Abstract：
The risk of above-ankle reamputation following a transmetatarsal amputation is around 30%. Patient selection may be crucial to achieve good outcomes, and to avoid futile operations and suffering. We are aware of no previous comparison between the two largest patient groups that undergo lower extremity amputations: patients with diabetes, and patients with non-diabetic peripheral artery disease. Patients with diabetes or nondiabetic peripheral artery disease who had undergone a transmetatarsal amputation from 2004 to 2018 at our institution were included. Patient characteristics and perioperative details were analyzed retrospectively. Subjects with diabetes were compared with subjects with nondiabetic peripheral artery disease regarding above-ankle reamputation, reamputation level, and mortality. Five-hundred-and-sixty transmetatarsal amputations in 513 subjects were included. The majority of transmetatarsal amputations (86%) occurred in diabetic subjects. Subjects with non-diabetic PAD had a higher risk of above-ankle reamputation (p = .008), and death (p < .001). At the time of data collection, only multiple-ray amputation (vs. single-ray) was an independent risk factor for above-ankle reamputation. Only age, medical comorbidity in general, and chronic heart failure were independent risk factors of death. To our knowledge, this study is the first to report marked differences in above-ankle reamputation rates and mortality following transmetatarsal amputation, comparing diabetics with non-diabetic patients with peripheral artery disease. However, the differences may be attributed to non-diabetics being older, having more medical comorbidities, and having more advanced foot ulcers at the time of transmetatarsal amputation. In patients exhibiting several of these risk factors, transmetatarsal amputation may be futile.
摘要：
经meta骨截肢后，踝关节上方截肢的风险约为30％。患者选择可能是取得良好结果的关键，避免徒劳的操作和痛苦。我们知道以前没有两个最大的下肢截肢患者组之间的比较：糖尿病患者，和非糖尿病性外周动脉疾病患者。纳入了从2004年到2018年在我们机构接受过经跖骨截肢的糖尿病或非糖尿病外周动脉疾病患者。回顾性分析患者特征和围手术期细节。将糖尿病患者与非糖尿病性外周动脉疾病患者的踝关节以上截肢进行比较，再截肢水平,和死亡率。包括513名受试者的五百六十个经meta骨截肢。大多数的经跖骨截肢（86％）发生在糖尿病受试者中。非糖尿病性PAD患者踝关节以上截肢的风险更高（p=.008），和死亡（p<.001）。在收集数据的时候,只有多射线截肢(vs.单射线）是踝关节以上截肢的独立危险因素。只有年龄,一般医学共病，慢性心力衰竭是死亡的独立危险因素。据我们所知,这项研究首次报道了踝关节以上截肢率和死亡率的显著差异，比较糖尿病患者和非糖尿病患者的外周动脉疾病。然而,差异可能归因于非糖尿病患者年龄较大，有更多的医疗合并症，并且在经跖骨截肢时患有更晚期的足部溃疡。在表现出这些危险因素的患者中，经跖骨截肢可能是徒劳的。临床证据水平：2级预后：回顾性研究。
