Hong Choon Chiet, Saha Soura, Pearce Christopher Jon
Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore, Singapore.
Foot Ankle Surg. 2023 Apr;29(3):228-232. doi: 10.1016/j.fas.2023.01.010. Epub 2023 Jan 27.
The first ray plays a vital role in the normal function of the foot and the gait cycle where in its absence can lead to abnormal changes in weight distribution to the residual first metatarsal stump and lesser metatarsals with predisposition to developing lesser toe deformities reulcerations and reamputations particularly in diabetic patients. This study aims to characterise the outcomes after first ray amputation and its associated risk factors with focus on the impact of residual first metatarsal length.
All diabetic patients with first ray amputations from January 2012 to December 2016 were reviewed. Residual first metatarsal length was measured using postoperative radiographs. Risk factors for outcomes such as readmission, reulceration and/or reamputation, transfer ulceration and/or amputation of lesser toes, proximal amputations, ulcer-free duration (UFD) and mortality were analysed using bivariate logistic/linear regression followed by multiple logistic/linear regression models adjusting for confounding factors.
Among 89 patients with first ray amputations, 65.3 % needed readmission for further treatment. Although only 10.1 % had reulceration at the first ray which all led to reamputation, there were 56.2 % with transfer ulceration and 40.4 % with transfer amputation of the lesser toes in this cohort. The prevalence of transmetatarsal amputation was 18 % and proximal amputations at 12.4 % while the average UFD was 27 months. Mortality rate was 31.5 % with an average of 3-year survival. Preservation of the first metatarsal length via metatarsophalangeal joint disarticulation independently reduced likelihood of readmissions and residual metatarsal length of > one third when compared to < one third after first ray amputations had lower likelihood of transfer amputation of lesser toes.
First ray amputation in diabetic patients leads to significant morbidities and mortality. Preservation of the residual first metatarsal length independently reduced the likelihood of readmissions and transfer amputation to the lesser toes.
第一跖骨在足部正常功能及步态周期中起着至关重要的作用，若缺失则会导致体重分布异常，使剩余的第一跖骨残端和较小跖骨受力不均，进而易引发小趾畸形、再溃疡和再次截肢，尤其是在糖尿病患者中。本研究旨在描述第一跖骨截肢后的结局及其相关危险因素，重点关注剩余第一跖骨长度的影响。
回顾了2012年1月至2016年12月期间所有接受第一跖骨截肢的糖尿病患者。利用术后X线片测量剩余第一跖骨长度。采用双变量逻辑/线性回归分析再入院、再溃疡和/或再次截肢、小趾转移溃疡和/或截肢、近端截肢、无溃疡持续时间（UFD）和死亡率等结局的危险因素，随后采用多变量逻辑/线性回归模型对混杂因素进行校正。
在89例接受第一跖骨截肢的患者中，65.3%需要再次入院接受进一步治疗。虽然仅10.1%的患者在第一跖骨处发生再溃疡且均导致再次截肢，但该队列中有56.2%的患者出现小趾转移溃疡，40.4%的患者出现小趾转移截肢。经跖骨截肢的发生率为18%，近端截肢的发生率为12.4%，平均UFD为27个月。死亡率为31.5%，平均生存3年。与第一跖骨截肢后剩余长度小于三分之一相比，通过跖趾关节离断术保留第一跖骨长度可独立降低再入院的可能性，且剩余跖骨长度大于三分之一时小趾转移截肢的可能性较低。
糖尿病患者的第一跖骨截肢会导致显著的发病率和死亡率。保留剩余第一跖骨长度可独立降低再入院和小趾转移截肢的可能性。
