跳到主要内容
Lê Hoàn Prosthetics & Orthotics

假肢

下肢截肢后尽早装配假肢：证据与建议

下肢截肢后是否应尽早用临时假肢站立和行走？汇总证据、国际指南与注意事项。

免费咨询 0985 211 888
下肢截肢后尽早装配假肢：证据与建议

下肢截肢后，患者常被告知要等残肢“成熟”再做假肢。但越来越多的证据表明，尽早用临时假肢站立和行走有益。

以下为证据与国际指南的摘要。含表格和参考文献的完整文章提供越南语和英语版本。

要点

  • 假肢提前约2.5周至2个月获得（荷兰：50天对110天）。
  • 膝关节挛缩更少，美国一项研究中残肢翻修手术也更少。
  • 早期获得假肢与较低死亡率相关（美国、瑞士），这是关联而非已证实的因果。
  • 假肢使用者的身体意象和情绪更好。
  • 在美国，头3个月内获得假肢与第一年总医疗费用约低25%、急诊就诊几乎减半相关。
How to read: both timelines start on the day of surgery (day 0). Top (green, EARLY FITTING): removable rigid dressing → early walking with a training aid → temporary prosthesis → definitive prosthesis. Bottom (orange, LATE FITTING): soft elastic bandage, waiting for the stump to settle, no weight-bearing training → late prosthesis, with muscle weakness and joint contracture. Key figure: about 50 days versus 110 days to the first prosthesis (van Velzen et al., Prosthet Orthot Int 2005, 149 transtibial amputees). The figure illustrates the principle only; it must not be used to decide fitting time on your own.
How to read: both timelines start on the day of surgery (day 0). Top (green, EARLY FITTING): removable rigid dressing → early walking with a training aid → temporary prosthesis → definitive prosthesis. Bottom (orange, LATE FITTING): soft elastic bandage, waiting for the stump to settle, no weight-bearing training → late prosthesis, with muscle weakness and joint contracture. Key figure: about 50 days versus 110 days to the first prosthesis (van Velzen et al., Prosthet Orthot Int 2005, 149 transtibial amputees). The figure illustrates the principle only; it must not be used to decide fitting time on your own.

科学证据

  • 2019年Cochrane综述（Kwah等）：因研究规模小且偏倚多，对硬质敷料获益的把握度较低。
  • 荷兰149例（van Velzen，2005）：首个假肢平均50天，弹力绷带组110天。
  • IMPACT研究（美国）：在0–3个月内获得假肢，12个月总费用降低25%。
  • 美国VA/DoD、英国BSRM和BACPAR、2020年荷兰指南均支持在多学科团队参与下尽早开始。

实用建议

  • 术后立即由多学科团队评估。
  • 小腿截肢：第一周使用可拆卸硬质敷料，在早期助行器或临时假肢辅助下练习行走。
  • 严重下肢缺血、感染未控制、严重心肺疾病者需谨慎。
  • 可调节接受腔：残肢萎缩时更换，不必等到完全稳定。

Lê Hoàn YouTube 频道视频

Chân giả cấp sớm giúp phục hồi chức năng sớm.
Chân giả cấp sớm giúp phục hồi chức năng sớm.
Quy trình tập luyện và lắp chân giả cho người bị cắt cụt trên gối cả hai bên chân
Quy trình tập luyện và lắp chân giả cho người bị cắt cụt trên gối cả hai bên chân
Transfemoral amputee with a prosthesis - Đi chân giả lần đầu với khớp gối thủy lực kiểm soát điện tử
Transfemoral amputee with a prosthesis - Đi chân giả lần đầu với khớp gối thủy lực kiểm soát điện tử

