Larsson J, Agardh C D, Apelqvist J, Stenström A
Department of Orthopedics, University Hospital of Lund, Sweden.
Acta Orthop Scand. 1994 Aug;65(4):387-93. doi: 10.3109/17453679408995476.
Local signs and symptoms were evaluated in 187 consecutively presenting diabetic patients undergoing amputation for foot ulcers. From admission until final outcome the patients were treated by the same multidisciplinary team both as in- and out-patients. At the time of amputation, the types of lesions were superficial/deep ulcer (n 17), ulcer with deep infection, but without gangrene (n 40), and gangrene with or without infection (n 130). Healing after a minor amputation (below the ankle) occurred in 74 patients, while 88 patients healed after a major amputation (above the ankle), and 25 patients died before healing had occurred. Deep infection and presence of popliteal or pedal pulses were associated with healing after minor amputation and so were ulcers on the small toes, metatarsal head area and midfoot. Pain, progressive gangrene, intermittent claudication, and decubital and multiple ulcers were related to healing after major amputation. In a logistic regression analysis, pain, progressive gangrene and intermittent claudication remained. However, none of these factors excluded healing of a minor amputation and thus selection of amputation level in diabetic patients with foot ulcers cannot be based upon these factors exclusively.
对187例因足部溃疡而连续接受截肢手术的糖尿病患者的局部体征和症状进行了评估。从入院到最终结果，患者作为门诊和住院患者均由同一多学科团队进行治疗。截肢时，病变类型为浅表/深部溃疡（n = 17）、伴有深部感染但无坏疽的溃疡（n = 40）以及伴有或不伴有感染的坏疽（n = 130）。74例患者在进行小腿以下的小截肢术后伤口愈合，88例患者在进行小腿以上的大截肢术后伤口愈合，25例患者在伤口愈合前死亡。深部感染以及腘动脉或足背动脉搏动的存在与小截肢术后的愈合相关，小脚趾、跖骨头区域和足中部的溃疡也与小截肢术后的愈合相关。疼痛、进行性坏疽、间歇性跛行以及褥疮性溃疡和多发性溃疡与大截肢术后的愈合相关。在逻辑回归分析中，疼痛、进行性坏疽和间歇性跛行仍然存在。然而，这些因素均不能排除小截肢术后伤口愈合的可能性，因此，不能仅基于这些因素来选择足部溃疡糖尿病患者的截肢水平。
