Amputation prevention by vascular surgery and podiatry collaboration in high-risk diabetic and nondiabetic patients. The Operation Desert Foot experience.
Amputation prevention by vascular surgery and podiatry collaboration in high-risk diabetic and nondiabetic patients. The Operation Desert Foot experience.
复制标题
通过血管外科和足病学合作预防高危糖尿病和非糖尿病患者的截肢。
DOI：
10.2337/diacare.22.5.678
复制
发表时间：
1999
期刊：
影响因子：
16.2
通讯作者：
C. G. Wheeler
中科院分区：
文献类型：
--
作者：
C. V. Van Gils;L. Wheeler;M. Mellstrøm;E. Brinton;S. Mason;C. G. Wheeler
目的
描述一种独特的多学科门诊干预下肢截肢高危患者。
研究设计和方法
患有足部溃疡并被认为是下肢截肢高风险的患者被转诊到卡尔T。海登退伍军人事务部医疗中心在亚利桑那州凤凰城，在那里病人接受同时血管手术和足病分类和治疗。约124例患者，包括90名糖尿病患者和34名非糖尿病患者，最初看到1991年10月1日至1992年9月30日，随后的下肢截肢率。
结果
在平均55个月的随访期内（范围3-77），124例患者中只有18例（15%）需要在大腿或小腿水平截肢。在18名截肢者中，17名（94%）患有2型糖尿病。术后3年避免肢体丧失率为86.5%，5年以上为83%。此外，15例存活超过2个月的截肢者中，只有1例（7%）在随后的12-65个月（平均35个月）内不得不接受对侧肢体截肢。与非糖尿病患者相比，糖尿病患者截肢的优势比为7.68（95% CI 5.63-9.74）（P < 0.01）。
结论
一个专门的诊所，用于预防下肢截肢。该人群的初始和对侧截肢率似乎远低于以前发表的类似人群的报告。相对于非糖尿病患者，糖尿病患者下肢截肢的可能性是非糖尿病患者的七倍多。这些数据表明，血管外科和足病学的积极合作可以有效地防止下肢截肢的高危人群。
OBJECTIVE
To describe a unique multidisciplinary outpatient intervention for patients at high risk for lower-extremity amputation.
RESEARCH DESIGN AND METHODS
Patients with foot ulcers and considered to be high risk for lower-extremity amputation were referred to the High Risk Foot Clinic of Operation Desert Foot at the Carl T. Hayden Veterans Affairs' Medical Center in Phoenix, Arizona, where patients received simultaneous vascular surgery and podiatric triage and treatment. Some 124 patients, consisting of 90 diabetic patients and 34 nondiabetic patients, were initially seen between 1 October 1991 and 30 September 1992 and followed for subsequent rate of lower-extremity amputation.
RESULTS
In a mean follow-up period of 55 months (range 3-77), only 18 of 124 patients (15%) required amputation at the level of the thigh or leg. Of the 18 amputees, 17 (94%) had type 2 diabetes. The rate of avoiding limb loss was 86.5% after 3 years and 83% after 5 years or more. Furthermore, of the 15 amputees surviving longer than 2 months, only one (7%) had to undergo amputation of the contralateral limb over the following 12-65 months (mean 35 months). Compared with nondiabetic patients, patients with diabetes had a 7.68 odds ratio for amputation (95% CI 5.63-9.74) (P < 0.01).
CONCLUSIONS
A specialized clinic for prevention of lower-extremity amputation is described. Initial and contralateral amputation rates appear to be far lower in this population than in previously published reports for similar populations. Relative to patients without diabetes, patients with diabetes were more than seven times as likely to have a lower-extremity amputation. These data suggest that aggressive collaboration of vascular surgery and podiatry can be effective in preventing lower-extremity amputation in the high-risk population.