Sharath Sherene, Henson Helene, Flynn Stacy, Pisimisis George, Kougias Panos, Barshes Neal R
Health Services & Research Development, Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston, TX;
J Rehabil Res Dev. 2015;52(7):851-8. doi: 10.1682/JRRD.2014.07.0176.
In describing functional outcomes and independent living in a cohort of bilateral major amputees, we sought to provide current estimates of function and independence after a second major amputation in an elderly Veteran population with peripheral arterial disease and/or diabetes. After retrospectively reviewing and excluding the electronic health records of those failing to meet the inclusion criteria, we identified 40 patients with a history of unilateral major amputation who underwent a second major amputation during the defined study period. Of these, 43% (17) were bilateral transfemoral amputations (TFAs); bilateral transtibial amputations (TTAs) and TFA-TTA accounted for the rest (33% and 25%, respectively). Of the 19 (48%) patients who were ambulatory prior to bilateral amputation, only 2 (11%) remained ambulatory after the second amputation, while 17 (89%) patients lost ambulatory capabilities. Compared with those who were </=65 yr, those between 66 and 79 yr were 18% less likely to ambulate precontralateral amputation (p = 0.03). All patients with bilateral TFA were nonambulatory. Independence postcontralateral amputation decreased from 88% (35) to 53% (21). When data were available (58%), pre and post Functional Independence Measure scores showed a decrease in 74% of patients, while 22% showed an increase. In conclusion, bilateral lower-limb amputation among dysvascular Veterans is highly associated with a loss of ambulation.
在描述一组双侧大截肢患者的功能结局和独立生活能力时，我们试图提供老年退伍军人外周动脉疾病和/或糖尿病患者第二次大截肢后功能和独立生活能力的当前估计值。在回顾性审查并排除不符合纳入标准者的电子健康记录后，我们确定了40例有单侧大截肢病史且在规定研究期间接受第二次大截肢的患者。其中，43%（17例）为双侧经股骨截肢（TFA）；双侧经胫骨截肢（TTA）和TFA-TTA分别占其余患者的33%和25%。在双侧截肢前能够行走的19例（48%）患者中，第二次截肢后只有2例（11%）仍能行走，而17例（89%）患者失去了行走能力。与年龄≤65岁的患者相比，66至79岁的患者对侧截肢前行走的可能性低18%（p = 0.03）。所有双侧TFA患者均不能行走。对侧截肢后的独立生活能力从88%（35例）降至53%（21例）。当有数据时（58%），功能独立性测量评分前后显示74%的患者评分下降，而22%的患者评分上升。总之，血管性疾病退伍军人的双侧下肢截肢与行走能力丧失高度相关。
