Faglia E, Favales F, Aldeghi A, Calia P, Quarantiello A, Barbano P, Puttini M, Palmieri B, Brambilla G, Rampoldi A, Mazzola E, Valenti L, Fattori G, Rega V, Cristalli A, Oriani G, Michael M, Morabito A
Diabetology Center, Niguarda Hospital, Italy.
J Diabetes Complications. 1998 Mar-Apr;12(2):96-102. doi: 10.1016/s1056-8727(97)98004-1.
From 1990 to 1993, 115 diabetic patients were consecutively hospitalized in our diabetologic unit for foot ulcer and 27 (23.5%) major amputations were carried out. The major amputation rate of this series of cases was compared with that occurring in diabetic subjects taken into our hospital for foot ulcer in two previous periods: 1979-1981 (17 major amputations in 42 inpatients or 40.5%) and 1986-1989 (26 major amputations in 78 inpatients or 33.3%). The comparison shows a progressive reduction in major amputation rate [Odds ratio 0.66, 95% confidence interval (CI) 0.46-0.96]. Univariate and multivariate analysis, carried out in the population of the 1990-1993 period, in order to detect the independent factors associated with major amputation show the following prognostic determinants of major amputation: Wagner grade (odds ratio 7.69, CI 1.58-37.53), prior stroke (odds ratio 35.05, CI 3.14-390.53), prior major amputation (odds ratio 3.49, CI 1.26-9.38), transcutaneous oxygen level (odds ratio 1.06, CI 1.01-1.12), and ankle-brachial blood pressure index (odds ratio 4.35, CI 1.58-12.05), while an independent protective role was attributed to hyperbaric oxygen treatment (odds ratio 0.15, CI 0.03-0.64). In accordance with other studies, we, therefore, conclude that a comprehensive protocol as well as a multidisciplinary approach in a dedicated center can assure a decrease in major amputation rate. The parameters of limb perfusion were the modifiable prognostic determinants most strongly predictive for amputation.
1990年至1993年期间，115例糖尿病足溃疡患者连续入住我院糖尿病科，其中27例（23.5%）接受了大截肢手术。将该系列病例的大截肢率与之前两个时期因足溃疡入住我院的糖尿病患者的大截肢率进行了比较：1979 - 1981年（42例住院患者中有17例大截肢，截肢率为40.5%）和1986 - 1989年（78例住院患者中有26例大截肢，截肢率为33.3%）。比较结果显示大截肢率呈逐渐下降趋势[优势比0.66，95%置信区间（CI）0.46 - 0.96]。为了检测与大截肢相关的独立因素，对1990 - 1993年期间的患者群体进行了单因素和多因素分析，结果显示大截肢的以下预后决定因素：瓦格纳分级（优势比7.69，CI 1.58 - 37.53）、既往中风（优势比35.05，CI 3.14 - 390.53）、既往大截肢（优势比3.49，CI 1.26 - 9.38）、经皮氧分压水平（优势比1.06，CI 1.01 - 1.12）以及踝肱血压指数（优势比4.35，CI 1.58 - 12.05），而高压氧治疗具有独立的保护作用（优势比0.15，CI 0.03 - 0.64）。因此，与其他研究一致，我们得出结论，在专门的中心采用综合方案以及多学科方法可以确保降低大截肢率。肢体灌注参数是对截肢预测最具决定性的可改变的预后因素。
