Armstrong D G, Lavery L A, van Houtum W H, Harkless L B
Department of Orthopaedics, University of Texas Health Science Center, San Antonio, USA.
J Foot Ankle Surg. 1997 Mar-Apr;36(2):146-50. doi: 10.1016/s1067-2516(97)80062-2.
The purpose of this study was to examine seasonal variations in nontraumatic amputation among diabetic and nondiabetic adults. We abstracted data from a database supplied by the state of New York for 14,555 amputations performed in 1990 and 1991. We categorized amputations into three different levels (foot, leg, and thigh). The most common season for a patient with diabetes to receive a lower-extremity amputation was spring (27.0%, p < 0.004; odds ratio 1.1, confidence interval 1.0 to 1.2), while winter was the most common in nondiabetic patients (27.3%, p < 0.005; odds ratio 1.1, confidence interval 1.0 to 1.2). When stratified by amputation level, fewer amputations at the level of the foot occurred during winter in patients with diabetes compared with those without diabetes (24.5% vs. 28.2%, p < 0.002; chi 2MM = 193.1, odds ratio = 1.2, confidence interval = 1.1 to 1.4). Fall was the least common season for amputation at nearly every level for both diabetic and nondiabetic groups, and more diabetic patients presented with an admission diagnosis of vascular disease (74.6% vs. 54.9%, p < 0.0001; chi 2MM = 612.3, odds ratio = 2.4, confidence interval = 2.3 to 2.6). In most diabetic patients, a primary etiologic factor for amputation is an infected neuropathic ulceration brought about or exacerbated by increased activity. By limiting activity, cold weather should act as a protective measure. The data in this study seem to support this notion.
本研究的目的是调查糖尿病和非糖尿病成年人非创伤性截肢的季节变化。我们从纽约州提供的数据库中提取了1990年和1991年进行的14555例截肢手术的数据。我们将截肢分为三个不同级别（足部、腿部和大腿）。糖尿病患者进行下肢截肢最常见的季节是春季（27.0%，p<0.004；优势比1.1，置信区间1.0至1.2），而非糖尿病患者中最常见的季节是冬季（27.3%，p<0.005；优势比1.1，置信区间1.0至1.2）。按截肢级别分层时，糖尿病患者足部截肢在冬季的发生率低于非糖尿病患者（24.5%对28.2%，p<0.002；卡方检验=193.1，优势比=1.2，置信区间=1.1至1.4）。秋季是糖尿病和非糖尿病组几乎所有级别截肢最不常见的季节，更多糖尿病患者入院诊断为血管疾病（74.6%对54.9%，p<0.0001；卡方检验=612.3，优势比=2.4，置信区间=2.3至2.6）。在大多数糖尿病患者中，截肢的主要病因是活动增加导致或加重的感染性神经性溃疡。通过限制活动，寒冷天气应起到保护作用。本研究中的数据似乎支持这一观点。
