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首页> 外文期刊>Vascular and endovascular surgery >Below-Knee Amputation Failure and Poor Functional Outcomes Are Higher Than Predicted in Contemporary Practice
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Below-Knee Amputation Failure and Poor Functional Outcomes Are Higher Than Predicted in Contemporary Practice

机译：膝下截肢失败和功能不良结果高于现代实践中的预测

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Objective: The perceived functional benefit of below-knee amputation (BKA) must be carefully weighed against the need for potential reinterventions. This study sought to examine the contemporary clinical and functional outcomes of patients undergoing BKA in the endovascular era. Methods: All patients who underwent BKA from January 2008 to December 2014 at a single tertiary medical center were retrospectively reviewed. Demographics, comorbidities, ambulation status, and transcutaneous oximetry (TcPO2) values were recorded. Study end points included freedom from conversion to above-knee amputation (AKA), freedom from conversion to AKA or death, BKA healing, and ambulation. Statistical modeling was performed to determine associations with BKA failure. Results: Over the study interval, 130 limbs underwent BKA in 120 patients. Transcutaneous oximetry studies were obtained in 65% (n = 85). Thirty-eight percent (n = 46) of all BKA patients went on to heal and ambulate. Twenty-five percent (n = 33) required reintervention, 24 with conversion to AKA, and 9 with BKA revision. One-year freedom from conversion to AKA was 76% and was decreased among those with lower TcPO2 levels (60% TcPO2 < 40 vs 81% TcPO2 >= 40; P - .04). One-year composite freedom from conversion to AKA/death was 60% and was decreased among those with lower TcPO2 readings (39% TcPO2 < 40 vs 69% TcPO2 >= 40; P = .01). Conclusion: Despite a perceived functional bias toward knee salvage at the time of major amputation, most patients failed to postoperatively ambulate. Those with decreased TcPO2 levels (< 40 mm Hg) have a 2-fold higher risk of AKA conversion or death, while nearly one-fourth of all BKA patients will succumb to the same fate irrespective of TcPO2. This suggests that many BKA patients in the endovascular era fail to derive the perceived benefit of knee salvage at the time of their index amputation. These findings highlight the need for careful patient selection and for a shared decision-making model in this frail population.
机译：目的：必须仔细权衡膝盖以下截肢术（BKA）所感知的功能益处与潜在再干预的需求。这项研究试图检查血管内时代接受BKA的患者的当代临床和功能结局。方法：回顾性分析2008年1月至2014年12月在单一三级医疗中心接受BKA治疗的所有患者。记录人口统计学，合并症，走动状态和经皮血氧饱和度（TcPO2）值。研究终点包括免于转换为膝上截肢术（AKA），免于转换为AKA或死亡，BKA康复和下床活动。进行统计建模以确定与BKA失败的关联。结果：在整个研究期间，有120例患者的130肢进行了BKA。经皮血氧饱和度研究占65％（n = 85）。所有BKA患者中有38％（n = 46）继续to愈并行走。需要重新干预的比例为25％（n = 33），转换为AKA的比例为24，修订BKA的比例为9。一年内从转化为AKA的自由度为76％，在较低TcPO2水平的患者中有所减少（60％TcPO2 <40与81％TcPO2> = 40; P-.04）。从转换为AKA /死亡的一年复合自由度为60％，而在TcPO2读数较低的人群中，复合自由度降低了（39％TcPO2 <40与69％TcPO2> = 40; P = 0.01）。结论：尽管在大截肢时感觉到抢救功能存在偏见，但大多数患者术后无法进行下肢活动。 TcPO2水平降低（<40 mm Hg）的患者发生AKA转化或死亡的风险增加了2倍，而所有BKA患者中几乎有四分之一的人会死于相同的命运，而与TcPO2无关。这表明，在血管内时代的许多BKA患者在截肢时未能获得膝关节救助的感知收益。这些发现表明，在这个脆弱的人群中，需要仔细选择患者并采用共同的决策模型。

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