Ebskov L B, Hindsø K, Holstein P
Danish Amputation Register, Department of Orthopedic Surgery, County Hospital, Herlev, Denmark.
Eur J Vasc Endovasc Surg. 1999 Jan;17(1):35-40. doi: 10.1053/ejvs.1998.0689.
To determine if the level of amputation after failed vascular reconstruction was comparable to the level of amputation after primary amputation.
Medline literature search (1975-1996), meta-analysis.
The odds ratio of transtibial to transfemoral (TT/TF) amputations was 927/657 = 1.41 (95% confidence limits: 1.278-1.561) in postrevascularisation amputation (PRVA) and 1590/1162 = 1.37 (95% confidence limits: 1.269-1.477) in primary amputation (PA) (p = 0.65). The pooled data show that the number of conversions from transtibial (TT) to transfemoral (TF) amputations due to amputation stump complications were 85/369 (23%) in PRVA against 93/752 (12.4%) in PA (p < 0.01).
We could not detect any difference in TT/TF ratio between PRVA and PA. However, the risk of conversion i.e. reamputation to a higher level is higher after PRVA compared to PA. The chance of having a successful transtibial amputation is approximately 58% for postrevascularisation amputation as well as for primary amputations. An aggressive approach towards vascular reconstruction seems justified.
确定血管重建失败后的截肢平面是否与一期截肢的平面相当。
对1975 - 1996年的Medline文献进行检索并进行荟萃分析。
血管重建术后截肢（PRVA）中，经胫骨与经股骨（TT/TF）截肢的比值比为927/657 = 1.41（95%置信区间：1.278 - 1.561），一期截肢（PA）中为1590/1162 = 1.37（95%置信区间：1.269 - 1.477）（p = 0.65）。汇总数据显示，因截肢残端并发症导致从经胫骨（TT）截肢转为经股骨（TF）截肢的例数在PRVA中为85/369（23%），在PA中为93/752（12.4%）（p < 0.01）。
我们未发现PRVA和PA之间在TT/TF比值上存在差异。然而，与PA相比，PRVA后转为更高平面再次截肢的风险更高。对于血管重建术后截肢和一期截肢，成功进行经胫骨截肢的几率约为58%。对血管重建采取积极的方法似乎是合理的。
