Thiagarajan P
Department of Orthopaedic Surgery, National University Hospital, Singapore.
Ann Acad Med Singap. 1999 Mar;28(2):227-30.
An in-depth analysis of the course of events leading to 49 delayed amputation of the lower extremity in 47 patients with open lower limb fractures is presented. Seventeen amputations were performed within one month mainly for vascular reasons. Eleven were between one month and one year, due to persistent sepsis and 21 amputations were performed more than a year after the original injury for infected non-union. Below-knee amputation was done in 32 limbs, above-knee amputation in 13 limbs and Symes' amputation in 4 limbs. The delay in timing of the amputation was analysed with respect to the nature of the injury, the primary treatment and the Mangled Extremity Severity Score (MESS). The MESS score was computed for all injuries and a score of 7 or more predicted an early amputation. We suggest that in all severe lower limb injuries, particularly in Type III C fractures with associated neurological injury, the benefits of an early amputation be considered as an alternative to a limb salvage procedure.
本文对47例开放性下肢骨折患者中49例延迟下肢截肢的事件过程进行了深入分析。17例截肢在1个月内进行，主要是由于血管原因。11例在1个月至1年之间进行，原因是持续存在败血症，21例截肢在原始损伤1年多后因感染性骨不连进行。32例肢体进行了膝下截肢，13例肢体进行了膝上截肢，4例肢体进行了赛姆斯截肢。根据损伤的性质、初始治疗和肢体损伤严重程度评分（MESS）对截肢时间的延迟进行了分析。计算了所有损伤的MESS评分，7分或更高的评分预示着早期截肢。我们建议，在所有严重的下肢损伤中，特别是伴有神经损伤的III C型骨折，应考虑早期截肢的益处，作为保肢手术的替代方案。
