Sharma Sansar, Devgan Ashish, Marya K M, Rathee Nitesh
Department of Orthopaedics, Paraplegia and Rehabilitation, Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India.
Injury. 2003 Jul;34(7):493-6. doi: 10.1016/s0020-1383(02)00214-0.
Amputation of a mangled extremity is repugnant to the patient and the surgeon. However, prolonged unsuccessful attempts at salvage are costly, highly morbid and sometimes lethal. Much discussion has taken place regarding which criteria predict successful salvage, and predictive indices have been proposed in an attempt to identify limbs for which attempted salvage is unlikely to succeed. The mangled extremity severity score, or MESS system is the most thoroughly validated of the various classification systems, but at present there is no predictive scale that can be used with confidence to determine whether to amputate or attempt to salvage a mangled lower extremity. MESS system based on four significant criteria (with increasing points with worsening prognosis) i.e. skeletal injury, limb ischaemia, shock and patient age, has become a standard method to determine which one of the mangled extremities will eventually undergo amputation or salvage. Keeping in view the paucity of studies on Indian patients, a prospective trial of MESS was done in 50 patients who had 56 mangled extremities during the last 3 years. A significant difference between the MESS value of salvaged limbs (4.7) and amputated limbs (8.6) was found. MESS value of more than 7 was most specific and was found to have a positive predictive value of 100%. The results have been compared with Western literature and authors suggest that nerve injuries and irreparable soft tissue loss should be given an extra point each. In bilateral cases, the MESS value of each limb should be properly assessed (especially when patient is in shock), as the score may increase because of the other injured limb.
对严重毁损的肢体进行截肢，这对患者和外科医生来说都是难以接受的。然而，长时间进行挽救但未成功的尝试代价高昂、并发症严重，有时甚至会致命。关于哪些标准可预测挽救成功，已经进行了大量讨论，并且有人提出了预测指标，试图识别那些挽救尝试不太可能成功的肢体。严重毁损肢体严重程度评分系统（MESS系统）是各种分类系统中经过最充分验证的，但目前尚无一种可放心用于确定是否对严重毁损的下肢进行截肢或尝试挽救的预测量表。基于四个重要标准（预后越差分数越高）的MESS系统，即骨骼损伤、肢体缺血、休克和患者年龄，已成为确定哪些严重毁损的肢体最终会接受截肢或挽救的标准方法。鉴于针对印度患者的研究较少，我们对过去3年中50例有56个严重毁损肢体的患者进行了MESS的前瞻性试验。结果发现，成功挽救肢体的MESS值（4.7）与截肢肢体的MESS值（8.6）之间存在显著差异。MESS值大于7最为特异，其阳性预测值为100%。我们将结果与西方文献进行了比较，作者建议神经损伤和无法修复的软组织损失应各加1分。在双侧病例中，应正确评估每个肢体的MESS值（尤其是当患者处于休克状态时），因为由于另一个受伤肢体，分数可能会增加。
