Campbell W B, St Johnston J A, Kernick V F, Rutter E A
Ann R Coll Surg Engl. 1994 May;76(3):205-9.
During a 5-year period, 210 patients (125 male: aged 43-96 years, median 76 years) had 228 primary amputations for peripheral arterial disease. Level selection was by clinical criteria, and there were 148 below-knee (BK, 65%), 72 above-knee (AK, 32%) and eight Gritti-Stokes (GS, 3%). Revision was needed in 43 (19%). The 30-day mortality was 14%. There were 69 patients who had previously undergone bypass grafting (< 30 days in 36; 30 days-1 year 20; > 1 year 13). In these there were 57% BK and 43% AK with a revision rate of 13%--no worse than in patients who had not had attempted limb salvage. Decisions about rehabilitation were made by a team of doctors, nurses and therapists. The 69 patients fitted with prosthetic limbs between 1987 and 1990 were followed up for eventual mobility (minimum 6 months). Of these patients, 81% used their prosthesis at least around the house, but only 16% achieved near normal mobility. This series fails to support the claim that failed arterial bypass surgery prejudices amputation level or healing. Despite attempts to achieve a high rate of below-knee amputation and good rehabilitation, the revision rate remains high and really good prosthesis usage remains low in these elderly patients.
在5年期间，210例患者（125例男性，年龄43 - 96岁，中位年龄76岁）因外周动脉疾病接受了228次初次截肢手术。截肢平面根据临床标准选择，其中膝下截肢（BK）148例（65%），膝上截肢（AK）72例（32%），Gritti-Stokes截肢（GS）8例（3%）。43例（19%）需要进行翻修手术。30天死亡率为14%。有69例患者此前接受过旁路移植手术（36例在<30天内；20例在30天至1年；13例在>1年）。在这些患者中，BK截肢占57%，AK截肢占43%，翻修率为13%，并不比未尝试保肢的患者差。康复决策由医生、护士和治疗师团队做出。对1987年至1990年间安装假肢的69例患者进行了最终活动能力随访（最短6个月）。在这些患者中，81%至少在房屋周围使用假肢，但只有16%的患者实现了接近正常的活动能力。该系列研究不支持动脉旁路手术失败会影响截肢平面或愈合的说法。尽管试图实现高比例的膝下截肢和良好的康复效果，但在这些老年患者中，翻修率仍然很高，真正良好的假肢使用率仍然很低。
