Medical Modeling, Simulation and Mission Support Department, Naval Health Research Center San Diego, San Diego, CA 92106, USA.
J Orthop Trauma. 2013 Feb;27(2):e31-7. doi: 10.1097/BOT.0b013e3182517e1c.
The present study: (1) reports the early physical health complications, mental health outcomes, and outpatient health care utilization of patients with serious extremity injuries sustained during the Iraq or Afghanistan wars and (2) compares clinical outcomes between amputee and nonamputee extremity injury groups.
This was a retrospective review of clinical records in military health databases for patients injured in the Iraq and Afghanistan wars. Health outcomes of amputee (n = 382, injured 2001-2005) and nonamputee patients (n = 274, injured 2001-2007) with serious extremity injuries (abbreviated injury score ≥ 3) were followed up to 24 months post injury. This study was performed at Naval Health Research Center, San Diego.
Amputee and nonamputee groups had similar injury severity scores. Amputees had nearly double the risk of certain adverse complications (infections, anemia, septicemia, and thromboembolic disease), but other complications (osteomyelitis and nonhealing wound) were similar between the 2 groups. Amputees had significantly greater odds of certain mental health disorders including mood, sleep, pain, and postconcussion syndrome. However, amputees had significantly reduced odds of posttraumatic stress disorder compared with nonamputees. Amputees used various outpatient clinics significantly more than nonamputees.
Patients with serious combat extremity injuries showed high rates of adverse health outcomes in the short term. Amputees had higher rates of many but not all clinically important physical and mental health outcomes compared to nonamputees. These results are important for military orthopaedic surgeons and allied providers who care for and counsel these patients and clinicians and researchers who seek to understand and improve health outcomes in patients with extremity war injuries.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
本研究：(1)报告了在伊拉克或阿富汗战争中遭受严重四肢损伤的患者的早期身体健康并发症、心理健康结果和门诊医疗保健利用情况；(2)比较了截肢和非截肢四肢损伤组的临床结果。
这是对军事健康数据库中伊拉克和阿富汗战争中受伤患者的临床记录进行的回顾性研究。对 2001-2005 年期间受伤的 382 名截肢患者（损伤严重程度评分≥3）和 2001-2007 年期间受伤的 274 名非截肢患者（损伤严重程度评分≥3）的健康结果进行了 24 个月的随访。本研究在圣地亚哥的海军健康研究中心进行。
截肢组和非截肢组的损伤严重程度评分相似。截肢患者发生某些不良并发症（感染、贫血、败血症和血栓栓塞性疾病）的风险几乎是后者的两倍，但两组之间的其他并发症（骨髓炎和伤口不愈合）相似。截肢患者出现某些心理健康障碍（情绪、睡眠、疼痛和脑震荡后综合征）的几率明显更高。然而，与非截肢患者相比，截肢患者发生创伤后应激障碍的几率显著降低。截肢患者比非截肢患者更多地使用各种门诊诊所。
患有严重战斗性四肢损伤的患者在短期内出现了较高的不良健康结果发生率。与非截肢患者相比，截肢患者在许多但不是所有重要的身体和心理健康结果方面的发生率更高。这些结果对于照顾和咨询这些患者的军事矫形外科医生和相关医务人员以及试图了解和改善四肢战争伤员健康结果的临床医生和研究人员非常重要。
预后 II 级。有关证据等级的完整说明，请参见作者说明。
