Foot Ankle Int. 2009 Dec;30(12):1177-82. doi: 10.3113/FAI.2009.1177.
This study analysed the factors affecting wound healing of a transmetatarsal amputation (TMA) in patients with diabetes.
Twenty-one patients who failed a TMA and were revised to transtibial amputation (TTA) within the first year were compared with a matched cohort of 21 successful TMA's. The factors compared included demographics, systemic issues, and local conditions in the foot. Chi-square comparisons were used for group data, and Analysis of Variance (ANOVA) for numeric data.
Blood glucose control as measured by HbA1c was the most important single factor predicting the success of TMA. Need for debridement after TMA was also found to be a significant predictor of failure of TMA. There was a trend towards duration of ulcer prior to TMA and smoking being significant. All other variables, including vascular status or renal failure were not significantly different between the two groups.
The primary factor determining the success of a TMA was the quality of glucose control. The results of this study can be extrapolated to diabetic patients undergoing other types of surgery, with preoperative diabetic control as measured by HbA1c being an important determinant of the outcome of surgery. As a result of this study we currently do not perform any elective, trauma or emergency surgery on diabetic patients with an HbA1c of over 8 unless the need for surgery is to save life or limb.
本研究分析了影响糖尿病患者经跖骨截肢（TMA）后伤口愈合的因素。
将 21 例 TMA 术后 1 年内失败并改行胫骨截肢（TTA）的患者与 21 例 TMA 成功患者进行比较。比较的因素包括人口统计学、系统性问题和足部的局部情况。使用卡方检验比较组间数据，方差分析（ANOVA）比较数值数据。
糖化血红蛋白（HbA1c）所反映的血糖控制情况是预测 TMA 成功的最重要单一因素。TMA 后清创的需要也被发现是 TMA 失败的一个显著预测因素。TMA 前溃疡的持续时间和吸烟有一定的趋势，但无统计学意义。两组间的其他变量，包括血管状态或肾衰竭均无显著差异。
决定 TMA 成功的主要因素是血糖控制质量。本研究的结果可以推广到接受其他类型手术的糖尿病患者，术前糖化血红蛋白（HbA1c）作为手术结果的重要决定因素。基于这项研究，我们目前不会对糖化血红蛋白（HbA1c）超过 8 的糖尿病患者进行任何择期、创伤或急诊手术，除非手术是为了挽救生命或肢体。
