Remes Leena, Isoaho Raimo, Vahlberg Tero, Viitanen Matti, Rautava Päivi
Institute of Clinical Medicine, Department of Public Health, University of Turku, FI-20014 Turku, Finland.
Aging Clin Exp Res. 2009 Apr;21(2):129-35. doi: 10.1007/BF03325220.
Major lower extremity amputation (LEA) leads to great loss in mobility, exposing old people to the risk of losing their independent living status. This study applies predictors for institutionalization and considers prosthesis use by major lower leg amputees with peripheral arterial disease (PAD).
119 PAD patients admitted from home (mean age 73.6, SD 11.5 years, 48% men) underwent their first major LEA, 1998- 2002, and survived at least one month after the operation. Logistic regression analysis was run to clarify institutionalization predictors. Prosthesis use and ambulatory capacity were recorded during the follow-up.
Older age, living alone, and unilateral above-knee amputation (AKA) or bilateral amputation predicted institutionalization. Of prosthesis users, 69% (27/39) were younger than 75 and 44% (17/39) were able to walk both in- and outdoors. Reasons for not receiving a prosthesis after amputation were: 1) short expected survival; 2) old age, combined with unilateral AKA or bilateral amputation; 3) unilateral AKA or bilateral amputation and a comorbid condition such as hemiparesis, paraplegia, uremia, dementia, or alcohol misuse. After one year, 72% (36/50) of amputees who were able to return home and 9% (3/32) of amputees in institutional care used a prosthesis.
The majority of amputated patients cannot return home after their first LEA. Comorbid conditions particularly influencing functional capacity also hinder ambulation with a prosthesis.
下肢大截肢（LEA）会导致行动能力大幅丧失，使老年人面临失去独立生活状态的风险。本研究应用机构化预测指标，并考虑外周动脉疾病（PAD）导致的小腿大截肢患者使用假肢的情况。
1998年至2002年期间，119例从家中收治的PAD患者（平均年龄73.6岁，标准差11.5岁，48%为男性）接受了首次下肢大截肢手术，且术后存活至少1个月。进行逻辑回归分析以明确机构化预测指标。随访期间记录假肢使用情况和步行能力。
年龄较大、独居以及单侧膝上截肢（AKA）或双侧截肢可预测机构化。在使用假肢的患者中，69%（27/39）年龄小于75岁，44%（17/39）能够在室内外行走。截肢后未接受假肢的原因包括：1）预期生存期短；2）年龄较大，合并单侧AKA或双侧截肢；3）单侧AKA或双侧截肢以及存在偏瘫、截瘫、尿毒症、痴呆或酒精滥用等合并症。一年后，能够回家的截肢患者中有72%（36/50）使用了假肢，机构护理中的截肢患者中有9%（3/32）使用了假肢。
大多数截肢患者在首次下肢大截肢后无法回家。尤其影响功能能力的合并症也会阻碍使用假肢行走。
