Rajasekaran S, Sabapathy S Raja
Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore 641009, TamilNadu, India.
Injury. 2007 Feb;38(2):137-46. doi: 10.1016/j.injury.2006.04.135. Epub 2006 Sep 6.
In the management of Type IIIb injuries, Gustilo's classification has the disadvantages of a poor intra and inter-observer agreement rate, low specificity and sensitivity to salvage and inability to predict functional outcomes. We propose here a validated score which assesses the severity of injury to the covering structures, skeletal structures and functional tissues of the injured limb separately along with providing weightage to the presence of co-morbid factors. A high sensitivity and specificity for amputation was documented when a score of 14 was used as the threshold score. In salvaged limbs, the score was found to offer guidelines in protocols for reconstruction. According to the total score, injuries were treated by 'Fix and close' protocol; 'Fix, Bone Graft and Close' protocol, 'Fix and Flap' protocol or 'Stabilise, Watch, Assess and Reconstruct' protocol. The score was thus found to be useful clinically not only to assess salvage but also to provide guidelines in reconstruction.
在Ⅲb型损伤的治疗中， Gustilo分类法存在以下缺点：观察者间和观察者内的一致性较差，对保肢的特异性和敏感性较低，且无法预测功能结果。我们在此提出一种经过验证的评分系统，该系统分别评估受伤肢体的覆盖结构、骨骼结构和功能组织的损伤严重程度，并考虑合并症因素的权重。当以14分为阈值评分时，截肢的敏感性和特异性较高。在保肢的情况下，该评分可为重建方案提供指导。根据总分，损伤采用“固定并闭合”方案、“固定、植骨并闭合”方案、“固定并皮瓣”方案或“稳定、观察、评估并重建”方案进行治疗。因此，该评分在临床上不仅有助于评估保肢情况，还能为重建提供指导。
