糖尿病足截肢者临床及康复特征对其预后影响的系统综述

doi:10.3969/j.issn.1006-9771.2024.11.006

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (11): 1281-1290.doi: 10.3969/j.issn.1006-9771.2024.11.006

糖尿病足截肢者临床及康复特征对其预后影响的系统综述

张皓媛¹, 田罡¹^,²^,³, 李雪峰⁴, 李鸿江⁴, 闵红巍¹^,²^,³, 唐鹏¹^,², 张睿¹^,², 顾蕊¹^,²^,³(), 刘克敏¹^,²^,³

1.首都医科大学康复医学院，北京市 100068
2.中国康复研究中心北京博爱医院骨科，北京市 100068
3.北京截肢者康复会诊中心，北京市 100068
4.北京市丰台康复医院外科，北京市 100071

收稿日期:2024-08-14 修回日期:2024-09-07 出版日期:2024-11-25 发布日期:2024-12-05
通讯作者: >顾蕊(1981-)，女，满族，北京市人，博士，副主任医师，主要研究方向：骨与关节损伤康复、截肢康复等。E-mail: jj6567@icloud.com
作者简介:张皓媛(1999-)，女，汉族，四川达州市人，硕士研究生，主要研究方向：康复医学、骨科康复。

Influence of clinical and rehabilitation characteristics on prognosis of diabetic foot amputees: a systematic review

ZHANG Haoyuan¹, TIAN Gang¹^,²^,³, LI Xuefeng⁴, LI Hongjiang⁴, MIN Hongwei¹^,²^,³, TANG Peng¹^,², ZHANG Rui¹^,², GU Rui¹^,²^,³(), LIU Kemin¹^,²^,³

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Department of Orthopaedics, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. Beijing Amputee Rehabilitation Center, Beijing 100068, China
4. Department of Surgery, Fengtai Rehabilitation Hospital of Beijing Municipality, Beijing 100071, China

Received:2024-08-14 Revised:2024-09-07 Published:2024-11-25 Online:2024-12-05
Contact: GU Rui, E-mail: jj6567@icloud.com

摘要/Abstract

摘要：

目的分析糖尿病足截肢者不同临床及康复特征对其预后影响。

方法检索建库至2024年8月中国知网、万方、PubMed、Cochrane Library和Google Scholar数据库的相关文献。由2名研究人员独立筛选文献和提取数据，并采用纽卡斯尔-渥太华量表(NOS)和美国卫生保健质量和研究机构推荐的评价标准进行文献质量评价，纳入中等质量以上文献，进行系统综述。

结果共纳入17篇文献，涉及研究对象9 239例，其中中文3篇，英文14篇；纳入研究类型为病例对照研究、队列研究和横断面研究；主要来源于康复医学、骨科学、运动医学、残疾研究等领域；发表时间在1998年至2023年。糖尿病足截肢者预后相关的临床及康复特征包括截肢水平、社会经济状况(文化程度、收入水平、社会参与等)、心理状况(焦虑、抑郁等)、生理状况(年龄、性别、疼痛、假肢使用及步行能力等)。这些特征会影响糖尿病足截肢者的生活质量，导致再截肢和死亡。

结论截肢水平、社会经济状况、心理状况和生理状况均是导致糖尿病足截肢者预后不良的重要临床及康复特征因素，控制上述因素可以有效降低糖尿病足截肢者的再截肢率、死亡率，提高生活质量，改善其预后，促进其功能康复。

关键词: 糖尿病足, 截肢, 预后, 生活质量, 系统综述

Abstract:

Objective To analyze the impact of different clinical and rehabilitation characteristics on the prognosis of diabetic foot amputees.

Methods Related literatures were searched in CNKI, Wanfang Data, PubMed, Cochrane Library and Google Scholar from establishment to August, 2024. The literatures were screened and extracted by two researchers independently, the Newcastle-Ottawa Scale (NOS) and the evaluation criteria recommended by Agency for Healthcare Research and Quality (US) were used for quality evaluation, and literatures with above medium quality were included, and a systematic review was conducted.

Results A total of 17 articles involving 9 239 subjects were included, in which three were Chinese, and 14 were English. The study designs were case-control study, cohort study and cross-sectional study. They mainly came from the fields of rehabilitation medicine, orthopedics, sports medicine and disability studies, and were published between 1998 to 2023. Clinical and rehabilitation characteristics related to the prognosis of diabetic foot amputees included amputation level, socioeconomic determinants (educational attainment, economic status, social participation, etc.), psychological states (anxiety, depression, etc.) and physiological factors (age, gender, pain, prosthetic limb usage, and ambulatory capacity, etc.). These different characteristics could affect the quality of life of diabetic foot amputees, and even lead to re-amputation or death.

Conclusion Factors of amputation level, socioeconomic status, psychological status and physiological status are important for poor prognosis in diabetic foot amputees. Controlling the above factors can effectively reduce the re-amputation rate and mortality, and improve the quality of life in diabetic foot amputees, thus improving their prognosis, and promoting functional rehabilitation.

