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Gliedmaßenerhalt oder Amputation nach schwerem Trauma der unteren Extremität

Evidenz aus der LEAP-Studie

Limb salvage or amputation after severe trauma to the lower extremities

Evidence from the LEAP Study

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Zusammenfassung

Die Entscheidung zwischen Erhaltungsversuch und primärer Amputation der schwersttraumatisierten unteren Extremität ist schwierig und folgenreich. In der Lower-Extremity-Assessment-Project(LEAP)-Studie wurden prospektiv Patienten mit schweren, den Erhalt der Extremität bedrohenden Verletzungen ab distal des Femurs mit drittgradig offenen Frakturen, definierten Weichteilschäden und Amputationsverletzungen eingeschlossen und nachuntersucht. Die vorliegende Übersichtsarbeit stellt die Ergebnisse der Studie, die in multiplen Teilaspekten publiziert wurde, unter Berücksichtigung der neueren Literatur dar und leitet Schlussfolgerungen für die klinische Praxis ab. Wichtige Ergebnisse sind: Bisher ist kein Score ausreichend reliabel, den Erfolg eines Extremitätenerhalts vorherzusagen. Das Ausmaß der muskulären Verletzung erscheint für die Funktion bedeutsamer als das der knöchernen Verletzung. Wesentlich für das Ergebnis sind Begleitverletzungen, die im individuellen Therapiekonzept berücksichtigt werden müssen, sowie Vorerkrankungen und andere patientenspezifische Faktoren (Alkohol, Nikotin, Versicherungsstatus, soziale Aspekte). Psychische Beeinträchtigungen sind häufige Folgen dieser Verletzungen und sollten bei der Rehabilitation Beachtung finden.

Abstract

Deciding between reconstruction and primary amputation after severe high-energy trauma to the lower extremities is difficult and consequential. The Lower Extremity Assessment Project (LEAP) prospectively included and investigated patients with severe, limb-threatening injuries below the femur, with third-grade open fractures, defined soft-tissue damage and amputation wounds. This paper aims to review the key results of the LEAP study, which were published in several parts, in due consideration of the newer relevant literature, and to deduce the consequences for clinical practice. The main results are as follows: No score is sufficiently reliable to predict the success of reconstruction. Loss of muscle seems to be more momentous than loss of bone. Any accompanying injuries that should be taken into account in the individual treatment concepts are crucial to the results, in addition to comorbidities and other individual patient-related factors, such as alcoholism, smoking, insurance, and social background. Psychological impairment is frequent after these injuries and should therefore be addressed regularly with regard to rehabilitation.

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Authors and Affiliations

  1. Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    C. W. Müller, C. Krettek, S. Decker & N. Hawi

  2. Klinik für Orthopädie und Unfallchirurgie, Sana Klinikum Hameln-Pyrmont, Hameln, Deutschland

    S. Hankemeier

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  1. C. W. Müller
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  2. C. Krettek
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  3. S. Decker
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  4. S. Hankemeier
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  5. N. Hawi
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Correspondence to C. W. Müller.

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Interessenkonflikt

C. W. Müller, C. Krettek, S. Decker, S. Hankemeier und N. Hawi geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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C. Krettek, Hannover

C. Willy, Berlin

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Müller, C.W., Krettek, C., Decker, S. et al. Gliedmaßenerhalt oder Amputation nach schwerem Trauma der unteren Extremität. Unfallchirurg 119, 400–407 (2016). https://doi.org/10.1007/s00113-016-0180-6

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  • DOI: https://doi.org/10.1007/s00113-016-0180-6

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