Simmons Jon D, Gunter Joseph W, Schmieg Robert E, Manley Justin D, Rushton Fred W, Porter John M, Mitchell Marc E
Division of Trauma and Surgical Critical Care, The University of Mississippi Medical Center, Jackson, Mississippi, USA.
Am Surg. 2011 Nov;77(11):1521-5.
Extended length of time from injury to definitive vascular repair is considered to be a predictor of amputation in patients with popliteal artery injuries. In an urban trauma center with a rural catchment area, logistical issues frequently result in treatment delays, which may affect limb salvage after vascular trauma. We examined how known risk factors for amputation after popliteal trauma are affected in a more rural environment, where patients often experience delays in definitive surgical treatment. All adult patients admitted to the Level I trauma center, the University of Mississippi Medical Center, with a popliteal artery injury between January 2000 and December of 2007 were identified. Demographic information management and outcome data were collected. Body mass index, mangled extremity severity score (MESS), Guistilo open fracture score, injury severity score, and time from injury to vascular repair were examined. Fifty-one patients with popliteal artery injuries (53% blunt and 47% penetrating) were identified, all undergoing operative repair. There were nine amputations (17.6%) and one death. Patients requiring amputation had a higher MESS, 7.8 versus 5.3 (P < 0.01), and length of stay, 43 versus 15 days (P < 0.01), compared with those with successful limb salvage. Body mass index, injury severity score, Guistilo open fracture score, or time from injury to repair were not different between the two groups. Patients with a blunt mechanism of injury had a slightly higher amputation rate compared with those with penetrating trauma, 25.9 per cent versus 8.3 per cent (P = non significant). MESS, though not perfect, is the best predictor of amputation in patients with popliteal artery injuries. Morbid obesity is not a significant predictor for amputation in patients with popliteal artery injuries. Time from injury to repair of greater than 6 hours was not predictive of amputation. This study further demonstrates that a single scoring system should be used with caution when determining the need for lower extremity amputation.
腘动脉损伤患者从受伤到最终血管修复的时间延长被认为是截肢的一个预测因素。在一个服务农村地区的城市创伤中心，后勤问题常常导致治疗延误，这可能会影响血管创伤后的肢体挽救。我们研究了在更偏远的农村环境中，已知的腘动脉创伤后截肢风险因素是如何受到影响的，在这种环境中患者往往在确定性手术治疗上出现延误。确定了2000年1月至2007年12月期间入住密西西比大学医学中心一级创伤中心且患有腘动脉损伤的所有成年患者。收集了人口统计学信息管理和结果数据。检查了体重指数、肢体毁损严重程度评分（MESS）、 Gustilo开放性骨折评分、损伤严重程度评分以及从受伤到血管修复的时间。确定了51例腘动脉损伤患者（53%为钝性伤，47%为穿透性伤），均接受了手术修复。有9例截肢（17.6%），1例死亡。与肢体挽救成功的患者相比，需要截肢的患者MESS更高，分别为7.8和5.3（P<0.01），住院时间更长，分别为43天和15天（P<0.01）。两组之间的体重指数、损伤严重程度评分、Gustilo开放性骨折评分或从受伤到修复的时间没有差异。钝性损伤机制的患者截肢率略高于穿透性创伤患者，分别为25.9%和8.3%（P=无显著性差异）。MESS虽然并不完美，但却是腘动脉损伤患者截肢的最佳预测因素。病态肥胖不是腘动脉损伤患者截肢的重要预测因素。受伤到修复时间大于6小时并不能预测截肢。这项研究进一步表明，在确定是否需要进行下肢截肢时，应谨慎使用单一评分系统。
