Major lower extremity amputation - Outcome of a modern series
Major lower extremity amputation - Outcome of a modern series
复制标题
DOI：
10.1001/archsurg.139.4.395
复制
发表时间：
2004-04-01
影响因子：
--
通讯作者：
Pomposelli, FB
中科院分区：
文献类型：
--
作者：
Aulivola, B;Hile, CN;Pomposelli, FB
假设：大腿截肢会导致显著的发病率和死亡率。设计：1990年1月1日至2001年12月31日的回顾性数据库查询和病历回顾。平均随访33.6月。地点：学术三级护理中心。患者：连续959次大腿截肢，其中膝下截肢(BKA)704例(73.4%)，膝上截肢(AKA)255例(26.6%)。主要观察指标：患者存活率、心脏并发症、感染并发症和后续手术。结果：总的30天死亡率为8.6%，AKA组(16.5%)比BKA组(5.7%)差(P<；.001)。截肢30天死亡率为14.3%，闭合截肢为7.8%(P=0.03)。并发症包括心脏(10.2%)、伤口感染(5.5%)和肺炎(4.5%)。AKA 12条(4.7%)，BKA 129条(18.4%)需再次手术。仅有66例(9.4%)需要中转AKA，平均术后77.1天。1年和5年总生存率分别为69.7%和34.7%。AKA组的存活率(50.6%和22.5%)明显低于BKA组(74.5%和37.8%)(P<；.001)。糖尿病患者1年和5年生存率分别为69.4%和30.9%，非糖尿病患者分别为70.8%和51.0%(P=0.002)。终末期肾病患者1年和5年生存率分别为51.9%和14.4%，而无肾功能衰竭患者分别为75.4%和42.2%(P<；.001)。患有BKA的幸存者很少需要修改或转换为AKA。对于患有糖尿病和终末期肾病的患者以及接受AKA治疗的患者来说，长期存活率是令人沮丧的。
Hypothesis: Major lower extremity amputation results in significant morbidity and mortality.Design: Retrospective database query and medical record review for January 1, 1990, to December 31, 2001. Mean follow-up was 33.6 months.Setting: Academic tertiary care center.Patients: Nine hundred fifty-nine consecutive major lower extremity amputations in 788 patients, including 704 below-knee amputations (BKAs) (73.4%) and 255 above-knee amputations (AKAs) (26.6%).Main Outcome Measures: Patient survival, cardiac morbidity, infectious complications, and subsequent operation.Results: Overall 30-day mortality was 8.6%, worse for AKA (16.5%) than BKA (5.7%) patients (P < .001). Thirty-day mortality for guillotine amputation for sepsis control was 14.3% compared with 7.8% for closed amputation (P = .03). Complications included cardiac (10.2%), wound infection (5.5%), and pneumonia (4.5%). Twelve AKA (4.7%) and 129 BKA (18.4%) limbs required subsequent operation. Only 66 BKAs (9.4%) required conversion to AKA (average, 77.1 days postoperatively). Overall survival was 69.7% and 34.7% at 1 and 5 years, respectively. Survival was significantly worse for AKAs (50.6% and 22.5%) than BKAs (74.5% and 37.8%) (P < .001). Survival in patients with diabetes mellitus (DM) was 69.4% and 30.9% vs 70.8% and 51.0% in patients without DM at 1 and 5 years, respectively (P = .002). Survival in end-stage renal disease patients was 51.9% and 14.4% vs 75.4% and 42.2% in patients without renal failure at 1 and 5 years, respectively (P< .001).Conclusions: Major amputation continues to result in significant morbidity and mortality. Survivors with BKA require revision or conversion to AKA infrequently. Longterm survival is dismal for patients with DM and endstage renal disease and those undergoing AKA.