Department of Orthopedics and Traumatology, Lausanne University Hospital, rue du Bugnon 46, 1011, Lausanne, Switzerland.
Department of Medical Research, Clinique Romande de Réadaptation SUVA, avenue du Grand-Champsec 90, 1950 Sion, Switzerland; Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation SUVA, avenue du Grand-Champsec 90, 1950 Sion, Switzerland; Division of Physical Medicine and Rehabiliation, Lausanne University Hospital, rue du Bugnon 46, 1011, Lausanne, Switzerland.
Ann Phys Rehabil Med. 2023 Jun;66(5):101727. doi: 10.1016/j.rehab.2022.101727. Epub 2023 Jan 15.
Individuals requiring non-traumatic Gritti-Stokes amputation or mid-thigh amputation usually have multiple comorbidities that place them at high risk of mortality.
To determine survival rate 5 years after Gritti-Stokes and mid-thigh amputation in individuals with vascular insufficiency and to identify the predictors of survival.
We conducted a retrospective observational study including all individuals with vascular insufficiency who underwent amputation from September 2007 to December 2015 in our University Hospital. The indication for amputation was limb necrosis in 86% of cases, infection in 10%, and complications with the stump (discomfort, neuroma or scar dehiscence) in 4%. Medical records were analysed to determine factors and comorbidities. The date of death was retrieved from the national death registry at a minimum of 5 years after amputation. Cox proportional-hazard regression was used to estimate associations between factors and post-amputation survival with hazard ratios (HR) and 95% confidence intervals (CIs).
We included 126 people with vascular insufficiency (83 men), mean age was 70 years [20; 97]; eighty-nine participants (71%) died during the study period. Survival rate was 68% at 1 year, 48% at 3 years and 37% at 5 years. Survival was associated with prosthetic fitting (HR 0.306 [95% CI 0.180; 0.521], p<0.001) and length of stay (HR 0.992 [95% CI 0.987; 0.997], p = 0.003). Conversely, limb necrosis was associated with a lower survival rate (HR 3.801 [95% CI 1.615; 8.949], p = 0.002). In a secondary multivariable analysis, Gritti-Stokes amputation was the only factor positively associated with prosthetic fitting (odds ratio 7.407 [95% CI 2.439; 22.489], p<0.001).
The survival rate at 5 years after Gritti-Stokes and mid-thigh amputation in people with vascular insufficiency was 37%. Prosthetic fitting was independently associated with better survival, and Gritti-Stokes amputation was the only factor positively related to prosthetic fitting.
需要进行非创伤性 Gritti-Stokes 截肢或大腿中段截肢的患者通常患有多种合并症，这些合并症使他们的死亡率处于较高水平。
确定血管功能不全患者行 Gritti-Stokes 截肢和大腿中段截肢 5 年后的生存率，并确定生存率的预测因素。
我们进行了一项回顾性观察性研究，纳入了 2007 年 9 月至 2015 年 12 月期间在我们大学医院因血管功能不全而接受截肢的所有患者。截肢的指征包括 86%的病例为肢体坏死，10%的病例为感染，4%的病例为残端并发症（不适、神经瘤或瘢痕裂开）。分析病历以确定因素和合并症。从国家死亡登记处获取至少截肢后 5 年的死亡日期。使用 Cox 比例风险回归估计因素与截肢后生存之间的关联，使用风险比（HR）和 95%置信区间（CI）。
我们纳入了 126 名血管功能不全患者（83 名男性），平均年龄为 70 岁[20；97]；89 名参与者（71%）在研究期间死亡。术后 1 年生存率为 68%，3 年生存率为 48%，5 年生存率为 37%。生存与假肢适配相关（HR 0.306 [95%CI 0.180；0.521]，p<0.001）和住院时间（HR 0.992 [95%CI 0.987；0.997]，p=0.003）。相反，肢体坏死与较低的生存率相关（HR 3.801 [95%CI 1.615；8.949]，p=0.002）。在二次多变量分析中，Gritti-Stokes 截肢是唯一与假肢适配呈正相关的因素（优势比 7.407 [95%CI 2.439；22.489]，p<0.001）。
血管功能不全患者行 Gritti-Stokes 截肢和大腿中段截肢 5 年后的生存率为 37%。假肢适配与更好的生存率独立相关，而 Gritti-Stokes 截肢是唯一与假肢适配呈正相关的因素。
