下肢截肢患者的長期義肢使用與功能追蹤

Long-term Prosthesis Use and Functional Outcome among Patients with Lower Extremity Amputations

楊哲魁(Je-Kuei Yang) ； 林銘川(Ming-Chuan Lin) ； 陳思遠(Ssu-Yuan Chen) ； 藍青(Ching Lan) ； 賴金鑫(Jin-Shin Lai) ； 連倚南(I-Nan Lien)

《台灣復健醫學雜誌》 32卷2期 (2004/06) Pp. 63-70

https://doi.org/10.6315/2004.32(2)02

摘要

本研究目的在探討因周邊血管疾病而施行下肢重大截肢的患者，在回到社區之後使用義肢的現況與功能。研究方法採用病歷回顧方式，記錄其截肢原因、截肢部位與健康狀況，然後採用電話問卷方式，調查其殘肢狀況、是否穿戴義肢、使用義肢遇到的問題、功能與日常生活情況。
在1993年1月至1999年12月間，總共有347例患者接受下肢截肢，其中有174例在電話訪問時已經死亡，67例病人失去追蹤，106例接受電話問卷訪問。其中重大截肢共有64例，平均年齡為72.2±11.1歲，平均追蹤時間為4.1±1.7年。男性為40例(62.5%)，單側機肢患者為45例(70.3%)。在全部64例截肢患者中，有34例(53.1%)能夠獨立進食，40例(62.5%)完成刷牙洗臉，35例(54.7%)自行洗澡，39例(60.9%)能獨自完成穿脫上身衣物，3例(56.3%)可獨自完成穿脫下身衣物，40例(71.l%)自行上廁所。有56例(87.5%)患者曾經穿戴過義肢，其中有44例(78.6%)在追蹤時仍持續使用義肢。其餘不使用義肢者的主要原因為殘肢疼痛。44例仍在使用義肢的患者，只有29.6%對義肢感到滿意。單側截肢使用義肢最常見之問題依序為穿脫麻煩、義肢太貴及殘肢疼痛，雙側截肢患者的問題依序為義肢過重、行走時會喘及常跌倒。36例目前仍使用義肢的單側截肢患者中，25例(69.4%)在追蹤時能獨立行走五十公尺以上，而8例雙側截肢患者中則有5例(62.5%)可以做到。
本研究結果顯示，大部分下肢截肢患者出院返家後仍繼續穿戴義肢且具有獨立的行走能力。但是多數患者對他們的義肢感到不滿意，主要原因是殘肢的不適。這些發現值得復健團隊做為以後訓練截肢病人時的參考。

關鍵字

下肢戴肢 ； 義肢 ； 功能預後

並列摘要

The purpose of this study was to investigate prosthesis use among patients who underwent lower extremity amputation owing to peripheral vascular disease and evaluate their functional outcome after returning to the community. We retrospectively reviewed medical charts of patients who underwent lower extremity amputation from 1993 to 1999. The causes of amputation, the level of amputation and patient's health condition were recorded. We then surveyed the patients by telephone, and recorded the stump condition, difficulties encountered in daily activities, and functional status. From January 1993 to December 1999, 347 patients underwent lower-limb amputations in our hospital. Of them, 174 died, 67 were lost follow-up, and 106 completed the telephone survey. Of the 106 patients, 64 underwent a major amputation and were included in this study. Their mean age was 72.2±11.1 years and the mean duration of follow-up was 4.1±1.7 years. The study group consisted of 40(62.5%)men and 45 women. Forty-five (70.3%) were unilateral amputees. Among the 64 major amputees, the number of patients who were independent in self-feeding was 34 (53.1%), grooming 40 (62.5%), bathing 35 (54.7%), dressing the upper body 39 (60.9%), dressing the lower body 36 (56.3%), and toileting 40 (71.1%). Fifty-six (87.5%) patients wore prostheses and 44 (78.6%) of them were continuing to use their prosthesis at follow-up. Stump pain was the primary reason to abandon the prosthesis. Of patients who continued to use their prosthesis, only 29.6% were satisfied with it. Common problems that unilateral amputees encountered were difficulties in donning and removing the prosthesis, cost of the prosthesis, and stump pain. Among bilateral amputees, the heavy weight of the prosthesis, exertional dyspnea and propensity to fall were the common complaints. Among the 36 patients who underwent unilateral amputation, 25 (69.4%) could walk for 50 meters at the time of follow-up. Among the patients who underwent bilateral amputation, only five (62.5%) could walk for 50 meters. After lower extremity amputations, most patients wore prostheses and continued to use them in the community. Although most patients could walk independently, only 29.6% expressed satisfaction with their prostheses. These findings provide the rehabilitation team with valuable information and could lead to prosthesis tailoring for patients with lower extremity amputations.

並列關鍵字

lower limb amputation ； prosthesis ； functional outcome