BS 7313-3-1993 Prosthetics and orthotics - Method of describing lower limb amputation stumps《修复术和矫形学 下肢截断残端描述方法》.pdf

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1、BRITISH STANDARD BS 7313-3: 1993 ISO 8548-2: 1993 Prosthetics and orthotics Part 3: Method of describing lower limb amputation stumps UDC 616-089.28:591.471.373BS7313-3:1993 This British Standard, having been prepared under the direction of the Health Care Standards Policy Committee, was published u

2、nder the authority of the Standards Board and comes into effect on15November1993 BSI 10-1999 The following BSI references relate to the work on this standard: Committee reference HCC/9 Draft for comment 91/55574 DC ISBN 0 580 22373 6 Committees responsible for this British Standard The preparation o

3、f this British Standard was entrusted by the Health Care Standards Policy Committee (HCC/-) to Technical Committee HCC/9, upon which the following bodies were represented: Association of Prosthetists and Orthotists British Institute of Surgical Technologists British Limbless Ex-Service Mens Associat

4、ion British Medical Association British Orthopaedic Association British Surgical Trades Association Chartered Society of Physiotherapy College of Occupational Therapists Department of Health Disablement Services Authority International Society for Prosthetics and Orthotics (United Kingdom National S

5、ociety) Limbless Association National Centre for Training and Education in Prosthetics and Orthotics Opportunities for the Disabled Orthotic and Prosthetic Training and Education Council (OPTEC) Royal College of Nursing Royal College of Surgeons of Edinburgh Royal College of Surgeons of England SATR

6、A Footwear Technology Centre Scottish Home and Health Department Scottish Office Society of Chiropodists and Pediatrists Surgical Appliance Manufacturers Association Amendments issued since publication Amd. No. Date CommentsBS7313-3:1993 BSI 10-1999 i Contents Page Committees responsible Inside fron

7、t cover National foreword ii 1 Scope 1 2 Normative references 1 3 Definitions 1 4 Measurement of lower limb amputation stumps 1 5 Method of describing lower limb amputation stump 2 Annex A (informative) Explanatory notes for descriptors used inTable 1 toTable 7 14 Figure 1 Reference levels and measu

8、rements for trans-femoral amputations 5 Figure 2 Reference levels and measurements for knee disarticulations 7 Figure 3 Reference levels and measurements for trans-tibial amputations 9 Figure 4 Reference levels and measurements for ankle disarticulations 11 Figure 5 Reference planes and measurements

9、 for partial foot amputations 13 Table 1 Descriptors for trans-pelvic amputations 3 Table 2 Descriptors for hip disarticulations 3 Table 3 Descriptors for trans-femoral (above-knee) amputations (including supracondylar and transcondylar amputations) 4 Table 4 Descriptors for knee disarticulations (n

10、ot including transcondylar and supracondylar amputations 6 Table 5 Descriptors for trans-tibial (below-knee) amputations 8 Table 6 Descriptors for ankle (Symes) disarticulations 10 Table 7 Descriptors for partial foot amputations 12 List of references Inside back coverBS7313-3:1993 ii BSI 10-1999 Na

11、tional foreword This Part of BS7313 has been prepared under the direction of the Health Care Standards Policy Committee. It is identical with ISO8548-2:1993 Prosthetics and orthotics Limb deficiencies Part 2: Method of describing lower limb amputation stumps, published by the International Organizat

12、ion for Standardization (ISO). Many different systems have been developed to classify amputation stumps, but none has achieved universal acceptance. The reasons for this are many. The members of the clinic teams in different countries, working with different patients and different technical possibil

13、ities, develop their own systems to meet their individual needs. Hence there is a need for an international system to be developed in order to compare one publication with another, one patient against another. The different care groups who will appreciate and use a standardized system of describing

14、stumps include surgeons of different disciplines, other doctors (especially those concerned with rehabilitation), physical and occupational therapists and prosthetists. Such a system is also of value to epidemiologists and government health officials. The system proposed has to meet the needs of the

15、 different members of the clinic team and to enable the description of the stump to be recorded in a way that can be easily incorporated in reports. This Part of BS7313 deliberately aims at defining the minimum information to be described. It should be feasible for this information to be included in

16、 forms designed by the individual institution; the information should also be capable of ready adaptation for computer analysis. Other Parts and Sections of BS7313 include: Part 1: Terminology; Section 1.1: Glossary of general terms relating to external limb prostheses and external orthoses; Section

17、 1.2: Glossary of terms relating to external limb prostheses and wearers of external limb prostheses; Section 1.3: Glossary of terms relating to external orthoses; Part 2: Method of describing limb deficiencies present at birth; Part 4: Method of describing upper limb amputation stumps. Additional i

