第一跖骨部分截肢与拇趾截肢后再溃疡和再截肢的比率和部位：糖尿病和非糖尿病人群的比较。
Rate and Location of Reulceration and Reamputation After Partial First-Ray Amputation versus Hallux Amputation in Diabetic and Nondiabetic Populations.
机构信息
*Podiatric Medicine and Surgery Residency Program, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA. Drs Hughes and Hurst are now with Foot and Ankle Surgery Department, Davis Medical Center, Elkins, WV.
†Department of Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA.
出版信息
J Am Podiatr Med Assoc. 2024 Mar-Apr;114(2). doi: 10.7547/22-029.
BACKGROUND
We sought to determine the rates of reulceration and reamputation in individuals who underwent partial first-ray amputations versus hallux amputations in diabetic and nondiabetic populations.
METHODS
Eighty-four amputations were reviewed in a retrospective fashion. A retrospective medical record review was performed to determine patients who underwent a hallux amputation, both partial and complete, and patients who underwent a partial first-ray amputation. Only patients from 2007 to 2019 were reviewed. The reulceration rate of hallux amputations was 61% compared with a partial first-ray amputation reulceration rate of 74%.
RESULTS
The reamputation rate of hallux amputation versus partial first-ray amputation was 43% versus 51%. At final follow-up, it was statistically significant that patients who underwent hallux amputation were more likely to be healed than those who underwent partial first-ray amputation, regardless of reulceration or reamputation. In addition, patients who underwent hallux amputation went on to digital amputation, and those who underwent partial first-ray amputation went on to transmetatarsal amputation.
CONCLUSIONS
Comparing partial first-ray amputation to hallux amputation, hallux amputation patients are more prone to subsequent digital ulceration. Patients who initially undergo hallux amputation have variable subsequent amputations, often digital. Reulceration primarily occurs at the incision site for partial first-ray amputations, with a higher likelihood of subsequent transmetatarsal amputation. Patients with a medical history of diabetes and staged procedures are more likely to receive partial first-ray amputations. However, hallux amputation patients have a lower risk of reulceration and reamputation, regardless of subsequent events. These findings underscore the importance of discussing risks and preventive measures with patients undergoing such amputations, emphasizing postoperative examinations for specific areas of concern. Hallux amputation appears to offer greater protection against reulceration and reamputation for both diabetic and nondiabetic populations.
背景
我们旨在确定在糖尿病和非糖尿病患者中，行第一跖骨部分截肢与拇趾截肢的患者中溃疡复发和再截肢的发生率。
方法
回顾性分析 84 例截肢患者的资料。对病历进行回顾性分析，确定接受部分和完全拇趾截肢以及第一跖骨部分截肢的患者。仅回顾 2007 年至 2019 年的患者。与第一跖骨部分截肢的溃疡复发率 74%相比，拇趾截肢的溃疡复发率为 61%。
结果
与第一跖骨部分截肢相比，拇趾截肢的再截肢率为 43%对 51%。最终随访时，无论溃疡复发或再截肢，接受拇趾截肢的患者更有可能愈合，这具有统计学意义。此外，接受拇趾截肢的患者进行了指端截肢，而接受第一跖骨部分截肢的患者进行了跖骨间截肢。
结论
与第一跖骨部分截肢相比，拇趾截肢患者更容易发生后续的足部溃疡。最初接受拇趾截肢的患者有不同的后续截肢，通常是指端截肢。第一跖骨部分截肢的再溃疡主要发生在切口部位，随后更有可能进行跖骨间截肢。有糖尿病病史和分期手术的患者更有可能接受第一跖骨部分截肢。然而，无论随后发生何种情况，拇趾截肢患者的溃疡复发和再截肢风险均较低。这些发现强调了与接受此类截肢的患者讨论风险和预防措施的重要性，强调对特定关注区域进行术后检查。对于糖尿病和非糖尿病患者，拇趾截肢似乎能更好地预防溃疡复发和再截肢。
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