性别、截肢水平和糖尿病对下肢大截肢术后假肢适配率的影响。
The impact of gender, level of amputation and diabetes on prosthetic fit rates following major lower extremity amputation.
作者信息
Davie-Smith Fiona, Paul Lorna, Nicholls Natalie, Stuart Wesley P, Kennon Brian
机构信息
1 University of Glasgow, Glasgow, UK.
2 MRC, Glasgow, UK.
出版信息
Prosthet Orthot Int. 2017 Feb;41(1):19-25. doi: 10.1177/0309364616628341. Epub 2016 Jul 9.
BACKGROUND
Diabetes mellitus is a leading cause of major lower extremity amputation.
OBJECTIVE
To examine the influence of gender, level of amputation and diabetes mellitus status on being fit with a prosthetic limb following lower extremity amputation for peripheral arterial disease.
STUDY DESIGN
Retrospective analysis of the Scottish Physiotherapy Amputee Research Group dataset.
RESULTS
Within the cohort with peripheral arterial disease ( n = 1735), 64% were men ( n = 1112) and 48% ( n = 834) had diabetes mellitus. Those with diabetes mellitus were younger than those without: mean 67.5 and 71.1 years, respectively ( p < 0.001). Trans-tibial amputation:trans-femoral amputation ratio was 2.33 in those with diabetes mellitus, and 0.93 in those without. A total of 41% of those with diabetes mellitus were successfully fit with a prosthetic limb compared to 38% of those without diabetes mellitus. Male gender positively predicted fitting with a prosthetic limb at both trans-tibial amputation ( p = 0.001) and trans-femoral amputation ( p = 0.001) levels. Bilateral amputations and increasing age were negative predictors of fitting with a prosthetic limb ( p < 0.001). Diabetes mellitus negatively predicted fitting with a prosthetic limb at trans-femoral amputation level ( p < 0.001). Mortality was 17% for the cohort, 22% when the amputation was at trans-femoral amputation level.
CONCLUSION
Of those with lower extremity amputation as a result of peripheral arterial disease, those with diabetes mellitus were younger, and more had trans-tibial amputation. Although both age and amputation level are good predictors of fitting with a prosthetic limb, successful limb fit rates were no better than those without diabetes mellitus. Clinical relevance This is of clinical relevance to those who are involved in the decision-making process of prosthetic fitting following major amputation for dysvascular and diabetes aetiologies.
背景
糖尿病是下肢大截肢的主要原因。
目的
探讨性别、截肢水平和糖尿病状态对因外周动脉疾病行下肢截肢后适配假肢的影响。
研究设计
对苏格兰物理治疗截肢者研究组数据集进行回顾性分析。
结果
在患有外周动脉疾病的队列（n = 1735）中，64%为男性（n = 1112），48%（n = 834）患有糖尿病。患有糖尿病的患者比未患糖尿病的患者年轻：平均年龄分别为67.5岁和71.1岁（p < 0.001）。糖尿病患者的胫部截肢与股骨截肢比例为2.33，非糖尿病患者为0.93。共有41%的糖尿病患者成功适配了假肢，而未患糖尿病的患者这一比例为38%。男性性别在胫部截肢（p = 0.001）和股骨截肢（p = 0.001）水平均为适配假肢的正向预测因素。双侧截肢和年龄增加是适配假肢的负向预测因素（p < 0.001）。糖尿病在股骨截肢水平是适配假肢的负向预测因素（p < 0.001）。该队列的死亡率为17%，截肢为股骨截肢水平时死亡率为22%。
结论
因外周动脉疾病行下肢截肢的患者中，患有糖尿病的患者更年轻，且更多行胫部截肢。尽管年龄和截肢水平都是适配假肢的良好预测因素，但成功适配假肢的比例并不优于未患糖尿病的患者。临床意义 这对于参与因血管性疾病和糖尿病病因行大截肢后假肢适配决策过程的人员具有临床意义。
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