18、nformation. Note that the expressions “joint power” and “muscle power” are used in4.3. These are terms commonly used in medical texts. A more scientifically correct description would be the strength and/or endurance of the muscles acting at the joint. Cross-references International Standard Correspo

19、nding British Standard BS 7313 Prosthetics and orthotics ISO 8548-1:1989 Part 2:1990 Method of describing limb deficiencies present at birth (Identical) ISO 8549-1:1989 Section 1.1:1990 Glossary of general terms relating to external limb prostheses and external orthoses (Identical) ISO 8549-2:1989 S

20、ection 1.2:1990 Glossary of terms relating to external limb prostheses and wearers of external limb prostheses (Identical)BS7313-3:1993 BSI 10-1999 iii A British Standard does not purport to include all the necessary provisions of a contract. Users of British Standards are responsible for their corr

21、ect application. Compliance with a British Standard does not of itself confer immunity from legal obligations. Summary of pages This document comprises a front cover, an inside front cover, pages i to iv, pages1to 14, an inside back cover and a back cover. This standard has been updated (see copyrig

22、ht date) and may have had amendments incorporated. This will be indicated in the amendment table on the inside front cover.iv blankBS7313-3:1993 BSI 10-1999 1 1 Scope This part of ISO8548 establishes a method of describing lower limb amputation stumps and for recording the descriptive information. 2

23、 Normative references The following standards contain provisions which, through reference in this text, constitute provisions of this part of ISO8548. At the time of publication, the editions indicated were valid. All standards are subject to revision, and parties to agreements based on this part of

24、 ISO8548 are encouraged to investigate the possibility of applying the most recent editions of the standards indicated below. Members of IEC and ISO maintain registers of currently valid International Standards. ISO 8548-1:1989, Prosthetics and orthotics Limb deficiencies Part 1: Method of describin

25、g limb deficiencies present at birth. ISO 8549-1:1989, Prosthetics and orthotics Vocabulary Part 1: General terms for external limb prostheses and external orthoses. ISO 8549-2:1989, Prosthetics and orthotics Vocabulary Part 2: Terms relating to external limb prostheses and wearers of these prosthes

26、es. 3 Definitions For the purposes of this part of ISO8548, the definitions given in ISO8548-1, ISO8549-1 and ISO8549-2 apply. 4 Measurement of lower limb amputation stumps 4.1 Reference levels and reference planes Identify the reference levels and planes relevant to the particular level of amputati

27、on as described in4.1.1 and4.1.2. 4.1.1 Reference levels 4.1.1.1 Crotch level the most proximal level at which a circumferential measurement, perpendicular to the centreline of the thigh, can be obtained. 4.1.1.2 Medial joint line the level of the medial tibial plateau, unless there is a fixed defor

28、mity of the knee, in which case this level is the highest at which a circumferential measurement perpendicular to the centreline of the stump can be obtained. 4.1.1.3 Stump end level the level of the stump end. 4.1.1.4 Ground level the level on which the patient is standing barefoot. 4.1.1.5 “Fall-a

29、way” level in trans-femoral and trans-tibial stumps only, the level on the medial side of the stump at which the slope of the stump shape changes as it curves in towards the end. 4.1.1.6 Minimum circumferential level in knee and ankle disarticulation stumps only, the level of the minimum circumferen

30、tial measurement. 4.1.1.7 Femoral condylar level in knee disarticulation stumps only. 4.1.1.8 Maximum distal circumferential level in ankle disarticulation stumps only, the level of the maximum distal circumferential measurement. 4.1.2 Reference planes (used for partial foot amputations only) 4.1.2.

31、1 Heel plane the plane at the posterior aspect of the heel parallel with the centreline of the leg. 4.1.2.2 Anterior tibial plane the plane at the anterior aspect of the tibia at the ankle joint line parallel with the centreline of the leg. 4.1.2.3 Stump end plane the plane at the stump end parallel

32、 with the centreline of the leg. 4.1.2.4 Toe plane the plane at the tips of the toes of the contralateral leg parallel with the centreline of the leg. 4.2 Measurements 4.2.1 Length measurements Measure and record the length measurements as specified in the appropriate table (seeTable 1 toTable 7) fo

33、r the particular level of amputation. 4.2.2 Circumferential measurements Measure and record the circumferential measurements as specified in the appropriate table (seeTable 1 toTable 7) for the particular level of amputation. 4.3 Assessment of joint function 4.3.1 General The aspects of joint functi

