Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden and Department of Clinical Sciences, Lund University, Lund, Sweden.
Faculty of Medicine, Lund University, Lund, Sweden.
J Foot Ankle Surg. 2024 Sep-Oct;63(5):584-592. doi: 10.1053/j.jfas.2024.05.017. Epub 2024 Jun 12.
The risk of above-ankle reamputation following a transmetatarsal amputation is around 30%. Patient selection may be crucial to achieve good outcomes, and to avoid futile operations and suffering. We are aware of no previous comparison between the two largest patient groups that undergo lower extremity amputations: patients with diabetes, and patients with non-diabetic peripheral artery disease. Patients with diabetes or nondiabetic peripheral artery disease who had undergone a transmetatarsal amputation from 2004 to 2018 at our institution were included. Patient characteristics and perioperative details were analyzed retrospectively. Subjects with diabetes were compared with subjects with nondiabetic peripheral artery disease regarding above-ankle reamputation, reamputation level, and mortality. Five-hundred-and-sixty transmetatarsal amputations in 513 subjects were included. The majority of transmetatarsal amputations (86%) occurred in diabetic subjects. Subjects with non-diabetic PAD had a higher risk of above-ankle reamputation (p = .008), and death (p < .001). At the time of data collection, only multiple-ray amputation (vs. single-ray) was an independent risk factor for above-ankle reamputation. Only age, medical comorbidity in general, and chronic heart failure were independent risk factors of death. To our knowledge, this study is the first to report marked differences in above-ankle reamputation rates and mortality following transmetatarsal amputation, comparing diabetics with non-diabetic patients with peripheral artery disease. However, the differences may be attributed to non-diabetics being older, having more medical comorbidities, and having more advanced foot ulcers at the time of transmetatarsal amputation. In patients exhibiting several of these risk factors, transmetatarsal amputation may be futile.
接受跖骨间截肢后，踝关节以上再截肢的风险约为 30%。患者选择对于获得良好的结果、避免无效的手术和痛苦可能至关重要。我们之前没有比较过接受下肢截肢的两个最大患者群体之间的情况：糖尿病患者和非糖尿病外周动脉疾病患者。我们纳入了 2004 年至 2018 年在我们机构接受跖骨间截肢的糖尿病或非糖尿病外周动脉疾病患者。回顾性分析了患者特征和围手术期细节。将糖尿病患者与非糖尿病外周动脉疾病患者在踝关节以上再截肢、再截肢水平和死亡率方面进行了比较。纳入了 513 例患者的 560 例跖骨间截肢。大多数跖骨间截肢（86%）发生在糖尿病患者中。非糖尿病 PAD 患者踝关节以上再截肢（p =.008）和死亡（p <.001）的风险更高。在数据收集时，只有多射线截肢（vs. 单射线）是踝关节以上再截肢的独立危险因素。只有年龄、一般医疗合并症和慢性心力衰竭是死亡的独立危险因素。据我们所知，这项研究首次报告了在接受跖骨间截肢后，糖尿病患者和非糖尿病外周动脉疾病患者在踝关节以上再截肢率和死亡率方面存在显著差异。然而，这些差异可能归因于非糖尿病患者年龄更大、合并症更多，并且在接受跖骨间截肢时足部溃疡更严重。在存在多个这些危险因素的患者中，跖骨间截肢可能是徒劳的。
