探讨老年糖尿病足患者保肢治疗失败后不同截肢时机选择对预后的影响。

回顾性分析2022年1月至2024年12月在天津医科大学第二医院接受保肢治疗失败后行截肢手术的37例老年糖尿病足患者的临床资料，根据截肢时机分为早期截肢组（保肢失败后≤72 h手术）16例和延迟截肢组（保肢失败后>72 h手术）21例。采用t检验或χ²检验比较两组患者术后并发症发生率、伤口愈合时间、住院时间、术后6个月生存率及生活质量评分。采用多因素Logistic回归分析影响预后的危险因素。

早期截肢组和延迟截肢组术后总并发症发生率分别为31.25%和66.67%，差异有统计学意义（χ²=5.231，P<0.05）；早期截肢组伤口愈合时间和住院时间分别为（28.6±5.2）d和（35.2±8.7）d，延迟截肢组分别为（42.5±7.8）d和（52.6±10.3）d，差异均有统计学意义（t=6.325、5.871，P<0.01）。术后6个月，早期截肢组生存率和生活质量评分分别为93.75%和（68.5±10.2）分，延迟截肢组分别为71.43%和（52.3±8.6）分，差异均有统计学意义（χ²=3.968，t=5.124；P<0.05或0.01）。多因素Logistic回归分析显示，截肢时机延迟、术前合并严重感染及营养状况差是影响预后的危险因素（OR=3.852、4.218、3.526，95%CI：1.215~12.163、1.356~13.132、1.087~11.445，P<0.05）。

老年糖尿病足患者在保肢治疗失败后，应在病情相对稳定的前提下尽早实施截肢手术，可降低术后并发症发生率，缩短愈合及住院时间，提高生存率和生活质量。

To investigate the impact of different amputation timings on the prognosis of elderly patients with diabetic foot after failed limb salvage therapy, and to provide evidence for optimizing clinical decision-making regarding amputation.

A retrospective analysis was conducted on the clinical data of 37 elderly patients with diabetic foot who underwent amputation after failed limb salvage therapy in the Department of Hand and Foot Surgery of our hospital from January 2022 to December 2024. According to the timing of amputation, patients were divided into an early amputation group (surgery within 72 hours after failed limb salvage, n=16) and a delayed amputation group (surgery more than 72 hours after failed limb salvage, n=21). T test or χ² test was used to compare the differences in incidence of postoperative complications, wound healing time, hospital stay, 6-month survival rate, and quality of life (SF-36) scores between the two groups. Multivariate Logistic regression analysis was used to identify risk factors affecting prognosis.

The total postoperative complication rates in the early amputation group and the delayed amputation group were 31.25% and 66.67% respectively, with a statistically significant difference (χ²=5.231, P < 0.05). The wound healing time and hospital stay in the early amputation group were (28.6±5.2) days and (35.2±8.7) days respectively, while those in the delayed amputation group were (42.5±7.8) days and (52.6±10.3) days, respectively. The differences were statistically significant between the two groups (t=6.325, 5.871; P < 0.01). At 6 months after surgery, the survival rate and quality of life score in the early amputation group were 93.75% and (68.5±10.2) points, respectively, while those in the delayed amputation group were 71.43% and (52.3±8.6) points, respectively. The differences were statistically significant between the two groups (χ²=3.968, t=5.124; P < 0.05 or P < 0.01). Multivariate Logistic regression analysis showed that delayed amputation timing, preoperative severe infection, and poor nutritional status were independent risk factors for poor prognosis (OR=3.852, 4.218, 3.526; 95%CI: 1.215~12.163, 1.356~13.132, 1.087~11.445; P < 0.05).

For elderly patients with diabetic foot after failed limb salvage therapy, early amputation (within 72 hours) under relatively stable conditions can reduce the incidence of postoperative complications, shorten wound healing time and hospital stay, and improve survival rates and quality of life, making it worthy of clinical promotion.