Selçuk Eşref, Erem Murat, Yıldırım Savaş, Çopuroğlu Cem, Çiftdemir Mert, Erkal Doğukan
Trakya Üniversitesi Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, 22030 Edirne, Türkiye.
Jt Dis Relat Surg. 2025 Jan 2;36(1):174-181. doi: 10.52312/jdrs.2025.2030. Epub 2024 Dec 13.
This study aimed to evaluate the rates and risk factors associated with revision amputation following ischemic lower major limb amputations, focusing on cases related to peripheral arterial disease.
This retrospective study included 253 patients (174 males, 79 females; mean age: 73.1±12.2 years; range, 44 to 99 years) who underwent ischemic foot amputation between December 2012 and December 2022. Eligible patients were over 18 years old and had major lower extremity amputations due to peripheral arterial disease or chronic arterial occlusion. Exclusions were made for amputations due to diabetic foot conditions, trauma, tumors, or osteomyelitis and minor lower extremity amputations.
Above-knee amputations were the most common type of amputation, accounting for 56.5% (n=143) of cases. Revision amputations occurred in 27.3% (n=69) of patients, with significantly higher rates in those with open wounds at first admission (chi-square [χ ]=9.81, p=0.002). Patients with occlusion at the popliteal artery level had a higher rate of revision amputation following below-knee amputation (p=0.034). Each additional year of age decreased the likelihood of revision amputation by 2.3% (p=0.049). Vacuum-assisted closure therapy was associated with higher revision rates (χ =22.71, p<0.001). Patients who developed infections (n=40) had a significantly higher rate of revision amputations (n=26, p<0.001). Elevated preoperative C-reactive protein levels were also correlated with an increased risk of revision (p=0.006).
Patients with ischemic lower limb amputations, particularly those presenting with open wounds, are at higher risk for revision amputation. Elevated preoperative C-reactive protein levels, infections, age, and the initial level of amputation significantly impact the likelihood of reamputation.
本研究旨在评估缺血性下肢大截肢术后翻修截肢的发生率及相关危险因素，重点关注与外周动脉疾病相关的病例。
这项回顾性研究纳入了2012年12月至2022年12月期间接受缺血性足部截肢手术的253例患者（174例男性，79例女性；平均年龄：73.1±12.2岁；范围44至99岁）。符合条件的患者年龄超过18岁，因外周动脉疾病或慢性动脉闭塞接受了下肢大截肢手术。因糖尿病足、创伤、肿瘤或骨髓炎导致的截肢以及下肢小截肢被排除在外。
膝上截肢是最常见的截肢类型，占病例的56.5%（n = 143）。27.3%（n = 69）的患者进行了翻修截肢，首次入院时有开放性伤口的患者翻修截肢率显著更高（卡方检验[χ²]= 9.81，p = 0.002）。腘动脉水平闭塞的患者膝下截肢后翻修截肢率更高（p = 0.034）。年龄每增加一岁，翻修截肢的可能性降低2.3%（p = 0.049）。负压封闭引流治疗与更高的翻修率相关（χ² = 22.71，p < 0.001）。发生感染的患者（n = 40）翻修截肢率显著更高（n = 26，p < 0.001）。术前C反应蛋白水平升高也与翻修风险增加相关（p = 0.006）。
缺血性下肢截肢患者，尤其是那些有开放性伤口的患者，翻修截肢风险更高。术前C反应蛋白水平升高、感染、年龄以及初始截肢水平显著影响再次截肢的可能性。
