上肢截肢精品课件.ppt

Wrist Disarticulation
• Retains distal radio-ulnar joint and therefore forearm rotation.
• Preservation distal radius improves prosthetic fitting.
• No need to retain carpal bones. • Should perform tenodesis of major forearm
• Important to maintain forearm length, because forearm strength and rotation are proportional to the residual length.
• Even a short BEA is preferable to amputation through or above the elbow, as long as the biceps insertion is intact.
Brachial Plexus Injury
• If the scapulothoracic joint can be stabilized, then shoulder fusion and muscle transfers to allow active elbow flexion may allow for Below-Elbow Amputation.
• Don’t close primarily in trauma, infections.
Techniques
Upper Arm Amputations
• Forequarter amputation • Shoulder disarticulation • Proximal above-elbow amputation • Distal above-elbow amputation • Elbow disarticulation
Indications for Amputation
• Trauma
– Severe open fracture with extensive skin and muscle loss, neurologic injury
– Flail limb (brachial plexus injury)
• Tumours • Peripheral vascular disease • Infection
Forearm (Below-Elbow) Amputations
• Forearm proximal • Forearm distal • Wrist disarticulation • Transcarpal
Below-Elbow Amputation
• Very functional, 70-80% of patients are able to use a prosthesis successfully.
Amputations of the Upper Extr Nhomakorabeamity
Andrew H. Schmidt, MD
Created March 2004
General Principles
• Disability ratings
– Loss of upper extremity: 50% – Loss of hand: 45% – Thumb amputation: 23%
Forequarter Amputation
• Done most often for malignancy
– Difficult skin flaps – Poor cosmesis
Shoulder Amputations
• Proximal humeral amputations behave like a shoulder disarticulation, but have better cosmesis and prosthesis suspension
Elbow/ Humeral Amputation
• Better prosthetic suspension with elbow disarticulation but poorer cosmesis
• Better function with distal humeral amputation (3.5 cm proximal to elbow)
• This unloads the shoulder joint and reduces subluxation resulting from the weight of the arm.
• In this situation, the patient will not likely be able to use a prosthesis.
Brachial Plexus Injury
• If the arm is flail and patient does not have scapulothoracic control, then the patient is a candidate for Above-Elbow Amputation.
Surgical Principles
• Level of amputation- usually best to maintain length
• Skin flaps - keep all viable skin initially
• Nerves - resect sharply, bury to avoid neuromas
Surgical Pointers Below Elbow Amputation
• For short stumps, leave the ulna a little longer than the radius
• For long stumps, the radius should be 1-2 cm longer than the ulna.