대한족부족관절학회지 (Journal of Korean Foot and Ankle Society)

  • 제23권1호
  • /
  • Pages.18-23
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  • 2019
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  • 1738-3757(pISSN)
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  • 2288-8551(eISSN)
대한족부족관절학회 (Korean Foot & Ankle Society)
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단일 족지 절단 환자의 상처 치유 위험인자에 대한 통계적 분석

Statistical Analysis of the Risk Factors for Single Toe Amputation Patients in Wound Healing

  • 정형진 (인제대학교 의과대학 정형외과학교실) ;
  • 배서영 (인제대학교 의과대학 정형외과학교실) ;
  • 신우진 (인제대학교 의과대학 정형외과학교실) ;
  • 이준호 (인제대학교 의과대학 정형외과학교실)
  • Chung, Hyung-Jin (Department of Orthopedic Surgery, Inje University College of Medicine) ;
  • Bae, Su-Young (Department of Orthopedic Surgery, Inje University College of Medicine) ;
  • Shin, Woo-Jin (Department of Orthopedic Surgery, Inje University College of Medicine) ;
  • Lee, Jun-Ho (Department of Orthopedic Surgery, Inje University College of Medicine)
  • 투고 : 2019.02.01
  • 심사 : 2019.03.06
  • 발행 : 2019.03.15
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초록

Purpose: This study compared and analyzed the risk factors that affect a wound healing group and healing failure group. Materials and Methods: From 2010 to 2018, 39 patients who had suffered a single toe amputation were evaluated retrospectively. The patients were divided into two groups (wound healing group and healing failure group - within at least 3 months following the amputation). Regarding the possible risk factors, age, gender, Wagner and Brodsky classifications, duration of diabetes mellitus, whether the patient had peripheral arterial occlusive disease (PAOD) or cardiovascular disease, body mass index, HbA1c, total cholesterol, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), smoking, and alcohol were investigated. Results: The mean duration of diabetes mellitus was 140 months in the healing group and 227 months in the healing failure group, and the duration of diabetes was significantly longer in the failure group (p=0.009). A significant difference in eGFR was observed between the two groups ($59.17mL/min/1.73m^2$ in the healing group and $31.1mL/min/1.73m^2$ in the failure group) (p=0.022). Sixteen patients with PAOD were found, all 10 patients in the healing failure group were PAOD patients. Conclusion: To reduce the additional complications in single toe amputation patients, the underlying disease and appropriate treatment are the most important factors. In addition, a more proximal level of amputation also should be considered in cases of patients with PAOD, high BUN and low eGFR, and patients with long-term diabetes.

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참고문헌

  1. Bae JI, Won JH, Han SH, Lim SH, Hong YS, Kim JY, et al. Endovascular revascularization for patients with critical limb ischemia: impact on wound healing and long term clinical results in 189 limbs. Korean J Radiol. 2013;14:430-8. https://doi.org/10.3348/kjr.2013.14.3.430
  2. Myerson MS, Bowker JH, Brodsky JW, Trevino S. Symposium: partial foot amputations. Contemp Orthop. 1994;29:139-42, 146-57.
  3. Canaud L, Alric P, Berthet JP, Marty-AnE C, Mercier G, Branchereau P. Infrainguinal cutting balloon angioplasty in de novo arterial lesions. J Vasc Surg. 2008;48:1182-8. https://doi.org/10.1016/j.jvs.2008.06.053
  4. Sharp CS, Bessman AN, Wagner FW Jr, Garland D. Microbiology of deep tissue in diabetic gangrene. Diabetes Care. 1978;1:289-92. https://doi.org/10.2337/diacare.1.5.289
  5. Brodsky JW. Evaluation of the diabetic foot. Instr Course Lect. 1999;48:289-303.
  6. Roon AJ, Moore WS, Goldstone J. Below-knee amputation: a modern approach. Am J Surg. 1977;134:153-8. https://doi.org/10.1016/0002-9610(77)90299-9
  7. Dickhaut SC, DeLee JC, Page CP. Nutritional status: importance in predicting wound-healing after amputation. J Bone Joint Surg Am. 1984;66:71-5. https://doi.org/10.2106/00004623-198466010-00011
  8. Wagner FW Jr. Management of the diabetic neurotrophic foot part II. A classification and treatment program for diabetic, neuropathic, and dysvascular foot problems. In: The American Academy of Orthopaedic Surgeons, editor. Instructional course lectures. St. Louis: C.V. Mosby; 1979. p.143-65.
  9. Creager MA, Loscalzo J. Vascular diseases of the extremities. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, editors. Harrison's principles of internal medicine. 18th ed. New York: McGraw-Hill Medical; 2012. p.2032-3.
  10. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217-28. https://doi.org/10.1001/jama.293.2.217
  11. Swaminathan A, Vemulapalli S, Patel MR, Jones WS. Lower extremity amputation in peripheral artery disease: improving patient outcomes. Vasc Health Risk Manag. 2014;10:417-24. https://doi.org/10.2147/VHRM.S50588
  12. Adler AI, Boyko EJ, Ahroni JH, Smith DG. Lower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers. Diabetes Care. 1999;22:1029-35. https://doi.org/10.2337/diacare.22.7.1029
  13. Maser RE, Steenkiste AR, Dorman JS, Nielsen VK, Bass EB, Manjoo Q, et al. Epidemiological correlates of diabetic neuropathy. Report from Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes. 1989;38:1456-61. https://doi.org/10.2337/diab.38.11.1456
  14. The DCCT Research Group. Factors in development of diabetic neuropathy. Baseline analysis of neuropathy in feasibility phase of Diabetes Control and Complications Trial (DCCT). Diabetes. 1988;37:476-81. https://doi.org/10.2337/diab.37.4.476
  15. Lee WC, Park HS, Kim HC, Kim CS, Choi DS, Rha JD. Influence of neuropathy and ischemia in the development and treatment of the diabetic foot. J Korean Orthop Assoc. 1999;34:749-53. https://doi.org/10.4055/jkoa.1999.34.4.749
  16. Mayfield JA, Reiber GE, Nelson RG, Greene T. A foot risk classification system to predict diabetic amputation in Pima Indians. Diabetes Care. 1996;19:704-9. https://doi.org/10.2337/diacare.19.7.704
  17. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.
  18. Kwon SH, Han DC. Diagnosis and screening of chronic kidney disease. Korean J Med. 2009;76:515-20.
  19. Miyajima S, Shirai A, Yamamoto S, Okada N, Matsushita T. Risk factors for major limb amputations in diabetic foot gangrene patients. Diabetes Res Clin Pract. 2006;71:272-9. https://doi.org/10.1016/j.diabres.2005.07.005
  20. Armstrong DG, Frykberg RG. Classifying diabetic foot surgery: toward a rational definition. Diabet Med. 2003;20:329-31. https://doi.org/10.1046/j.1464-5491.2003.00933.x
  21. Nehler MR, Whitehill TA, Bowers SP, Jones DN, Hiatt WR, Rutherford RB, et al. Intermediate-term outcome of primary digit amputations in patients with diabetes mellitus who have forefoot sepsis requiring hospitalization and presumed adequate circulatory status. J Vasc Surg. 1999;30:509-17. https://doi.org/10.1016/S0741-5214(99)70078-9