YouTube · Chân Tay Giả – Lê Hoàn

如果您或家人即将面临下肢截肢，请尽早联系我们：+84 985 211 888。

参考文献

  1. Kwah LK, Webb MT, Goh L, Harvey LA. Rigid dressings versus soft dressings for transtibial amputations. Cochrane Database Syst Rev 2019;(6):CD012427.
  2. van Velzen AD và cs. Early treatment of trans-tibial amputees: retrospective analysis of early fitting and elastic bandaging. Prosthet Orthot Int 2005.
  3. Ali MM và cs. A contemporary comparative analysis of immediate postoperative prosthesis placement following below-knee amputation. Ann Vasc Surg 2013;27(8):1146–53.
  4. Schon LC và cs. Benefits of early prosthetic management of transtibial amputees: a prospective clinical study of a prefabricated prosthesis. Foot Ankle Int 2002;23(6):509–514.
  5. Samuelsen BT và cs. The impact of the immediate postoperative prosthesis on patient mobility and quality of life after transtibial amputation. Am J Phys Med Rehabil 2017;96(2):116–119.
  6. Reichmann JP, Stevens PM và cs. Removable rigid dressings for postoperative management of transtibial amputations: a review of published evidence. PM&R 2018;10:516–523.
  7. Lee J và cs. Impact of PPAM aid use on the time to prosthetic limb delivery in patients with unilateral transtibial amputation. Prosthet Orthot Int 2023;47(3):258–264.
  8. Mazari FAK và cs. Hull Early walking aid for Rehabilitation of Transtibial amputees — randomized controlled trial (HEART).
  9. Miller TA, Wurdeman SR và cs. Impact of time to receipt of prosthesis on total healthcare costs 12 months postamputation. Am J Phys Med Rehabil 2020.
  10. The role of earlier receipt of a lower limb prosthesis on emergency department utilization. PM&R 2021.
  11. Early receipt of a prosthesis linked to lower mortality in older veterans. J Rehabil Res Dev 2015;52(4).
  12. Prosthetic fitting associated with better survival at 5 years after above-knee amputation due to vascular insufficiency. Ann Phys Rehabil Med 2023.
  13. Pohjolainen T và cs. Prosthetic use and functional and social outcome following major lower limb amputation. Prosthet Orthot Int 1990.
  14. Atay IM và cs. The prevalence of prosthesis use with the effects on body image, depression, anxiety and self-esteem in lower-extremity amputations. Turk J Phys Med Rehab 2014;60(3):184–187.
  15. VA/DoD Clinical Practice Guideline for Rehabilitation of Individuals with Lower Limb Amputation, 2017; cập nhật 2024.
  16. Amputee and Prosthetic Rehabilitation – Standards and Guidelines, 3rd ed. BSRM, London 2018.
  17. Fard B và cs. Amputation and prosthetics of the lower extremity: the 2020 Dutch evidence-based multidisciplinary guideline. Prosthet Orthot Int 2023;47(1):69–80.
  18. Femurett adjustable prosthesis in the assessment and walking training of new above-knee amputees. Prosthet Orthot Int 1989.
  19. Hình ảnh minh họa / Illustrations: dungcuchinhhinh.vn (website của Lê Hoàn Prosthetics & Orthotics)

相关解决方案

髋关节离断假肢

髋关节离断假肢

髋关节离断假肢帮助从髋关节处失去整条下肢的人恢复行动能力，采用现代接受腔设计重建站立与行走能力。

髋关节离断假肢
踝关节离断假肢的装配

踝关节离断假肢的装配

踝关节离断假肢适用于下肢最低的截肢水平，能最大限度保留自然的承重功能。了解装配流程以及哪些人需要这类假肢。

踝关节离断假肢的装配
值得信赖的优质高端假肢机构

值得信赖的优质高端假肢机构

了解什么是高端假肢、它为使用者带来哪些益处，以及Lê Hoàn矫形器中心为什么是值得信赖的高端假肢选择。

值得信赖的优质高端假肢机构

您或家人需要咨询吗？

预约河内到院评估，或发送资料进行远程咨询。我们会在24小时内回复。

预约咨询