Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Infectiology, Unit for Clinical and Applied Research and Infectiology, Balgrist University Hospital, Zurich, Switzerland.
Foot Ankle Int. 2022 Jul;43(7):957-967. doi: 10.1177/10711007221088552. Epub 2022 May 18.
Diabetic foot osteomyelitis (DFO) often leads to amputations in the lower extremity. Data on the influence of the initial anatomical DFO localization on ultimate major amputation are limited.
In this retrospective analysis, 583 amputation episodes in 344 patients (78 females, 266 males) were analyzed. All received a form of amputation in combination with antibiotic therapy. A multivariate logistic regression analysis with the primary outcome "major amputation" defined as an amputation above the ankle joint was performed. The association of risk factors including location of DFO, coronary artery disease, peripheral artery disease, neuropathy, nephropathy, and Charcot neuro-osteoarthropathy was analyzed.
Among 583 episodes, DFO was located in the forefoot in 512 (87.8%), in the midfoot in 43 (7.4%), and in the hindfoot in 28 episodes (4.8%). Overall, 53 of 63 (84.1%) major amputations were performed because of DFO in the setting of peripheral artery disease as primary indication. Overall, limb loss occurred in 6.1% (31/512) of forefoot, 20.9% (9/43) of midfoot, and 46.4% (13/28) of hindfoot DFO. Among these, 22 (41.5%) were performed as the primary treatment, whereas 31 (58.5%) followed previously failed minor amputations. Among this latter group of secondary major amputations, the DFO was localized to the forefoot in 23 of 583 (3.9%), the midfoot in 4 of 583 (0.7%) and the hindfoot in 4 of 583 (0.7%). In multivariate logistic regression analysis, initial hindfoot localization was a significant factor ( < .05), whereas peripheral artery disease, smoking, and a midfoot DFO were not found to be risk factors.
In our retrospective series, the frequency of limb loss in DFO increased with more proximal initial foot DFO lesions, with almost half of patients losing their limbs with a hindfoot DFO.
Level IV, retrospective cohort study.
糖尿病足骨髓炎（DFO）常导致下肢截肢。关于初始解剖学 DFO 定位对最终主要截肢的影响的数据有限。
在这项回顾性分析中，对 344 名患者（78 名女性，266 名男性）的 583 次截肢事件进行了分析。所有患者均接受了某种形式的截肢联合抗生素治疗。进行了多变量逻辑回归分析，主要结果为定义为踝关节以上截肢的“主要截肢”。分析了 DFO 位置、冠心病、外周动脉疾病、神经病、肾病和夏科氏骨神经关节病等危险因素的关联。
在 583 例截肢中，DFO 位于前足 512 例（87.8%），中足 43 例（7.4%），后足 28 例（4.8%）。总的来说，53 例（84.1%）主要截肢是因为外周动脉疾病作为主要指征的 DFO 引起的。总的来说，前足 DFO 截肢率为 6.1%（31/512），中足 20.9%（9/43），后足 46.4%（13/28）。其中，22 例（41.5%）为初次治疗，31 例（58.5%）为先前失败的小截肢后继发。在后一组继发性主要截肢中，583 例中有 23 例（3.9%）位于前足，4 例（0.7%）位于中足，4 例（0.7%）位于后足。多变量逻辑回归分析表明，初始后足定位是一个显著因素（<0.05），而外周动脉疾病、吸烟和中足 DFO 不是危险因素。
在我们的回顾性系列中，DFO 初始足部病变越靠近近端，肢体丧失的频率越高，近一半的后足 DFO 患者失去肢体。
IV 级，回顾性队列研究。
