Helfet D L, Howey T, Sanders R, Johansen K
Florida Orthopaedic Institute, Tampa 33617.
Clin Orthop Relat Res. 1990 Jul(256):80-6.
Objective criteria can predict amputation after lower-extremity trauma. The authors examined the hypothesis that objective data, available early in the evaluation of patients with severe skeletal/soft-tissue injuries of the lower extremity with vascular compromise, might discriminate the salvageable from the unsalvageable limbs. The Mangled Extremity Severity Score (MESS) was developed by reviewing 25 trauma victims with 26 severe lower-extremity open fractures with vascular compromise. The four significant criteria (with increasing points for worsening prognosis) were skeletal/soft-tissue injury, limb ischemia, shock, and patient age. (There was a significant difference in the mean MESS scores; 4.88 in 17 limbs salvaged and 9.11 in nine limbs amputated; p less than 0.01). This scoring system was then prospectively evaluated in 26 lower-extremity open fractures with vascular injury over a 12-month period at two trauma centers. Again, there was a significant difference in the mean MESS scores; 4.00 for the 14 salvaged limbs and 8.83 for the 12 amputated limbs (p less than 0.01). In both the prospective and retrospective studies, a MESS score of greater than or equal to 7 had a 100% predictable value for amputation. This relatively simple, readily available scoring system of objective criteria was highly accurate in acutely discriminating between limbs that were salvageable and those that were unsalvageable and better managed by primary amputation.
客观标准能够预测下肢创伤后的截肢情况。作者检验了这样一个假设：在评估伴有血管损伤的下肢严重骨骼/软组织损伤患者时，早期可获取的客观数据或许能够区分可挽救肢体与不可挽救肢体。通过回顾25例创伤患者的26处伴有血管损伤的严重下肢开放性骨折病例，制定了肢体损伤严重程度评分（MESS）。四个重要标准（预后越差分数越高）为骨骼/软组织损伤、肢体缺血、休克及患者年龄。（平均MESS评分存在显著差异；17例挽救肢体的评分为4.88，9例截肢肢体的评分为9.11；p<0.01）。然后在两个创伤中心对26例伴有血管损伤的下肢开放性骨折患者进行了为期12个月的前瞻性评估。同样，平均MESS评分存在显著差异；14例挽救肢体的评分为4.00，12例截肢肢体的评分为8.83（p<0.01）。在前瞻性和回顾性研究中，MESS评分大于或等于7对截肢具有100%的预测价值。这种相对简单、易于获取的客观标准评分系统在急性区分可挽救肢体与不可挽救肢体方面高度准确，对于一期截肢的处理效果更佳。
