Gürlek A, Bayraktar M, Savaş C, Gedik O
Hacettepe University School of Medicine, Department of Internal Medicine, Ankara, Turkey.
Exp Clin Endocrinol Diabetes. 1998;106(5):404-9. doi: 10.1055/s-0029-1212006.
To determine the lower extremity amputation rate and the risk factors for amputation, we analysed the medical records of 147 Turkish diabetic patients who have been referred to the clinic with diabetic foot. Eleven patients (7.5%) had type 1, and 136 patients (92.5%) had type 2 diabetes mellitus. Fifty-four patients (36.7%) have undergone amputation due to diabetic foot. Femoropopliteal by-pass has been performed in 4 patients in the non-amputees group who did not have gangrene. None of the patients in the amputees group has undergone a revascularisation procedure. Considering all lower-extremity amputations in the group studied, 25.9% were transphalangial amputations, 3.7% were transmetatarsal amputations, 7.4% were Syme type amputations, 51.9% were below-knee amputations, and 11.1% were above-knee amputations. In a logistic regression model, age, gender, duration of diabetes, smoking history, hypertension, retinopathy, nephropathy, and peripheral neuropathy were insignificant factors in determining the risk of amputation. In contrast, presence of peripheral vascular disease (odds ratio 4.0, 95% CI 1.17-13.4; p = 0.03), osteomyelitis (odds ratio 3.73, 95% CI 1.08-12.6; p = 0.04) and gangrene (odds ratio 30.8, 95% CI 7.39-121.5; p < 0.0001) were found to be the significant predictors of amputation. The mortality rate due to amputation during hospital stay was 13.2%. These data suggest that lower extremity amputation is a frequently encountered outcome of the hospitalized patients in Turkish diabetic population with diabetic foot which mainly occur due to peripheral vascular disease, osteomyelitis and gangrene. Lack of adequate vascularisation procedures might have contributed to a high percentage of major amputations in the group studied. Population-based studies should be undertaken in order to determine the status of lower extremity amputation as a whole in Turkish diabetic population.
为了确定下肢截肢率及截肢的危险因素，我们分析了147例因糖尿病足转诊至诊所的土耳其糖尿病患者的病历。11例患者（7.5%）为1型糖尿病，136例患者（92.5%）为2型糖尿病。54例患者（36.7%）因糖尿病足接受了截肢手术。在无坏疽的非截肢组中，有4例患者接受了股腘动脉搭桥手术。截肢组中无一例患者接受血管重建手术。在研究组的所有下肢截肢病例中，经趾截肢占25.9%，经跖截肢占3.7%，赛姆氏截肢占7.4%，膝下截肢占51.9%，膝上截肢占11.1%。在逻辑回归模型中，年龄、性别、糖尿病病程、吸烟史、高血压、视网膜病变、肾病和周围神经病变在确定截肢风险方面并非显著因素。相比之下，外周血管疾病（比值比4.0，95%可信区间1.17 - 13.4；p = 0.03）、骨髓炎（比值比3.73，95%可信区间1.08 - 12.6；p = 0.04）和坏疽（比值比30.8，95%可信区间7.39 - 121.5；p < 0.0001）被发现是截肢的显著预测因素。住院期间因截肢导致的死亡率为13.2%。这些数据表明，下肢截肢是土耳其糖尿病足住院患者常见的结局，主要由外周血管疾病、骨髓炎和坏疽引起。缺乏足够的血管重建手术可能是研究组中大部分大截肢病例的原因。应开展基于人群的研究，以确定土耳其糖尿病患者群体下肢截肢的整体状况。
