下肢主要截肢后的外科创伤并发症,因为慢性肢体威胁性缺血
Mirva Virolainen1, Eszter Bako2, Milla Kallio3
1University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Department of Clinical Medicine, Kuopio, Finland; Department of Surgery, North Karelia Central Hospital, Joensuu, Finland.
Journal of vascular surgery
|September 20, 2025
概括
手术伤口并发症 (SWC) 在膝下截肢 (BKA) 后常见,用于慢性四肢威胁性缺血症 (CLTI),增加了医疗保健资源的使用. 皮质类固醇使用是危险因素,而先前的剪刀截肢可能是保护性的.
科学领域:
- 血管外科 血管外科
- 截肢结果的结果
- 慢性四肢威胁性缺血症 (CLTI) 是一种疾病.
背景情况:
- 慢性四肢威胁性缺血症 (CLTI) 往往需要进行较大的下肢截肢.
- 膝下截肢 (BKA) 和膝上截肢 (AKA) 是CLTI的常见手术干预.
- 手术伤口并发症 (SWCs) 可以显著影响患者的治疗结果和医疗保健资源的利用.
研究的目的:
- 在CLTI患者中调查BKA和AKA之后的SWC的发病率和风险因素.
- 评估SWC对医疗保健资源消费的影响.
- 为了比较BKA和AKA之间的SWC率和相关因素.
主要方法:
- 为CLTI进行重大截肢手术的患者 (2011-2020) 的单中心回顾性研究.
- 主要终点:SWC (手术修复,较高截肢或1年后不愈合的伤口).
- 多变量分析确定了SWC的风险因素;估计了医疗保健资源的使用.
主要成果:
- 在BKA (47%) 后,与AKA (11%) 相比,SWC率显著更高.
- 膝下截肢 (BKA) 是SWC的一个独立风险因素 (OR,4.13).
- 皮质类固醇使用增加了BKA和AKA的SWC风险;之前的剪刀截肢对BKA有保护作用 (OR,0.16).
- 医疗保健中心的住院时间增加了一倍以上,并增加了再入院和门诊访问.
结论:
- 近一半接受BKA的CLTI患者经历了SWC,突出显示了显著的并发症率.
- 皮质类固醇的使用是SWC的风险因素,而先前的剪刀截肢可能会降低BKA后的SWC风险.
- 医疗健康中心 (SWC) 显著增加了医疗保健资源利用率,并且难以预测,使BKA与AKA的决定变得复杂.
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