Long Term Prognosis After Healed Amputation in Patients With Diabetes
Long Term Prognosis After Healed Amputation in Patients With Diabetes
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DOI：
10.1097/00003086-199805000-00021
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发表时间：
1998-05
影响因子：
4.2
通讯作者：
J. Larsson;C. Agardh;J. Apelqvist;A. Stenström
中科院分区：
文献类型：
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作者：
J. Larsson;C. Agardh;J. Apelqvist;A. Stenström
在这项前瞻性研究中，对 189 名已实现指数截肢愈合的糖尿病患者进行了同侧或对侧腿的死亡率、康复和新截肢的研究。 93 名患者在小指数（脚踝以下）截肢后康复，96 名患者因足部溃疡导致大指数（脚踝以上）截肢后康复。小截肢的愈合时间为 29 周（范围，3-191 周），初次大截肢的愈合时间为 8 周（范围，3-104 周）。指数截肢后 1 年、3 年和 5 年的死亡率分别为 15%、38% 和 68%，大截肢后愈合的患者比小截肢后愈合的患者更高。观察1年、3年和5年后新截肢率分别为14%、30%和49%。小指数截肢患者和大指数截肢患者之间没有差异。新发生大截肢的比率分别为 9%、13% 和 23%，并且在有指数大截肢的患者中更高。百分之八十五的新截肢是由足部溃疡引起的。在次截肢前独立生活的患者在小截肢后恢复独立生活的情况比大截肢后恢复独立生活的情况要多（93% 对 61%）。指数截肢一年后，小截肢后康复且截肢前可行走 1 公里或以上的患者中有 70% 恢复了步行能力，而大截肢患者的这一比例为 19%。 70% 的胫骨指数截肢患者在截肢前可以行走，并且安装了假肢，并且 52% 的患者定期使用假肢。与进行小截肢的糖尿病患者相比，进行大截肢的糖尿病患者死亡率较高，新截肢率相同，康复潜力较低。
In this prospective study, mortality, rehabilitation, and new amputations on the same or on the contralateral leg were studied in 189 patients with diabetes who had achieved healing of an index amputation. Ninety-three patients had achieved healing after an index minor (below the ankle) and 96 after an index major (above the ankle) amputation, precipitated by a foot ulcer. The healing time was 29 weeks (range, 3–191 weeks) with a minor amputation and 8 weeks (range, 3–104 weeks) with a primary major amputation. The mortality 1, 3, and 5 years after the index amputation was 15%, 38%, and 68%, respectively, and was higher in patients who had achieved healing after major amputation than in patients achieving healing after minor amputation. The rate of new amputations after 1, 3, and 5 years of observation was 14%, 30%, and 49%, respectively. There was no difference among patients with an index minor and those with an index major amputation. The rate of new major amputations was 9%, 13%, and 23%, respectively, and was higher in patients with an index major amputation. Eighty-five percent of new amputations were precipitated by a foot ulcer. Patients living independently before the index amputation returned to living independently more often after a minor than a major amputation (93% versus 61%). One year after the index amputation, 70% of patients who had achieved healing after having a minor amputation and who could walk 1 km or more before amputation had regained this walking capacity, compared with 19% of patients having a major amputation. Seventy percent of patients with an index transtibial amputation who could walk before amputation were fitted with a prosthesis, and 52% were using it regularly. Patients with diabetes who had an index major amputation had a higher mortality, an equal rate of new amputation, and a lower rehabilitation potential than did patients who had an index minor amputation.