Key words: diabetic foot, amputation, prognosis, quality of life, systematic review

中图分类号:

R587.2

张皓媛, 田罡, 李雪峰, 李鸿江, 闵红巍, 唐鹏, 张睿, 顾蕊, 刘克敏. 糖尿病足截肢者临床及康复特征对其预后影响的系统综述[J]. 《中国康复理论与实践》, 2024, 30(11): 1281-1290.

ZHANG Haoyuan, TIAN Gang, LI Xuefeng, LI Hongjiang, MIN Hongwei, TANG Peng, ZHANG Rui, GU Rui, LIU Kemin. Influence of clinical and rehabilitation characteristics on prognosis of diabetic foot amputees: a systematic review[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(11): 1281-1290.

图/表 5

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表4

纳入文献基本特征"

纳入文献	国家	研究类型	n	比较	主要结局
Vuorlaakso等^[15](2023)	芬兰	队列研究	1081	不同截肢水平比较不同年龄比较	再截肢率未提及死亡率降低生活质量提高 Barthel指数升高
Reisoğlu等^[16](2022)	土耳其	队列研究	484	不同截肢水平比较不同年龄比较不同性别比较	再截肢率降低死亡率降低生活质量未提及
杨佳等^[17](2021)	中国	病例对照研究	100	不同社会经济状况比较不同心理状况(无情绪障碍与存在焦虑、抑郁)比较不同年龄比较不同疼痛状况(无疼痛与存在残肢痛、幻肢痛)比较	再截肢率未提及死亡率未提及生活质量提高 DSQL得分降低
梁国女等^[18](2019)	中国	病例对照研究	110	不同社会经济状况比较不同心理状况(无情绪障碍与存在焦虑、抑郁)比较不同截肢水平比较不同年龄比较	再截肢率未提及死亡率未提及生活质量提高 DSQL得分降低
Pedras等^[19](2018)	葡萄牙	横断面研究	202	不同心理状况(无情绪障碍与存在焦虑、抑郁)比较	再截肢率降低死亡率降低生活质量提高 SF-36得分升高
Fajardo-Martos等^[20](2018)	西班牙	队列研究	169	不同截肢水平比较不同性别比较不同步行能力比较	再截肢率降低死亡率降低生活质量提高 DSQL得分降低
Davie-Smith等^[21](2017)	英国	队列研究	1735	不同截肢水平比较不同年龄比较装配假肢与未装配假肢比较	再截肢率降低死亡率降低生活质量未提及
Chu等^[22](2016)	中国	队列研究	245	不同截肢水平比较不同年龄比较年轻患者与高龄患者相比不同步行能力比较	再截肢率降低死亡率降低生活质量提高 Barthel指数升高
Venkataraman等^[23](2016)	新加坡	队列研究	256	不同年龄比较不同步行能力比较	再截肢率降低死亡率降低生活质量提高 Barthel指数升高
Siersma等^[24](2014)	意大利	横断面研究	1088	不同截肢水平比较不同心理状况(无情绪障碍与存在焦虑、抑郁)比较不同社会经济状况比较不同疼痛状况(无疼痛与存在残肢痛、幻肢痛)比较不同步行能力比较	再截肢率降低死亡率降低生活质量提高 Barthel指数升高
Wong等^[25](2013)	新加坡	队列研究	151	不同截肢水平比较装配假肢与未装配假肢比较	再截肢率降低死亡率降低生活质量未提及
Morbach等^[26](2012)	德国	队列研究	247	不同截肢水平比较不同年龄比较不同性别比较	再截肢率未提及死亡率降低生活质量提高 Barthel指数升高
Sinha等^[27](2011)	荷兰	横断面研究	605	不同社会经济状况比较不同疼痛状况(无疼痛与存在残肢痛、幻肢痛)比较装配假肢步行能力较好与未装配假肢步行能力较差比较	再截肢率未提及死亡率降低生活质量提高 SF-36得分升高
舒斌等^[28](2010)	中国	队列研究	82	不同截肢水平比较不同年龄比较	再截肢率降低死亡率未提及生活质量未提及
Dillingham等^[29](2008)	美国	队列研究	2468	不同年龄比较装配假肢与未装配假肢比较	再截肢率降低死亡率降低生活质量未提及
Ohsawa等^[30](2001)	日本	队列研究	27	不同年龄比较不同性别比较不同步行能力比较	再截肢率降低死亡率降低生活质量提高 SF-36得分升高
Larsson等^[31](1998)	瑞典	队列研究	189	不同截肢水平比较装配假肢步行能力较好与未装配假肢步行能力较差比较	再截肢率降低死亡率降低生活质量提高 Barthel指数升高

表4

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纳入文献	①	②	③	④	⑤	⑥	⑦	⑩	⑪	得分	质量
Pedras等^[19](2018)	√	√	√	√	√		√			6	中
Siersma等^[24](2014)	√	√	√	√	√	√			√	7	中
Sinha等^[27](2011)	√	√	√	√	√	√		√	√	8	高

糖尿病足截肢者临床及康复特征对其预后影响的系统综述

Influence of clinical and rehabilitation characteristics on prognosis of diabetic foot amputees: a systematic review

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