34、on which need to be recorded include abnormalities of range of joint movement, significant reduction of muscle power and any loss of joint stability. 4.3.2 Measurement of abnormal range of joint movement Record any abnormalities of the range of joint movement using the method of measurement of joint

35、 motion as adopted by the American Academy of Orthopaedic Surgeons in1964 in which all motions of the joint are measured from defined zero starting positions.BS7313-3:1993 2 BSI 10-1999 4.3.3 Assessment of joint power Record any reduction of muscle power likely to affect performance significantly. N

36、OTE 1Muscle power can be measured objectively but requires expensive and bulky apparatus which is inapplicable here. The scales relating to measurements of power in poliomyelitis cases are equally inappropriate. The subjective judgement as to whether there is significant reduction of power or not ha

37、s to be based on an appreciation as to whether the power demonstrated would be sufficient to stabilize the proximal joint with the stump in a well-fitted socket in the prosthetic stance phase. 4.3.4 Assessment of joint stability Record an assessment of the joint stability. NOTE 2It is recognized tha

38、t stability of a joint is a function of the integrity of the osseous, ligamentous and neuro-muscular elements. In the context of this part of ISO8548, the recording of the joint instability refers solely to bony and/or ligamentous impairments and their consequences. 5 Method of describing lower limb

39、 amputation stump 5.1 General Describe the stump using the relevant descriptors listed in the appropriate tables (seeTable 1 to Table 7), and by the use of the guidance given inAnnex A. 5.2 Trans-pelvic amputation Use the descriptors shown inTable 1. 5.3 Hip disarticulation Use the descriptors shown

40、 inTable 2. NOTE 3“Hip disarticulation” refers to amputation at the acetabulo-femoral joint or an amputation above the proximal reference level as described for the usual trans-femoral amputation. 5.4 Trans-femoral amputation (above-knee) Use the descriptors shown inTable 3. NOTE 4The upper referenc

41、e level for length measurements is the crotch but, in the case of a flexion deformity, the upper reference level for length would be the highest level at which a circumferential measurement is possible at right angles to the centreline of the stump. 5.5 Knee disarticulation Use the descriptors shown

42、 inTable 4. NOTE 5The upper reference level for length measurements is the crotch but, in the case of a flexion deformity, the upper reference level for length would be the highest level at which a circumferential measurement is possible at right angles to the centreline of the stump. 5.6 Trans-tibi

43、al amputation (below-knee) Use the descriptors shown inTable 5. NOTE 6The upper reference level for length measurements is the medial joint line but, in the case of a flexion deformity, the upper reference level for length would be the highest level at which a circumferential measurement is possible

44、 at right angles to the centreline of the stump. 5.7 Ankle (Symes) disarticulation Use the descriptors shown inTable 6. NOTE 7The upper reference level for length measurements is the medial joint line but, in the case of a flexion deformity, the upper reference level for length would be the highest

45、level at which a circumferential measurement is possible at right angles to the centreline of the stump. 5.8 Partial foot amputation Use the descriptors shown inTable 7.BS7313-3:1993 BSI 10-1999 3 Table 1 Descriptors for trans-pelvic amputations (see5.2 andAnnex A) Table 2 Descriptors for hip disart

46、iculations (see5.3 andAnnex A) Descriptor Statements to be recorded Measurements Not relevant Stump shape Pelvic remnant Absent/present If the contralateral limb is the site of an amputation, state the level Skin of the stump Amputation scar Healed/unhealed Mobile/adherent General Skin barrier intac

47、t/skin barrier not intact Sensation normal/sensation impaired No additional scarring/additional scarring Circulation Oedema None/present/excessive Soft tissues of the stump Amount Adequate/inadequate/excessive Consistency Normal/flabby/indurated Significant pain Spontaneous pain No/yes Tenderness No

48、/yes (generalized)/yes (localized) Painful neuroma No/yes Phantom pain No/yes Pain after exercise No/yes Descriptor Statements to be recorded Measurements Not relevant Stump shape Upper femoral remnant Absent/present but not prominent/present and prominent If the contralateral limb is the site of an

49、 amputation, state the level Skin of the stump Amputation scar Healed/unhealed Mobile/adherent General Skin barrier intact/skin barrier not intact Sensation normal/sensation impaired No additional scarring/additional scarring Circulation Oedema None/present/excessive Soft tissues of the stump Amount Adequate/inadequate/excessive Consistency Normal/flabby/indurated Significant pain Spontaneous pain No/yes Tenderness No/yes (generalized)/yes (localized) Painful neuroma No/yes Phantom pain No/yes P