University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Foot Ankle Int. 2012 Sep;33(9):707-16. doi: 10.3113/FAI.2012.0707.
Transtibial amputations (TTA) are performed for recalcitrant or infected ulcers of the midfoot, hindfoot, or ankle. This procedure results in decreased ambulatory status caused by increased oxygen demands and energy expenditure. Partial foot amputations have the advantage of being an end-bearing limb and require less work to walk, theoretically suggesting improved functional outcome. The purpose of this research was to examine the longevity, outcome, and mortality of partial foot amputations as an alternative to TTA.
Retrospective chart review identified diabetic patients with transmetatarsal, Chopart's, and calcanectomy amputations for osteomyelitis or nonhealing ulcers. A control group consisted of diabetic patients who underwent TTA. A comparison between groups examined mortality, proximal ipsilateral reamputation, and a validated ambulatory functional outcome measure.
Eighteen TTA patients were enrolled. The 5-year mortality rate was 0.45, one patient required reamputation, and the mean postoperative ambulatory score was 2.8. Twenty-one transmetatarsal patients were enrolled. The 5-year mortality rate was 0.30, two patients required reamputation, and the mean postoperative ambulatory score was 4.3. Ten Chopart's amputation patients were enrolled. The 5-year mortality rate was 0.36, six patients required reamputation, and the mean postoperative ambulatory score was 4.3. Seventeen partial calcanectomy patients were enrolled. The 5-year mortality rate was 0.69, six patients required reamputation, and the mean postoperative ambulatory score was 4.3. Sixteen total calcanectomy patients were enrolled. The 5-year mortality rate was 0.59, five patients required reamputation, and the mean postoperative ambulatory score was 3.3.
TTA is associated with high morbidity and mortality, which suggests that the advantage of partial foot amputations should be investigated. Only transmetatarsal amputations at 1 and 3 years were statistically lower for mortality than TTA. Partial foot amputations at the other levels failed to show statistically improved survivorship. Transmetatarsal and Chopart's amputations had high ambulatory levels and the longest durability, which suggests that these amputations may provide some ambulatory advantage.
胫骨截肢术（TTA）用于治疗中足、后足或踝关节的难治性或感染性溃疡。该手术会导致步行时氧气需求和能量消耗增加，从而降低活动能力。部分足截肢术具有承重肢体的优势，行走所需的工作量较小，理论上表明功能结果得到改善。本研究旨在检查部分足截肢术作为 TTA 的替代方法的寿命、结果和死亡率。
回顾性病历回顾确定了因骨髓炎或不愈合溃疡而行经跖骨、Chopart 关节和跟骨切除术的糖尿病患者。对照组由接受 TTA 的糖尿病患者组成。对两组进行比较，检查死亡率、同侧近端再截肢和经过验证的步行功能预后测量。
纳入了 18 例 TTA 患者。5 年死亡率为 0.45，1 例患者需要再截肢，术后平均步行评分 2.8。纳入了 21 例经跖骨患者。5 年死亡率为 0.30，2 例患者需要再截肢，术后平均步行评分 4.3。纳入了 10 例 Chopart 关节截肢患者。5 年死亡率为 0.36，6 例患者需要再截肢，术后平均步行评分 4.3。纳入了 17 例部分跟骨切除术患者。5 年死亡率为 0.69，6 例患者需要再截肢，术后平均步行评分 4.3。纳入了 16 例全跟骨切除术患者。5 年死亡率为 0.59，5 例患者需要再截肢，术后平均步行评分 3.3。
TTA 发病率和死亡率较高，这表明应研究部分足截肢术的优势。只有在 1 年和 3 年时，经跖骨截肢术的死亡率在统计学上低于 TTA。其他水平的部分足截肢术在存活率方面没有表现出统计学上的改善。经跖骨和 Chopart 关节截肢术具有较高的步行水平和最长的耐用性，这表明这些截肢术可能提供一些步行优势。
