BS 7313-4-1993 Prosthetics and orthotics - Method of describing upper limb amputation stumps《修复术和矫形学 上肢截断残端描述方法》.pdf

1、BRITISH STANDARD BS 7313-4: 1993 ISO 8548-3: 1993 Prosthetics and orthotics Part 4: Method of describing upper limb amputation stumps UDC 616-089.28:591.471.372BS7313-4:1993 This British Standard, having been prepared under the directionof the Health Care Standards Policy Committee, waspublished und

2、er the authorityof the Standards Boardand comes intoeffecton 15November1993 BSI 10-1999 The following BSI references relate to the work on this standard: Committee reference HCC/9 Draft for comment 91/55575 DC ISBN 0 580 22374 4 Committees responsible for this British Standard The preparation of thi

3、s 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 Association B

4、ritish 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 Societ

5、y) 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 SATRA Foo

6、twear 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 CommentsBS7313-4:1993 BSI 10-1999 i Contents Page Committees responsible Inside front cov

7、er National foreword ii 1 Scope 1 2 Normative references 1 3 Definitions 1 4 Measurement of upper limb amputation stumps 1 5 Method of describing upper limb amputation stump 2 Annex A (informative) Explanatory notes for descriptors used inTable 1 toTable 7 14 Figure 1 Measurement of trans-humeral am

8、putation 6 Figure 2 Measurement of elbow disarticulation 8 Figure 3 Measurement of trans-radial amputation 10 Figure 4 Measurement of wrist disarticulation 12 Table 1 Descriptors for recording forequarter amputations 3 Table 2 Descriptors for recording shoulder disarticulations 4 Table 3 Descriptors

9、 for recording trans-humeral (above-elbow) amputations 5 Table 4 Descriptors for recording elbow disarticulations 7 Table 5 Descriptors for recording trans-radial (below-elbow) amputations 9 Table 6 Descriptors for recording wrist disarticulations 11 Table 7 Descriptors for recording partial hand am

10、putations 13 List of references Inside back coverBS7313-4:1993 ii BSI 10-1999 National foreword This Part of BS7313 has been prepared under the direction of the Health Care Standards Policy Committee. It is identical with ISO8548-3:1993 Prosthetics and orthotics Limb deficiencies Part 3: Method of d

11、escribing upper limb amputation stumps, published by the International Organization 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 diffe

12、rent countries, working with different patients and different technical possibilities, 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 differ

13、ent care groups who will appreciate and use a standardized system of describing 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 a

14、nd government health officials. The system proposed has to meet the needs of the 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 informati

15、on to be described. It should be feasible for this information to be included in 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 g

16、eneral terms relating to external limb prostheses and external orthoses; Section 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 a

17、t birth; Part 3: Method of describing lower limb amputation stumps. Additional information. 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 t

18、he muscles acting at the joint. Cross-references International Standard Corresponding 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

19、 to external limb prostheses and external orthoses (Identical) ISO 8549-2:1989 Section 1.2:1990 Glossary of terms relating to external limb prostheses and wearers of external limb prostheses (Identical)BS7313-4:1993 BSI 10-1999 iii A British Standard does not purport to include all the necessary pro

20、visions of a contract. Users of British Standards are responsible for their correct 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, pages 1 to 14,

21、an inside back cover and a back cover. This standard has been updated (see copyright date) and may have had amendments incorporated. This will be indicated in the amendment table on the inside front cover.iv blankBS7313-4:1993 BSI 10-1999 1 1 Scope This part of ISO8548 establishes a method of descri

22、bing upper limb amputation stumps and for recording the descriptive information. 2 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

23、standards are subject to revision, and parties to agreements based on this part of 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 85

24、48-1:1989, Prosthetics and orthotics Limb deficiencies Part 1: Method of describing 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 Vocabular

25、y Part 2: Terms relating to external limb prostheses and wearers of these prostheses. 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 upper limb amputation stumps 4.1 Reference levels and reference planes Ide

26、ntify the reference levels and planes relevant to the particular level of amputation as described in4.1.1 and4.1.2, preferably with the patient standing erect and with the stump hanging unconstrained. 4.1.1 Reference levels 4.1.1.1 Axilla level the most proximal level at which a circumferential meas

27、urement, perpendicular to the centreline of the upper arm, can be obtained. 4.1.1.2 Medial epicondyle level the level of the medial epicondyle of the humerus. 4.1.1.3 Stump end level the level of the end of the stump. 4.1.1.4 Ulnar styloid level the level of the tip of the ulnar styloid in wrist dis

