Alexander J J, Piotrowski J J, Graham D, Franceschi D, King T
Department of Surgery, Cleveland Metropolitan General Hospital, Case Western Reserve University, Ohio.
Am J Surg. 1991 Aug;162(2):111-6. doi: 10.1016/0002-9610(91)90170-i.
Thirty-two patients undergoing limb salvage procedures for complex vascular and orthopedic injuries of the lower extremity were studied in order to identify prognostic indicators for delayed amputation in this select group. A high incidence of nerve (38%), soft tissue (66%), and remote injury (47%) was noted. A comprehensive and integrated approach to vascular, orthopedic, and plastic reconstruction was utilized. Of the 32 patients studied, 1 (3.1%) died as a result of remote injury and sepsis. Amputation was required in 9 patients (28%), while 13 (56%) of the patients with limb salvage showed persistent functional or neurologic deficits. Infection was the most significant factor associated with amputation (p less than 0.0005) and was not avoided by the perioperative use of antibiotics. Delayed amputation resulted in a significant extension of total hospitalization (p less than 0.005). The authors favor an aggressive approach to limb salvage with IIIC injury but recommend early amputation in the presence of significant nerve disruption. An attentive use of tissue debridement, intravenous antibiotics, and early wound coverage is needed to limit infection.
对32例因下肢复杂血管和骨科损伤而接受保肢手术的患者进行了研究，以确定这一特定群体中延迟截肢的预后指标。发现神经损伤（38%）、软组织损伤（66%）和远处损伤（47%）的发生率很高。采用了一种全面综合的血管、骨科和整形重建方法。在研究的32例患者中，1例（3.1%）因远处损伤和败血症死亡。9例患者（28%）需要截肢，而保肢的患者中有13例（56%）存在持续的功能或神经功能缺损。感染是与截肢相关的最显著因素（p<0.0005），围手术期使用抗生素并不能避免感染。延迟截肢导致总住院时间显著延长（p<0.005）。作者赞成对IIIC型损伤采取积极的保肢方法，但建议在存在严重神经损伤时尽早截肢。需要谨慎使用组织清创、静脉注射抗生素和早期伤口覆盖以控制感染。
