Objective

The purpose of this study is to describe a population of individuals with chronic spinal cord injury (SCI), who underwent lower limb amputations, identify indications for amputations, medical co-morbidities and summarize resulting complications and functional changes.

Design

Retrospective observational cohort study.

Setting: SCI Service, Department of Veterans Affairs (VA) Health Care System.

Participants

Veterans with SCI of greater than one-year duration who underwent amputation at a VA Medical Center over a 15-year period, using patient registry and electronic health records. Diagnosis and procedure codes were utilized to identify amputations.

Interventions

Not applicable.

Outcome measures

Amputation level, complications, functional status, change in prescribed mobility equipment and mortality.

Results

52 individuals with SCI received amputation surgery with a mean age of 62.9 years at time of amputation. Thirty-seven (71.2%) had paraplegia, and 34 (65.3%) had motor-complete SCI. Pressure injuries and osteomyelitis were most common indications for amputation. Amputations were primarily (83%) at the transtibial level or more proximal, with the most common amputation level at transfemoral/through-knee (29;55.8%). Postoperative complications occurred in five individuals. Seven of nine individuals who were ambulatory pre-surgery remained ambulatory. Equipment modifications were required in 37 (71%) of individuals. Five-year survival following amputations was 52%, and presence of peripheral vascular disease was significantly associated with mortality (P = 0.006).

Conclusions

Pressure injuries and osteomyelitis were most common etiologies for limb loss. Less than half experienced functional change after amputation; more than half required new or modified mobility equipment. An increase in mortality may reflect overall health deterioration over time.

中文翻译：

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慢性脊髓损伤患者的肢体丧失

目的

这项研究的目的是描述患有慢性脊髓损伤（SCI）的个体人群，这些个体经历了下肢截肢，确定截肢的适应症，医学上的合并症并总结了由此引起的并发症和功能改变。

设计

回顾性观察队列研究。

地点：退伍军人事务部（VA）卫生保健系统的SCI服务。

参加者

SCI持续时间超过一年的退伍军人使用患者登记册和电子健康记录在VA医疗中心进行了15年的截肢手术。诊断和程序代码用于识别截肢。

干预措施

不适用。

结果指标

截肢水平，并发症，功能状态，处方移动设备的变化和死亡率。

结果

52例SCI患者接受截肢手术，截肢时的平均年龄为62.9岁。三十七（71.2％）名患有截瘫，34名（65.3％）患有运动完全性脊髓损伤。压力伤和骨髓炎是截肢的最常见指征。截肢主要是在胫骨水平或更高的截肢（83％），而最常见的截肢水平是在股骨/通过膝盖的截肢（29; 55.8％）。五个人发生了术后并发症。进行非卧床手术前的九个人中有七个仍处于非卧床状态。37名（71％）的人需要对设备进行改装。截肢后的五年生存率为52％，周围血管疾病的存在与死亡率显着相关（P = 0.006）。

结论

压伤和骨髓炎是肢体丢失的最常见病因。截肢后不到一半的人经历了功能改变；超过一半的人需要新的或改装的机动设备。死亡率增加可能反映出总体健康状况随时间而恶化。