Malay D Scot, Margolis David J, Hoffstad Ole J, Bellamy Scarlett
Ankle and Foot Medical Center of the Delaware Valley, Philadephia, PA 19104, USA.
J Foot Ankle Surg. 2006 Nov-Dec;45(6):366-74. doi: 10.1053/j.jfas.2006.08.002.
The primary goal of this retrospective cohort study was to determine the incidence of failure to heal after lower extremity amputation for the treatment of diabetic neuropathic foot ulcer, and the secondary goal was to identify risk factors associated with the outcome. We evaluated 1775 patients who underwent amputation for the treatment of 5314 neuropathic foot ulcers, and who were treated in a network of wound care centers. We calculated the incidence of failure to heal after the initial amputation, and used generalized estimation equations and generalized linear latent and mixed model regression to evaluate the association of failure to heal by the 20th week of care. The unadjusted incidence of failure to heal was 34.01%, and male sex, number of wounds, wound grade, and adjunct therapy were all significantly associated with failure to heal. With the exception of wound grade, the associations were not significantly affected by the treating wound care center, and a sensitivity analysis showed the results to be resistant to the theoretical influence of an unmeasured potential confounder. These findings should be useful to clinicians treating diabetic neuropathic foot ulcers, and should aid surgeons in the determination of the most appropriate level for lower extremity amputation.
这项回顾性队列研究的主要目的是确定因治疗糖尿病神经性足溃疡而进行下肢截肢术后愈合失败的发生率，次要目的是识别与该结局相关的风险因素。我们评估了1775例接受截肢治疗5314处神经性足溃疡的患者，这些患者在一个伤口护理中心网络接受治疗。我们计算了初次截肢后愈合失败的发生率，并使用广义估计方程以及广义线性潜在和混合模型回归来评估护理第20周时愈合失败的相关性。未调整的愈合失败发生率为34.01%，男性、伤口数量、伤口分级和辅助治疗均与愈合失败显著相关。除伤口分级外，这些相关性不受治疗伤口护理中心的显著影响，敏感性分析表明结果不受未测量的潜在混杂因素的理论影响。这些发现对于治疗糖尿病神经性足溃疡的临床医生应是有用的，并应有助于外科医生确定下肢截肢的最合适水平。
