Kumar M Kiran, Badole Cm, Patond Kr
Department of Orthopedics, Narayana Medical College, Chinthareddypalem, Nellore - 524 002, (AP), India.
Indian J Orthop. 2007 Jul;41(3):183-7. doi: 10.4103/0019-5413.33679.
The purpose of the present study was to evaluate the clinical utility of Mangled extremity severity score (MESS) in severely injured lower limbs.
Retrospectively 25 and prospectively 36 lower limbs in 58 patients with high-energy injuries were evaluated with the use of MESS, to assist in the decision-making process for the care of patients with such injuries. Difference between the mean MESS scores for amputated and salvaged limbs was analyzed.
In the retrospective study 4.65 (4.65 ± 1.32) was the mean score for the salvaged limbs and 8.80 (8.8 ± 1.4) for the amputated limbs. In the prospective study 4.53 (4.53 ± 2.44) was the mean score for the salvaged limbs and 8.83 (8.83 ± 2.34) for the amputated limbs. There was a significant difference in the mean scores for salvaged and amputated limbs. Retrospective 21 (84%) and prospective 29 (80.5%) limbs remained in the salvage pathway six months after the injury.
MESS could predict amputation of severely injured lower limbs, having score of equal or more than 7 with 91% sensitivity and 98% specificity. There was a significant difference in the mean MESS scores in the prospective study (n=36), 4.53 (4.53 ± 2.44) in thirty salvaged limbs (83.33%) and 8.83 (8.83 ± 2.34) in six amputated limbs (16.66%) with a P-value 0.002 (P-value < 0.01). Similarly there was a significant difference in the mean MESS score in the retrospective study (n=25), 4.65 (4.65 ± 1.32) in twenty salvaged limbs (80%) and 8.80 (8.8 ± 1.4) in five amputated limbs (20%) with a P-value 0.00005 (P-value < 0.01). MESS is a simple and relatively easy and readily available scoring system which can help the surgeon to decide the fate of the lower extremity with a high-energy injury.
本研究旨在评估肢体损伤严重程度评分（MESS）在严重下肢损伤中的临床应用价值。
对58例高能损伤患者的25例下肢进行回顾性评估，对36例下肢进行前瞻性评估，采用MESS评分辅助此类损伤患者的治疗决策。分析截肢肢体与保肢肢体的平均MESS评分差异。
回顾性研究中，保肢肢体的平均评分为4.65（4.65±1.32），截肢肢体的平均评分为8.80（8.8±1.4）。前瞻性研究中，保肢肢体的平均评分为4.53（4.53±2.44），截肢肢体的平均评分为8.83（8.83±2.34）。保肢与截肢肢体的平均评分存在显著差异。回顾性研究中有21例（84%）、前瞻性研究中有29例（80.5%）肢体在受伤6个月后仍处于保肢治疗路径。
MESS可预测严重下肢损伤后的截肢情况，评分等于或高于7时，敏感性为91%，特异性为98%。前瞻性研究（n=36）中，30例保肢肢体（83.33%）的平均MESS评分为4.53（4.53±2.44），6例截肢肢体（16.66%）的平均评分为8.83（8.83±2.34），P值为0.002（P值<0.01）。同样，回顾性研究（n=25）中，20例保肢肢体（80%）的平均MESS评分为4.65（4.65±1.32），5例截肢肢体（20%）的平均评分为8.80（8.8±1.4），P值为0.00005（P值<0.01）。MESS是一个简单、相对容易且易于获得的评分系统，可帮助外科医生决定高能损伤下肢的治疗结局。
