Bosse M J, MacKenzie E J, Kellam J F, Burgess A R, Webb L X, Swiontkowski M F, Sanders R W, Jones A L, McAndrew M P, Patterson B M, McCarthy M L, Cyril J K
Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC 28232-2861, USA.
J Bone Joint Surg Am. 2001 Jan;83(1):3-14. doi: 10.2106/00004623-200101000-00002.
High-energy trauma to the lower extremity presents challenges with regard to reconstruction and rehabilitation. Failed efforts at limb salvage are associated with increased patient mortality and high hospital costs. Lower-extremity injury-severity scoring systems were developed to assist the surgical team with the initial decision to amputate or salvage a limb. The purpose of the present study was to prospectively evaluate the clinical utility of five lower-extremity injury-severity scoring systems.
Five hundred and fifty-six high-energy lower-extremity injuries were prospectively evaluated with use of five injury-severity scoring systems for lower-extremity trauma designed to assist in the decision-making process for the care of patients with such injuries. Four hundred and seven limbs remained in the salvage pathway six months after the injury. The sensitivity, specificity, and area under the receiver operating characteristic curve were calculated for the Mangled Extremity Severity Score (MESS); the Limb Salvage Index (LSI); the Predictive Salvage Index (PSI); the Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score (NISSSA); and the Hannover Fracture Scale-97 (HFS-97) for ischemic and nonischemic limbs. The scores were analyzed in two ways: including and excluding limbs that required immediate amputation.
The analysis did not validate the clinical utility of any of the lower-extremity injury-severity scores. The high specificity of the scores in all of the patient subgroups did confirm that low scores could be used to predict limb-salvage potential. The converse, however, was not true. The low sensitivity of the indices failed to support the validity of the scores as predictors of amputation.
Lower-extremity injury-severity scores at or above the amputation threshold should be cautiously used by a surgeon who must decide the fate of a lower extremity with a high-energy injury.
下肢的高能量创伤在重建和康复方面存在挑战。保肢努力失败与患者死亡率增加及高昂的医院成本相关。下肢损伤严重程度评分系统旨在协助手术团队做出截肢或保肢的初步决策。本研究的目的是前瞻性评估五种下肢损伤严重程度评分系统的临床效用。
采用五种下肢创伤损伤严重程度评分系统对556例高能量下肢损伤进行前瞻性评估，这些评分系统旨在协助对此类损伤患者的护理决策过程。受伤6个月后，407条肢体仍处于保肢路径中。计算了肢体毁损伤严重程度评分（MESS）、保肢指数（LSI）、预测保肢指数（PSI）、神经损伤、缺血、软组织损伤、骨骼损伤、休克及患者年龄评分（NISSSA）以及汉诺威骨折量表-97（HFS-97）对缺血和非缺血肢体的敏感性、特异性和受试者工作特征曲线下面积。评分以两种方式进行分析：包括和排除需要立即截肢的肢体。
分析未验证任何一种下肢损伤严重程度评分的临床效用。所有患者亚组中评分的高特异性确实证实低评分可用于预测保肢潜力。然而，反之则不然。这些指数的低敏感性未能支持评分作为截肢预测指标的有效性。
对于必须决定高能量损伤下肢命运的外科医生，应谨慎使用等于或高于截肢阈值的下肢损伤严重程度评分。
