上肢截肢患者之義肢使用調查

A Survey of Prosthesis Use Among Patients with Upper Limb Amputation

本研究的目的在於探討曾向中央健康保險局申請義肢補助之上肢截肢（amputation）患者的使用義肢（prosthesis）現況，研究方法是電話問卷調查，研究內容包括受訪者之截肢原因、截肢部位、目前是否穿義肢、不穿義肢的理由、穿著義肢的種類、滿意度及問題、截肢對日常生活能力、工作、經濟來源等方面的影響。從民國87年1月到民國89年12月共三年間，曾向中央健康保險局申請義肢補助之上肢截肢患者共566位，而這566位上肢截肢患者中，電話聯絡上的共244位，其中7位已死亡，目前還存活的有237位。237位中有穿過義肢者共232位，其中單側截肢216位，雙側截肢16位。216位單側上肢截肢患者當中，男性較多，其平均年齡為42.7歲，女性平均年齡為40.5歲。截肢原因大多為外傷（86.6%）。截肢部位以肘下截肢（transradial amputation）最多（50.5%），其次為肘上截肢（transhumeral amputation）（19.9%）。義肢使用狀況方面，71.3%患者目前仍使用義肢，但所使用的義肢種類以美觀性義肢（cosmetic prosthesis）最多（68.3%），功能性機械式義肢（functional prosthesis）次之（24.7%）。大多數患者（53.9%）對義肢的滿意度為普通。目前沒有穿義肢者其主要原因為義肢太重（54.8%）。至於16位雙側截肢患者則全部為男性。截肢原因大多為外傷（14位），截肢部位以雙側肘下截肢最多（5位），其次為雙側肘上截肢（4位）。目前仍穿義肢的有13位，其中有7位對義肢的滿意度為普通。這16位雙側上肢截肢患者所穿戴的義肢種類則以功能性機械式義肢最多（10位），美觀性義肢反而較少（1位）。232位上肢截肢患者當中，有49.1%目前沒有工作，但也有41.2%靠自己工作賺錢。此外，大部份的患者均可獨自完成其日常生活。總之，國內之上肢截肢患者，其截肢原因、截肢部位及執行日常生活的能力皆與歐美之醫學報告無異，然而在使用功能性機械式義肢的比率及對義肢滿意度方面偏低，而且回到工作崗位之比率也較低，這些是國內截肢復健領域有待努力的地方。

The aim of this study was to survey the prosthesis use among patients with upper limb amputation during the period 1998~2000. Study subjects who applied for the sponsor of prosthesis for upper limb amputations were identified from the database of the Bureau of National Health Insurance. A questionnaire was administered for every amputee by phone. The questions included the causes and levels of the amputation, experiences of the usage of prostheses, type of the prostheses they wore, the satisfaction for the prostheses, current functional condition, social-economic status, and employment condition. There were 237 patients enrolled in our study and 232 amputees had the experience of prostheses fitting. Of 232 amputees, 216 patients (male 172, female 44) were unilateral amputees and 16 male patients were bilateral amputees. The most common level of amputation was transradial amputation and left side was more common. The most common cause of amputation was trauma. Most (71.3%) of the 216 unilateral amputees had used prostheses and the most common reason for not using prostheses was the heavy weight of the prosthesis. Cosmetic prosthesis was the common type of prostheses, and satisfaction for prosthesis was fair for nearly half unilateral amputees. Of the 16 bilateral amputees, functional prosthesis usage was more frequent than cosmetic prosthesis. With regard to age and sex, the most common cause of amputation, the satisfaction for prostheses, the location of amputation, and whether amputees use prostheses, the responses of the bilateral amputees were similar to that of unilateral amputees. Only one third of upper limbs amputees used functional prostheses. The major reason for not using prosthesis was the heavy weight of prostheses. Most unilateral amputees used cosmetic prostheses and most bilateral amputees used functional prostheses. The satisfaction for prosthesis was fair for most of the upper limbs amputees. Most upper limbs amputees were unemployed after amputation. Most upper limbs amputees earned money by themselves and lived together with their family. Most upper limbs amputees could do activities of daily living independently except bilateral amputees who needed moderate assistance for dressing.