amputation, because of the imbalance of muscle strength, it is easy to produce foot ptosis and varus deformation. At the same time, it is necessary to consider the problem of wearing shoes after the operation. Therefore, under the condition of fully considering the re suture and transplantation of tendons, we can choose shopper joint.
In addition, for trampling and foot amputation, it is often necessary to take into account the bearing capacity, the fitting of prosthesis and the impact on the wearing of shoes. Therefore, pirogov amputation and Boyd amputation, which were often used before, are rarely used now. For the reasons of 70% foot deformation, skin scar, poor bearing capacity and other factors, the amputation of Schopper's joint and Lisfranc's joint are severed The impact is no longer applied at home and abroad.