Department of Diabetes and Endocrinology, Derby Hospitals NHS Foundation Trust, Derby, UK.
Diabetes Metab Res Rev. 2012 Feb;28 Suppl 1:97-100. doi: 10.1002/dmrr.2244.
Over two decades ago, the St. Vincent Declaration set a 50% reduction of lower-limb amputations as a principal target for patients with diabetes. During this time, enormous strides have been taken in our understanding of diabetic foot disease, the complexities of wound healing and the organization of care to prevent what is one of the most feared complications of the disease. Despite this, we are aware that worldwide, we have not achieved the target set in 1989, with current estimations being that a limb is lost to diabetes somewhere in the world every 30 s. However, it has to be remembered that amputation is a treatment and not a disease, and it is indeed a treatment usually prescribed at the end of a long chronic illness. It is well known that patients whose disease is severe enough for amputation to be considered frequently have other complications of their diabetes, cardiovascular and peripheral vascular diseases and end-stage renal disease, in particular. The life expectancy of the patients is therefore frequently reduced, and their functional status poor even prior to the intervention of surgeons. Just as the functional status of the patients is often a contra-indication to other disease treatments, chemotherapy for some cancers, for example, then we should be considering carefully whether we should be removing limbs from patients whose functional and medical status will not improve significantly as a result. Equally, there may be patients who may benefit from an early amputation and ambulation with a prosthesis.
二十多年前，《圣文森特宣言》（St. Vincent Declaration）将降低下肢截肢率 50%作为糖尿病患者的主要目标。在此期间，我们对糖尿病足病、伤口愈合的复杂性以及预防该疾病最可怕的并发症之一的护理组织有了更深入的了解。尽管如此，我们意识到，在全球范围内，我们尚未实现 1989 年设定的目标，目前估计全球每 30 秒就有一条腿因糖尿病而截肢。然而，必须记住的是，截肢是一种治疗方法，而不是一种疾病，而且它确实是一种在慢性疾病末期通常采用的治疗方法。众所周知，那些病情严重到需要截肢的患者通常还患有其他糖尿病并发症、心血管和外周血管疾病以及终末期肾病等疾病。因此，这些患者的预期寿命往往会缩短，而且他们的功能状态往往很差，甚至在接受外科医生的干预之前就是如此。正如患者的功能状态常常是其他疾病治疗的禁忌症一样，例如某些癌症的化疗，那么我们应该仔细考虑是否应该为那些功能和医疗状况不会因截肢而显著改善的患者进行截肢。同样，可能有一些患者可能会受益于早期截肢和使用假肢行走。