28、articulation stumps and on the contralateral limb. 4.1.1.5 Bone end level the level of the bone end in trans-humeral and trans-radial amputation stumps. 4.1.1.6 Minimum circumferential level the level of the minimum circumferential measurement in elbow disarticulation stumps. 4.1.2 Reference planes

29、4.1.2.1 Posterior ulnar plane the plane of the posterior aspect of the shaft of the ulna, parallel with the centreline of the forearm when the elbow is flexed at90 . 4.1.2.2 Anterior elbow crease plane the plane perpendicular to the centreline of the forearm at the level of the anterior elbow crease

30、 with the elbow flexed at90 . 4.2 Measurements 4.2.1 Length measurements Measure and record the length measurements as specified in the appropriate table (seeTable 1 toTable 7) for the particular level of amputation. 4.2.2 Circumferential measurements Measure and record the circumferential measureme

31、nts 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 function which need to be recorded include abnormalities of range of joint movement, significant reduction of muscle power and

32、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 motion as adopted by the American Academy of Orthopaedic Surgeons in1964 in which all motions of the joint are measured

33、from defined zero starting positions. 4.3.3 Assessment of joint power Record any reduction of muscle power likely to affect performance significantly. NOTE 1Muscle power can be measured objectively but requires expensive and bulky apparatus which is inapplicable here. The scales relating to measurem

34、ents of power in poliomyelitis cases are equally inappropriate. The subjective judgement as to whether there is significant reduction of power or not has 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-f

35、itted socket.BS7313-4:1993 2 BSI 10-1999 4.3.4 Assessment of joint stability Record an assessment of the joint stability. NOTE 2It is recognized that the stability of a joint is a function of the integrity of the skeletal, ligamentous and neuro-muscular elements. In the context of this part of ISO85

36、48, the recording of the joint instability refers solely to bony and/or ligamentous impairments and their consequences. 5 Method of describing upper limb amputation stump 5.1 General Describe the stump using the relevant descriptors listed in the appropriate tables (seeTable 1 to Table 7), and by th

37、e use of the guidance given inAnnex A. 5.2 Forequarter amputation Use the descriptors shown inTable 1. 5.3 Shoulder disarticulation Use the descriptors shown inTable 2. NOTE 3Shoulder disarticulation refers either to amputation at the scapula-humeral joint or to amputation above the upper reference

38、level as described for the usual trans-humeral level (see5.4). 5.4 Trans-humeral amputation (above-elbow) Use the descriptors shown inTable 3. NOTE 4The upper reference level for length measurements is the axilla but, in the case of a flexion deformity, the upper reference level for length would be

39、the highest level at which a circumferential measurement is possible at right angles to the centreline of the stump. 5.5 Elbow disarticulation Use the descriptors shown inTable 4. NOTE 5The upper reference level for length measurements is the axilla but, in the case of a flexion deformity, the upper

40、 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-radial amputation (below-elbow) Use the descriptors shown inTable 5. NOTE 6The upper reference level for length measurements is the medi

41、al epicondyle 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. 5.7 Wrist disarticulation Use the descriptors shown inTable 6. NOTE 7The upper ref

42、erence level for length measurements is the medial epicondyle 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. 5.8 Partial hand amputation Use th

43、e descriptors shown inTable 7. Describe the abnormality of the hand remnant in terms of deformity, range of movements and power, stability and overall function.BS7313-4:1993 BSI 10-1999 3 Table 1 Descriptors for recording forequarter amputations (see5.2 andAnnex A) Descriptor Statements to be record

44、ed Measurements Not relevant Stump shape Scapular remnant Absent/present Clavicular remnant Absent/present If the contralateral arm is the site of an amputation, state the level Skin of the stump Amputation scar Healed/unhealed Mobile/adherent General Skin barrier intact/skin barrier not intact Sens

45、ation 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 (locali

46、zed) Painful neuroma No/yes Phantom pain No/yesBS7313-4:1993 4 BSI 10-1999 Table 2 Descriptors for recording shoulder disarticulations (see5.3 andAnnex A) Descriptor Statements to be recorded Measurements Not relevant Stump shape Upper humeral remnant Absent/present but not prominent/present and pro

47、minent If the contralateral arm is the site of an 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/p

48、resent/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/yesBS7313-4:1993 BSI 10-1999 5 Table 3 Descriptors for r

49、ecording trans-humeral (above-elbow) amputations (see5.4, Figure 1 andAnnex A) Descriptor Statements to be recorded Measurements Record the following measurements: the length from the axilla to the stump end, l 1 the length from the bone end to the stump end, l 2 the length of the contralateral arm from the axilla to the ulnar styloid, l 3 the length of the contralateral arm from the axilla to the medial epicondyle, l 4 the length of the contralateral arm from the axilla to the posterior