Luther M
Surgical Department, Vasa Central Hospital, Finland.
Eur J Surg. 1998 Jan;164(1):35-43. doi: 10.1080/110241598750004931.
To evaluate mobility and care level required after amputation and arterial reconstruction for chronic critical leg ischaemia.
A 5 year follow up study in three hospitals serving a defined population.
One regional and two district hospitals, Finland.
117 Consecutive patients.
Survival, amputations, mobility, and care level required.
66 Primary reconstructions, 51 primary and 35 later major amputations were done. Preoperatively 27 (53%) of the patients who underwent a primary amputation were in permanent institutional care. Of 86 patients who were living outside an institution, 62 (72%) had a reconstruction. One and five year mortality were 43% and 84% after amputation, and 20% and 57% after reconstruction, respectively. Of the patients who had had an amputation 10% were able to walk and 25% could manage to live outside an institution. Mobility and treatment level after primary and secondary amputations were similar. Forty seven (71%) of the patients who had had a reconstruction did not have an amputation. All patients whose reconstructions were successful preserved their walking ability and independent living.
To maintain mobility and an independent living in patients with chronic critical leg ischaemia it is necessary to do a reconstruction that can salvage the leg. In old, institutionalised patients chronic critical leg ischaemia is often the harbinger of approaching death and then amputation is the only possible solution.
评估慢性严重下肢缺血患者截肢及动脉重建术后所需的活动能力和护理水平。
在为特定人群服务的三家医院进行的一项为期5年的随访研究。
芬兰的一家地区医院和两家区级医院。
117例连续患者。
生存率、截肢情况、活动能力及所需护理水平。
共进行了66例初次重建手术、51例初次及35例二期大截肢手术。术前，接受初次截肢的患者中有27例（53%）接受长期机构护理。在86例非机构居住患者中，62例（72%）接受了重建手术。截肢术后1年和5年死亡率分别为43%和84%，重建术后分别为20%和57%。接受截肢手术的患者中，10%能够行走，25%能够在机构外生活。初次和二次截肢后的活动能力及治疗水平相似。接受重建手术的患者中有47例（71%）未进行截肢。所有重建手术成功的患者均保留了行走能力及独立生活能力。
为维持慢性严重下肢缺血患者的活动能力及独立生活能力，有必要进行能挽救肢体的重建手术。对于年老的机构居住患者，慢性严重下肢缺血往往是临近死亡的先兆，此时截肢可能是唯一可行的解决办法。
