Borkosky Sara L, Roukis Thomas S
Gundersen Lutheran Medical Foundation, La Crosse, WI, USA.
J Foot Ankle Surg. 2013 May-Jun;52(3):335-8. doi: 10.1053/j.jfas.2013.02.004. Epub 2013 Mar 26.
The reliability and durability of partial first ray amputation in patients with diabetes and peripheral neuropathy has recently been questioned. In an effort to determine the repeat amputation rate after a partial first ray amputation associated with diabetes mellitus and peripheral neuropathy at our institution, we performed an 11-year retrospective review. A total of 59 patients (40 males and 19 females), with a mean age of 63 (range 39 to 97) years, were included. The mean follow-up was 33.8 (range 1 to 123) months, with initial incision healing occurring in all 59 patients. Despite the initial healing, 69% developed a mean of 3.1 subsequent foot ulcerations at a mean of 10.5 months, 36% required ancillary surgical procedures, and more than 90% of patients were prescribed multiple courses of antibiotics at a mean of 26.6 clinic visits during the follow-up period. A total of 25 patients (42.4%) underwent more proximal repeat amputation at a mean of 25 (range 1 to 97) months after the initial partial first ray amputation. The results of our retrospective review revealed that nearly 1 of every 2 patients with diabetes and peripheral neuropathy who undergo a partial first ray amputation will progress to a more proximal repeat amputation, despite initial healing. These data question the reliability and durability of this level of amputation as a primary procedure in this patient population. A more proximal level amputation, such as a balanced transmetatarsal, might provide a better functional and reliable residual weightbearing foot and should be considered at the initial presentation. This is especially true given that nearly one half of the patients died during the follow-up period. However, this remains a matter for conjecture because of the limited data available; therefore, additional prospective investigations are warranted.
近期，糖尿病合并周围神经病变患者行部分第一跖骨截肢术的可靠性和耐久性受到质疑。为确定我院糖尿病合并周围神经病变患者行部分第一跖骨截肢术后的再次截肢率，我们进行了一项为期11年的回顾性研究。共纳入59例患者（40例男性和19例女性），平均年龄63岁（范围39至97岁）。平均随访时间为33.8个月（范围1至123个月），所有59例患者的初始切口均愈合。尽管初始切口愈合，但69%的患者平均在10.5个月时出现了3.1次后续足部溃疡，36%的患者需要辅助手术，超过90%的患者在随访期间平均就诊26.6次，接受了多疗程抗生素治疗。共有25例患者（42.4%）在初次部分第一跖骨截肢术后平均25个月（范围1至97个月）接受了更靠近近端的再次截肢。我们的回顾性研究结果显示，每2例接受部分第一跖骨截肢术的糖尿病合并周围神经病变患者中，就有近1例尽管初始愈合，但仍会进展为更靠近近端的再次截肢。这些数据质疑了这种截肢水平作为该患者群体主要手术的可靠性和耐久性。更靠近近端的截肢，如平衡的经跖骨截肢，可能会提供一个功能更好且可靠的残余负重足部，在初次就诊时就应予以考虑。考虑到近一半的患者在随访期间死亡，情况尤其如此。然而，由于现有数据有限，这仍只是一种推测；因此，有必要进行更多的前瞻性研究。
