Hong C C, Tan J H, Lim S H, Nather A
National University Hospital, 1E Kent Ridge Road, Singapore.
Bone Joint J. 2017 Nov;99-B(11):1502-1507. doi: 10.1302/0301-620X.99B11.BJJ-2016-0793.R2.
Limb salvage for diabetic foot infections often require multiple procedures. Some patients will eventually end up with below knee amputation (BKA) when all limb salvage attempts fail. We seek to study the patients' ability to return to normal life, functional status, prosthesis usage and perspectives on multiple limb salvage procedures that culminated in BKA to review if they would undertake a similar path if their situation was repeated.
A total of 41 patients who underwent BKA between July 2011 and June 2013 were reviewed. They were divided into primary and creeping (prior multiple salvage procedures) amputations. The Barthel's Index (BI) and the Reintegration to Normal Living Index (RNLI) were used. A questionnaire was used to identify whether the patient would undergo the same multiple attempts at limb salvage again if faced with the same problem.
All patients had a good mean BI of 14.2 (3 to 20) and RNLI of 73.2 (31 to 100). There was no difference in prosthesis usage, BI and RNLI between both groups. We found that 16 (94.1%) out of 17 patients with creeping amputation would undergo the same multiple salvage procedures if given a similar option. Conversely, only 15 (62.5%) patients with primary amputation would do the same again while the other nine (37.5%) patients choose to do everything possible to save their leg if faced with a similar situation (p = 0.001).
Most patients preferred to undergo multiple procedures to salvage the limb from diabetic foot infection even if it ultimately concluded with a BKA. All the patients had a moderately good functional outcome and ability to return to normal living after BKA. Cite this article: 2017;99-B:1502-7.
对于糖尿病足感染患者，保肢通常需要进行多次手术。当所有保肢尝试均失败时，一些患者最终会接受膝下截肢术（BKA）。我们试图研究患者恢复正常生活的能力、功能状态、假肢使用情况以及对最终导致BKA的多次保肢手术的看法，以评估如果情况再次出现，他们是否会选择类似的治疗方式。
回顾性分析2011年7月至2013年6月期间接受BKA的41例患者。这些患者被分为初次截肢组和渐进性截肢组（之前接受过多次保肢手术）。采用巴氏指数（BI）和重返正常生活指数（RNLI）进行评估。通过问卷调查确定如果面临相同问题，患者是否会再次接受相同的多次保肢尝试。
所有患者的平均BI为14.2（3至20），平均RNLI为73.2（31至100），功能状态良好。两组患者在假肢使用、BI和RNLI方面无差异。我们发现，17例渐进性截肢患者中有16例（94.1%）表示如果有类似选择，会再次接受相同的多次保肢手术。相反，初次截肢患者中只有15例（62.5%）会再次这样做，而另外9例（37.5%）患者表示如果面临类似情况，会尽一切可能保住自己的腿（p = 0.001）。
大多数患者更愿意接受多次手术以挽救因糖尿病足感染而面临截肢的肢体，即使最终结果是BKA。所有患者在BKA术后功能恢复情况中等良好，能够回归正常生活。引用本文：2017;99-B:1502 - 7。
