糖尿病与下肢截肢——区域性医院的康复路径和结果。

Diabetes and lower extremity amputation - rehabilitation pathways and outcomes at a regional hospital.

机构信息

School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa.

Department of General Surgery, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa.

出版信息

S Afr J Surg. 2021 Sep;59(3):128a-128g.

PMID:34515432

Abstract

BACKGROUND

Lower extremity amputations (LEAs) are most frequently due to diabetes mellitus (DM), a disease on the rise. The objective of this study was to determine the prevalence and aetiology of LEAs at Addington Hospital from 2013 to 2017 and to explore the physiotherapy referral practices and outcomes.

METHODS

Retrospective study carried out at Addington Hospital, Durban. Patients who underwent LEAs were filtered from theatre registers and the hospital Meditech database. Data collected included patients' demographic profile, diabetic status, level of amputation, limb orientation, physiotherapy referral status, and rehabilitation outcomes. Physiotherapy files were scanned for the attendance of referred patients. Study endpoints were prevalence, diabetes status, referral status, compliance and rehabilitation outcomes.

RESULTS

From 2013 to 2017, 1 028 LEAs in 843 patients were identified with single amputations (697) and multiple amputations (146). The median age was 61 (IQR 52-68) years, and the M:F ratio was 1.3:1. A total of 574 (68.1%) patients had DM. Seven hundred and thirty-eight (71.8%) amputations were as a result of DM. The level of amputations was below-knee (479; 46.6%), toectomy (236; 23%), above-knee (196; 19%) and trans-metatarsal (117; 11.4%). Only 148 patients (17.6%) were referred for physiotherapy, of which 91 (61.5%) attended. Mobility in those who attended rehabilitation was with a walking frame (51; 56%), crutches (29; 31.9%), prosthesis and crutches (7; 7.7%), and wheelchair-bound (4; 4.4%).

CONCLUSION

Over half the amputations were associated with DM, which was also a risk factor for multiple amputations. Although referral and attendance for physiotherapy were very poor, mobility in those who attended was excellent, indicating a dire need to improve hospital referral pathways.

摘要

背景

下肢截肢（LEAs）最常由糖尿病（DM）引起，而这种疾病的发病率正在上升。本研究的目的是确定 2013 年至 2017 年期间 Addington 医院 LEAs 的患病率和病因，并探讨物理治疗转介的实践和结果。

方法

在德班的 Addington 医院进行回顾性研究。从手术室登记册和医院 Meditech 数据库中筛选出接受 LEAs 的患者。收集的数据包括患者的人口统计学特征、糖尿病状况、截肢水平、肢体方向、物理治疗转介状况和康复结果。扫描物理治疗档案以了解转介患者的就诊情况。研究终点为患病率、糖尿病状况、转介状况、依从性和康复结果。

结果

2013 年至 2017 年期间，在 843 名患者中发现了 1028 例 LEAs，其中单肢截肢（697 例）和多肢截肢（146 例）。中位年龄为 61（IQR 52-68）岁，男女比例为 1.3:1。共有 574 名（68.1%）患者患有糖尿病。738 例（71.8%）截肢是由糖尿病引起的。截肢水平为膝下（479 例，占 46.6%）、跖骨切除术（236 例，占 23%）、膝上（196 例，占 19%）和跖间（117 例，占 11.4%）。只有 148 名（17.6%）患者被转介接受物理治疗，其中 91 名（61.5%）就诊。接受康复治疗的患者的活动能力是使用助行架（51 例，占 56%）、拐杖（29 例，占 31.9%）、假肢和拐杖（7 例，占 7.7%）和轮椅（4 例，占 4.4%）。