Peters E J, Childs M R, Wunderlich R P, Harkless L B, Armstrong D G, Lavery L A
Department of Orthopedics, University of Texas Health Science Center, San Antonio, Texas, USA.
Diabetes Care. 2001 Oct;24(10):1799-804. doi: 10.2337/diacare.24.10.1799.
It is reasonable to predict that diabetes-related lower-extremity amputations have a detrimental impact on quality of life. However, we are unaware of any study in the medical literature describing the functional level of diabetic patients with amputations. The objective of this study was to evaluate amputations among diabetic patients and to determine the functional level of these patients with the Sickness Impact Profile (SIP).
We enrolled 124 patients with diabetes. Case subjects (n = 35) were defined as patients who had undergone amputation of the lower-extremity, and control subjects (n = 89) were defined as patients who had not undergone amputation. Study participants received a standard history and physical examination.
Both the physical dimension scores (33.5 +/- 14.9 vs. 22.3 +/- 14.7, P < 0.001) and the total SIP scores (27.6 +/- 9.9 vs. 22.5 +/- 10.3, P = 0.013) were significantly higher for amputees. However, the psychosocial dimension scores were not significantly different between case and control subjects (14.9 +/- 8.9 vs. 15.2 +/- 10.0, P > 0.05). Post hoc analysis showed that the group of patients who had undergone transtibial amputation had a significantly higher total impairment score than patients who had not undergone amputation (P = 0.039). This is in contrast to patients with toe or midfoot amputations, for whom total impairment scores were not significantly higher than those for the control subjects. Interestingly, bilateral amputees did not have significantly higher scores on either SIP dimension compared with unilateral amputees.
These findings exemplify the detrimental physical and psychosocial health status of patients with diabetes-related lower-extremity amputation.
可以合理预测，糖尿病相关的下肢截肢对生活质量有不利影响。然而，我们未在医学文献中发现任何描述截肢糖尿病患者功能水平的研究。本研究的目的是评估糖尿病患者中的截肢情况，并使用疾病影响量表（SIP）确定这些患者的功能水平。
我们纳入了124例糖尿病患者。病例组（n = 35）定义为接受过下肢截肢的患者，对照组（n = 89）定义为未接受过截肢的患者。研究参与者接受了标准的病史采集和体格检查。
截肢患者的身体维度得分（33.5±14.9对22.3±14.7，P < 0.001）和SIP总分（27.6±9.9对22.5±10.3，P = 0.013）均显著更高。然而，病例组和对照组的心理社会维度得分无显著差异（14.9±8.9对15.2±10.0，P > 0.05）。事后分析显示，接受胫骨截肢的患者组的总损伤得分显著高于未接受截肢的患者（P = 0.039）。这与脚趾或中足截肢患者不同，他们的总损伤得分并不显著高于对照组。有趣的是，与单侧截肢患者相比，双侧截肢患者在SIP的任何一个维度上的得分均无显著更高。
这些发现例证了糖尿病相关下肢截肢患者有害的身体和心理社会健康状况。
