I. Causes of amputation
(A) Severe trauma :
Due to severe trauma, the blood circulation of the limb is impaired and the limb tissue may be necrotic or beyond repair, including limb necrosis caused by burns and frostbite. In our country, the cause of amputation is mostly due to trauma.
(ii) Diabetes mellitus.
Amputation is required when gangrene of the limb occurs in diabetic patients. Amputations due to diabetes are becoming more common.
(iii) Severe infections.
Life-threatening acute infections of the limb, such as gas gangrene and dengue. Some chronic infections, such as chronic osteomyelitis, are difficult to cure with long-term recurrent episodes, causing extensive tissue destruction and severe limb deformity, loss of function, and even induced carcinogenesis.
(iv) Malignant tumors:
Because of the infiltrative growth of limb malignant tumor, it is difficult to be completely removed and the recurrence rate is very high after surgery, plus the lack of effective means for distant metastasis, so the hope of improving the efficacy for a long time in the past was almost all on the complete removal method – amputation. At present, the medical profession believes that amputation is still an indispensable means of limb malignant tumor treatment and has good effect on the control of local recurrence of tumor.
(E) Congenital malformations and developmental abnormalities.
The limb is severely deformed, non-functional, and cannot be corrected.
Second, the classification of amputation
There are many classification methods of amputation, and most of them are clinically classified according to the amputation site, which is divided into upper limb amputation and lower limb amputation according to the different amputation sites.
(A) upper limb amputation: shoulder amputation, upper arm amputation, elbow amputation, forearm amputation and wrist amputation, etc.
(B) lower limb amputation: half (full) pelvic resection, hip amputation, thigh amputation, knee amputation, calf amputation, ankle amputation, Schobert amputation, Sem amputation, etc.
Third, the rehabilitation after amputation
Severe disability after amputation requires prosthesis and active and effective rehabilitation treatment to help amputees rebuild the lost limb motor function and reduce the adverse effects of amputation on patients’ physical health and psychological activities.
(A) The time of installing prosthesis after amputation
According to the traditional concept, after amputation, we have to wait until the residual limb is shaped before fitting the prosthesis, which often takes as long as half a year. With the progress of amputation surgery and prosthetic assembly technology, the time of installing prosthesis after amputation is greatly advanced, generally after the removal of stitches, wound healing can be installed prosthesis. Due to the existence of phantom limb sensation, amputees can easily control the prosthesis, so early installation of prosthesis is very important for amputee patients. After the installation of the prosthesis, the walking training after wearing the prosthesis according to the functional design of the prosthesis. Training should be gradual, through formal walking training to form a good gait close to normal.
(B) post-amputation rehabilitation treatment
1.Rehab treatment before wearing prosthesis
1.Short-term rehabilitation after amputation: post-operative cryotherapy, physical factor therapy (including high and low frequency), rehabilitation of cardiopulmonary function, etc.
2.After amputation surgery, special attention should be paid to the functional exercise of the residual limb and the whole body. Functional exercise is an indispensable part of rehabilitation treatment, without it, functional recovery is not only slow and unsatisfactory. Functional exercise can promote local and systemic blood circulation, promote the swelling of the residual limb; reduce muscle wasting atrophy and joint adhesion stiffness, promote the recovery of the residual limb and systemic motor function, and avoid the occurrence of various wasting syndromes. Functional exercise should be started as early as possible, generally the first day after surgery should be in bed for healthy limb exercise, three or four days to start the active movement of the residual limb. In the case of upper limb amputation, the early activity of getting up should be emphasized, and in the case of lower limb amputation, single-leg walking or walking with crutches should be practiced in the walker or parallel bar as early as possible.
3.Ultrasonic therapy: Ultrasonic therapy has the effect of helping to reduce swelling, analgesia and soften the scar of the residual limb. Part of the skin of the residual limb will be in direct contact with the prosthetic receiving cavity or, when the skin injury after trauma, post-surgery, burns, burns and other causes of the residual limb has a scar, when wearing a prosthetic limb produces easily lead to frictional damage or the formation of tension blisters at the scar. Through ultrasonic treatment with residual limb keratinization training, it can soften the scar, enhance the abrasion resistance of the scar, so that the amputee can adapt to wearing a prosthesis as soon as possible.
4, residual limb keratinization training: rubbing and massaging the skin of the residual limb with towels, toothbrushes and manipulation can promote the abrasion resistance of the skin of the residual limb and relieve the patient’s phantom limb pain, etc.
5.Air splint massage: due to poor blood circulation at the end of the residual limb after amputation, and the resulting swelling at the end of the residual limb, air splint massage can improve the blood circulation condition of the residual limb.
6.Joint movement techniques: after amputation, long-term braking, joint fracture, scar contracture and other reasons may lead to residual limb joint contracture.
2.Rehabilitation training after wearing prosthesis
1.Prosthetic limb donning training: teach the patient to put on the prosthesis.
2.Standing balance training: practice standing on both lower limbs, weight transfer, standing balance on the healthy limbs and standing balance on the side of the prosthesis.
3.Walking training: first in the double bar training, and finally to independent walking, turning, up and down the stairs, over obstacles, ground pick-up training, as well as training to stand up after a fall.
4.Self-care ability training: the ability to return to society after wearing the prosthesis training.