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.

目的：本研究的目的是描述接受下肢截肢的慢性脊髓损伤 (SCI) 人群，确定截肢指征、内科并发症并总结由此产生的并发症和功能变化。

设计：回顾性观察性队列研究。

地点： SCI 服务，退伍军人事务部 (VA) 医疗保健系统。

参与者：使用患者登记和电子健康记录在 VA 医疗中心接受截肢超过 15 年的 SCI 病程超过一年的退伍军人。诊断和程序代码用于识别截肢。

干预措施：不适用。

结果测量：截肢水平、并发症、功能状态、规定移动设备的变化和死亡率。

结果：52 名 SCI 患者接受了截肢手术，截肢时平均年龄为 62.9 岁。37 人 (71.2%) 有截瘫，34 人 (65.3%) 有运动完全性 SCI。压力性损伤和骨髓炎是最常见的截肢指征。截肢主要（83%）在胫骨水平或更近端，最常见的截肢水平是经股/膝关节（29；55.8%）。五人发生术后并发症。9 个手术前不卧床的人中有 7 个仍然可以卧床。37 人 (71%) 需要对设备进行改造。截肢后的五年生存率为 52%，外周血管疾病的存在与死亡率显着相关（P = 0.006）。

结论：压力损伤和骨髓炎是肢体丧失最常见的病因。截肢后不到一半的人经历了功能变化；一半以上需要新的或改装的移动设备。死亡率的增加可能反映了整体健康状况随着时间的推移而恶化。