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Titre : | Rate of and factors associated with ambulation after unilateral major lower-limb amputation at an urban us tertiary-care hospital with a multidisciplinary limb salvage team |
Type de document : | article de périodique |
Auteurs : | Laura E. Sansosti, Auteur |
Année de publication : | 2017 |
Article en page(s) : | p. 355-364 |
Langues : | Anglais (eng) |
Descripteurs (mots clés) : | [Thésaurus Mesh]Amputation chirurgicale [Thésaurus Mesh]Démarche [Thésaurus Mesh]Membre inférieur [Thésaurus Mesh]Prothèses et implants
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Mots-clés : | amputation gait lower extremity prostheses and implants |
Résumé : | Background: One relatively universal functional goal after major lower-limb amputation is ambulation in a prosthesis. This retrospective, observational investigation sought to 1) determine what percentage of patients successfully walked in a prosthesis within 1 year after major limb amputation and 2) assess which patient factors might be associated with ambulation at an urban US tertiary-care hospital. Methods: A retrospective medical record review was performed to identify consecutive patients undergoing major lower-limb amputation. Results: The overall rate of ambulation in a prosthesis was 29.94% (50.0% of those with unilateral below-the-knee amputation [BKA] and 20.0% of those with unilateral abovethe-knee amputation [AKA]). In 24.81% of patients with unilateral BKA or AKA, a secondary surgical procedure of the amputation site was required. In those with unilateral BKA or AKA, statistically significant factors associated with ambulation included male sex (odds ratio [OR] ¼ 2.50) and at least 6 months of outpatient follow-up (OR ¼ 8.10), survival for at least 1 postoperative year (OR ¼ 8.98), ambulatory preamputation (OR ¼ 14.40), returned home after the amputation (OR ¼ 6.12), and healing of the amputation primarily without a secondary surgical procedure (OR ¼ 3.62). Those who had a history of dementia (OR ¼ 0.00), a history of peripheral arterial disease (OR ¼0.35), and a preamputation history of ipsilateral limb revascularization (OR ¼0.14) were less likely to walk. We also observed that patients with a history of outpatient evaluation by a podiatric physician before major amputation were 2.63 times as likely to undergo BKA as opposed to AKA and were 2.90 times as likely to walk after these procedures. Conclusions: These results add to the body of knowledge regarding outcomes after major amputation and could be useful in the education and consent of patients faced with major amputation. ( |
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