足部截肢的假肢处理方式

Titelmasterformat durch Klicken bearbeiten,Textmasterformat bearbeiten,Zweite Ebene,Dritte Ebene,Vierte Ebene,Fnfte Ebene,#,Prosthetic Treatment for Partial Foot,Amputation,足部截肢的假肢处理方式,Christian Schlierf,Prosthetist/Orthotist,Guangzhou,China,November 2011,Foot bone,structures,（足部骨骼结构）,The 27 bones of the foot,skeleton,（足部,27,块骨骼）,Forefoot,（前足）,Rear,foot,（后足）,Digiti,pedis(toes),脚趾部,Metatarsus(middle foot,),中足,Tarsus(foot root,),足跟,Levels of Foot,Amputation,s,（足部截肢平面）,If amputat,ion,in the area of toes,is needed,no middle,or,basic part,s of bones,should remain because they tend to deviate to wrong positions.,（,如果必须足趾截肢的话，中部骨骼或骨骼的根部没有必要留下，因为它们将会偏离到错误位置）,The disarticulation,is optimal in this case as it e,nsures unproblematic,prosthetic,treatment.,（,假如能确保假肢安装没问题的话，跖趾离断是最佳选择,）,An exception is the big toe.If only the hallux is,amputated,only,a s,tiff sole and an appropriate roll-over edge,would be an adequate prosthetic treatment,.The shoe should have a flat,sole,in order to avoid too much strain on the,stump,.Where toes II-V,are amputated,an insole with,some compensation of the shape,would,be,appropriate,.,（,大脚趾是个例外。如果大拇趾被截肢，具有滚动边的硬鞋垫就是合理的假肢处理方式。应该穿平底鞋，避免残趾处应力集中。第二至第五足趾截肢，残缺部补好形状的的鞋垫就可以。）,Disarticulation of,T,oes,（,跖趾关节离断）,International,name,:Trans,-,metatarsal peripheral,amp.,（国际通用名,:,经跖骨远端截肢）,Clinical,sign:Amputation according to,Sharp,（临床名：,Sharp,截肢,),Here the amputation line goes through the heads of the metatarsus bones,therefore through the spongious bone areas.Amputations at the diaphysis level are very,unfavorable because,the,bones thin down and,become very pointed,thus making the prosthetic treatment very complicated,.,(,截肢线经过跖骨头部，因此经过跖骨髁部。经跖骨干截肢不好，因为此处骨变小而且很尖，安装假肢将很复杂。,）,The ends of the bones cut by amputation must be well curved on the plantar side.The scar should be positioned on the,cranial side,of the foot so that the skin of the foot sole can be pulled over the ends of the cut bones.,（被截肢骨末端的足底面应该圆滑修整，伤疤应该安置在足背面，因此，足底皮肤可以被拉上来覆盖截骨末端。）,Transmetatarsal A,mputation:,L,ong Stump,（经跖骨截肢,:,长残肢）,Levels of Foot,Amputation,s,（足部截肢平面）,International sign:,Trans,-,metatarsal proximal,amp,.,（国际通用名,:,经跖骨远端截肢）,Clinical sign:,Amputation according to Sharp-Jger,（临床名：,Sharp-Jger,截肢）,If the metata,r,sus cannot,be,preserved,amputation,line will go through,the bas,is,of the,metatarsus bones,.,Prosthetic device is indicated here,but an orthopedic-technical shoe treatment,is,recommended,especially for elderly,patients,.,（如果跖骨不能保留，截肢线应经过跖骨基底。此处可以安装假肢，但要配符合矫形技术的鞋，尤其对老年人来说。）,Transmetatarsal A,mputation:,S,hort,S,tump,（经跖骨截肢,:,短残肢）,Levels of Foot,Amputation,s,（足部截肢平面）,Disarticulation of,toes,跖趾关节离断,Transmetatarsal peripheral,跖骨远端,Transmetatarsal,proximal,跖骨近端,Levels of Foot,Amputation,s,（足部截肢平面）,Clinical,name,:,Amputation,according to,Lisfranc,（临床名：,Lisfranc,截肢）,D,isarticulation in the Lisfranc line cannot be treated without prosthetic problems because the bones of,tarsus,are of different length and the stump end is uneven,.,经,Lisfranc,（线离断截肢不处理的，安置假肢会有问题，因为跗骨长短不一、残端不平整。）,If the,lengths of the tarsus,bones are adjusted through,operation,they,show good functional results(according to Baumgartner).,如果跗骨长度通过手术处理的话，会有很好的功能效果（,据,Baumgartner,）,For this type of amputation,shoe-technical possibilities are no longer enough,therefore,there is a clear indication for prosthetic treatment.,这种类型截肢，矫形鞋技术已经不够，因此，需要安置假肢处理。,Amputation in the,Tarsus Area,:L,ong,S,tump,（跗骨部截肢：远端）,Levels of Foot,Amputation,s,（足部截肢平面）,Clinical,name,:,Amputation according to,Bona-Jger,（临床名：,Bona-Jger,截肢）,Line of distal bones of tarsus is removed and the os cuboideum is cut.Stump end is round,.,跗骨远端切除和骰骨切开，残端变圆滑。,With the amputation line moving more proximally,the tendency of the foot to move to plantarflexion increases.Moreover,the back part of the foot tends to move to,supination position,.,由于这种截肢太接近近端，足倾向于跖屈状态，而且，足背部倾向于反掌运动。,Through tendon caused forces single tarsus bones,are,likely to,move to,a more lateral/medial,and plantar,position,s,.,由于跟腱产生的,l,力作用于单一的跗骨上，使这一跗骨可能移位在更外,/,内侧和跖屈位上,Amputation in the tarsus area-short,stump,（跗骨部截肢：近端）,Levels of Foot,Amputation,s,（足部截肢平面）,Clinical sign:Disarticulation,according to,Chopart,（临床名：,Chopart,离断）,Here the amputation goes through Chopart line.To improve the loading abilities of the stump,lower front edge of calcaneus should be rounded.With this amputation loading may be,painful because the,joints,can move freely.,To prevent that,some surgeons shift the tendon of the m.,tibialis anterior especially,in,younger patients.,经,Chopart,线截肢，为了提高残端的负重能力，跟骨下前沿应该修整圆滑。这种截肢承重会造成疼痛，因为关节可以自由活动。为防止这种情况，可通过手术移位胫前肌，尤其对年轻的患者。,With total loss of movements in the joints of the stump in corrected plantar-flexed and supinated position,arthrodesis,is possible,.,由于残端关节总体运动功能丧失并处于不正确的跖屈和反掌位，故关节融合术是可能的。,Amputation in the tarsus,area,（,跗骨部截肢）,Levels of Foot,Amputation,s,（足部截肢平面）,Lisfranc,amputation,Lisfranc,截肢,Bona-Jger,amputation,Bona-Jger,截肢,Chopart,amputation,Chopart,截肢,Levels of Foot,Amputation,s,（足部截肢平面）,In this type of amputation,the dorsal p