未进行血管重建治疗的糖尿病足溃疡患者经跖骨截肢术的临床结局
Clinical Outcomes of Transmetatarsal Amputation in Patients with Diabetic Foot Ulcers Treated without Revascularization.
作者信息
Zhang Shanshan, Wang Shumin, Xu Lei, He Yang, Xiang Jiali, Tang Zhengyi
机构信息
Department of Endocrine and Metabolic Diseases, Shengli Oilfield Central Hospital, Dongying, 257034, China.
Shanghai Clinical Center for Endocrine and Metabolic Diseases, Yuanyang Subdivision for Diabetic Foot Disease, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital Affiliated To Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
出版信息
Diabetes Ther. 2019 Aug;10(4):1465-1472. doi: 10.1007/s13300-019-0653-z. Epub 2019 Jun 26.
INTRODUCTION
Most studies on outcomes of transmetatarsal amputation (TMA) have been for patients who underwent revascularization. This study was performed to evaluate the outcomes of TMA in diabetic patients without revascularization.
METHODS
One hundred two diabetic patients who were not candidates for revascularization underwent TMA and received a multidisciplinary treatment. These patients were followed up for a mean period of 38 months to observe the outcomes, including wound healing, above-the-ankle amputation and death. The associations between variables and the outcomes were analyzed by Cox regression analysis.
RESULTS
By the end of the follow-up, 97 patients with full data were analyzed. Sixty-three (64.9%) patients had wounds healed completely after a median interval of 8 months, 16 (16.5%) patients underwent above-the-ankle amputation, and 26 (26.8%) died. Cox regression analysis showed that patients with higher ABI (RR = 3.097, 95% CI: 1.587-6.043) and serum albumin (RR = 2.755, 95% CI: 1.335-5.687) exhibited a higher probability of wound healing.
CONCLUSIONS
Diabetic patients who were not candidates for revascularization who underwent TMA could achieve a satisfactory wound healing rate with a multidisciplinary treatment. ABI and serum albumin were significant predictors of wound healing.
引言
大多数关于经跖骨截肢术（TMA）结局的研究针对的是接受血管重建术的患者。本研究旨在评估未接受血管重建术的糖尿病患者行TMA的结局。
方法
102例不适合血管重建术的糖尿病患者接受了TMA并接受了多学科治疗。对这些患者进行了平均38个月的随访，以观察结局，包括伤口愈合、踝关节以上截肢和死亡。通过Cox回归分析分析变量与结局之间的关联。
结果
随访结束时，对97例有完整数据的患者进行了分析。63例（64.9%）患者在中位间隔8个月后伤口完全愈合，16例（16.5%）患者接受了踝关节以上截肢，26例（26.8%）患者死亡。Cox回归分析显示，踝臂指数（ABI）较高（RR = 3.097，95% CI：1.587 - 6.043）和血清白蛋白较高（RR = 2.755，95% CI：1.335 - 5.687）的患者伤口愈合的可能性更高。
结论
未接受血管重建术的糖尿病患者行TMA后，通过多学科治疗可获得满意的伤口愈合率。ABI和血清白蛋白是伤口愈合的重要预测指标。
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