Servicio de Angiología y Cirugía Vascular, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España.
Servicio de Angiología y Cirugía Vascular, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España.
Cir Esp (Engl Ed). 2020 Aug-Sep;98(7):403-408. doi: 10.1016/j.ciresp.2019.11.007. Epub 2020 Jan 30.
This study sought to evaluate the natural history of patients undergoing below-knee amputation (BKA) and compare their evolution over 2 decades, as well as survival predictors, prosthetic fitting, and contralateral amputation.
Retrospective study of 209 consecutive patients (mean age 72.9 years; 68% males) who underwent BKA in 2 periods: 1996-2005 and 2006-2015. The fitting of prostheses, risk of contralateral amputation and survival, as well as their predictive factors, were assessed by survival analysis.
133 BKA were performed from 1996-2005 and 106 from 2006-2015. The etiology that motivated the BKA was acute ischemia (4.3%), chronic ischemia (34.0%), infection (9.1%) or mixed (chronic+infection, 52.6%), with no differences found between periods. Survival: mortality within one month=9.2%, one year=31.9%, 2 years=43.8% and 5 years=63.9%, with no significant differences between the 2 periods. Prosthetic: the fitting rate was 44.5% throughout the follow-up, with no significant differences between the two periods. 41.1% patients managed to walk. Contralateral amputation: 20.1% of the patients later required a major contralateral amputation, with no significant differences between the two periods.
In the last decade, fewer BKA have been performed probably, due to higher previous interventional revascularization. Despite this, the results of fitting, contralateral amputation or survival were not modified. In any case, the number of patients who are able to achieve ambulation is modest, so it emphasizes the need for an optimal selection of patients with BKA with the goal of prosthetic fitting.
本研究旨在评估接受膝下截肢（BKA）患者的自然病史，并比较他们在 20 年内的演变情况，以及生存预测因素、假肢适配和对侧截肢。
回顾性研究了 209 例连续患者（平均年龄 72.9 岁；68%为男性），他们在两个时期接受了 BKA：1996-2005 年和 2006-2015 年。通过生存分析评估了假肢适配、对侧截肢和生存的风险及其预测因素。
1996-2005 年进行了 133 例 BKA，2006-2015 年进行了 106 例。导致 BKA 的病因是急性缺血（4.3%）、慢性缺血（34.0%）、感染（9.1%）或混合（慢性+感染，52.6%），两个时期之间没有差异。生存：一个月内死亡率=9.2%，一年内死亡率=31.9%，两年内死亡率=43.8%，五年内死亡率=63.9%，两个时期之间无显著差异。假肢：整个随访过程中，适配率为 44.5%，两个时期之间无显著差异。41.1%的患者能够行走。对侧截肢：20.1%的患者后来需要进行主要的对侧截肢，两个时期之间无显著差异。
在过去的十年中，由于先前的介入血管重建术较高，可能进行了较少的 BKA。尽管如此，适配、对侧截肢或生存的结果并未改变。无论如何，能够实现行走的患者数量是适中的，因此强调了对 BKA 患者进行最佳选择的必要性，以实现假肢适配。
