Deja Włodzimierz, Wieczorek Dariusz, Deja Agata, Lasek Jerzy, Kawecka Aleksandra, Marks Wojciech
Z Katedry i Kliniki Chirurgii Urazowej, Akademii Medycznej, Gdańsku.
Wiad Lek. 2006;59(7-8):446-52.
Major vascular injuries in extremities are rare and constitute problems for surgeons and their sequelae strongly influence remote future of the patients. The aim of study is to evaluate surgical treatment of vascular injuries in extremities and some aspects of quality of life. Since 1983 until 2002 sixty four patients with vascular limbs injuries were treated in the department. Remote evaluation has been performed in 33 persons. Severity of limb injuries was measured by Mangled Extremity Severity Score (MESS). In 20 patients (60.6%) very good and good recent results were obtained, satisfactory in 24.2% and bad results in 15.2% persons. Evaluation of functional status has been made by means of locomotion test and Jebsen-Taylor's test, social approval questionnaire, depression Beck's scale, the scale of hypochondria and by an original questionnaire to evaluate the quality of life. As considerable interdependence has been found between the functional status and the following factors: injury severity expressed in MESS (p < 0.01), clinic reception procedure (p < 0.001), ischemia time (p < 0.01), coincidence of other injuries (fractures and dislocations, muscle, tendon and nerve lesions) (p < 0.01), limb amputation (p < 0.01). Hand function significantly influences the quality of life. Patients who were in shock after trauma in the remote assessment showed susceptibility to the lowered mood and depression (p < 0.05). Quality of life is strongly connected with the features of personality, correlating mainly with the mood and tendencies of concentration upon somatic symptoms. Function of the hand influences strongly the quality of life. Amputated patients may in spite of their crippling limitations are able to adapt to everyday life.
四肢的主要血管损伤较为罕见,这给外科医生带来了难题,而且其后遗症会严重影响患者的长远未来。本研究的目的是评估四肢血管损伤的外科治疗以及生活质量的某些方面。自1983年至2002年,该科室共治疗了64例四肢血管损伤患者。对33例患者进行了远期评估。采用肢体损伤严重程度评分(MESS)来衡量肢体损伤的严重程度。20例患者(60.6%)近期结果非常好或良好,24.2%的患者结果满意,15.2%的患者结果不佳。通过运动测试、杰布森 - 泰勒测试、社会认可度问卷、贝克抑郁量表、疑病症量表以及一份评估生活质量的原创问卷来评估功能状态。研究发现功能状态与以下因素之间存在显著的相互依存关系:以MESS表示的损伤严重程度(p < 0.01)、临床接诊程序(p < 0.001)、缺血时间(p < 0.01)、其他损伤(骨折、脱位、肌肉、肌腱和神经损伤)的合并情况(p < 0.01)、肢体截肢(p < 0.01)。手部功能对生活质量有显著影响。在远期评估中,创伤后休克的患者表现出情绪低落和抑郁的易感性(p < 0.05)。生活质量与人格特征密切相关,主要与情绪以及关注躯体症状的倾向相关。手部功能对生活质量有很大影响。截肢患者尽管有严重的身体限制,但仍能够适应日常生活。