Hunsaker R H, Schwartz J A, Keagy B A, Kotb M, Burnham S J, Johnson G
J Vasc Surg. 1985 Nov;2(6):812-6. doi: 10.1067/mva.1985.avs0020812.
Amputation done on an emergency basis of severely ischemic or infected limbs in critically ill patients frequently results in increased morbidity and mortality. To evaluate the effect of delaying an inevitable operative amputation by a simplified method of freezing the involved extremity, the records of 56 patients who underwent preoperative cryoamputation during a 12-year period were reviewed. Data concerning risk factors, associated medical conditions, local or systemic signs of sepsis, level of amputation, morbidity, and mortality were analyzed. Following cryoamputation of 57 limbs, 16 above-knee amputations (AKA) and 41 below-knee amputations (BKA) were performed. The overall mortality rate associated with cryoamputation was 14% (8 of 57); four postoperative deaths occurred in both the AKA and BKA groups. The mortality rate for 1021 primary operative major amputations during the same period was 7% (p less than 0.04). The only factor identified that significantly affected survival following cryoamputation was diabetes mellitus, which was present in 68% of surviving patients and in 12% of those who died (p less than 0.001). This experience suggests that cryoamputation is a valuable, simple technique that allows for deliberate stabilization and preparation of seriously ill, septic patients prior to surgical procedures, which, when performed on an emergency basis have been associated with mortality rates exceeding 40%.
对重症患者严重缺血或感染的肢体进行急诊截肢，往往会导致发病率和死亡率上升。为了评估通过一种简化的冷冻受累肢体的方法来延迟不可避免的手术截肢的效果，我们回顾了56例在12年期间接受术前冷冻截肢患者的记录。分析了有关风险因素、相关疾病状况、脓毒症的局部或全身体征、截肢水平、发病率和死亡率的数据。在对57条肢体进行冷冻截肢后，进行了16例膝上截肢（AKA）和41例膝下截肢（BKA）。与冷冻截肢相关的总死亡率为14%（57例中有8例）；AKA组和BKA组术后均有4例死亡。同期1021例一期主要手术截肢的死亡率为7%（p<0.04）。唯一被确定的对冷冻截肢后生存有显著影响的因素是糖尿病，68%的存活患者和12%的死亡患者患有糖尿病（p<0.001）。这一经验表明，冷冻截肢是一种有价值的简单技术，它能在手术前对重症、脓毒症患者进行有意识的稳定和准备，而急诊手术的死亡率超过40%。
