Prasarn Mark L, Helfet David L, Kloen Peter
Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
Strategies Trauma Limb Reconstr. 2012 Aug;7(2):57-66. doi: 10.1007/s11751-012-0137-4. Epub 2012 Jun 13.
The management of a mangled extremity continues to be a matter of debate. With modern advances in trauma resuscitation, microvascular tissue transfer, and fracture fixation, severe traumatic extremity injuries that would historically have been amputated are often salvaged. Even if preserving a mangled limb is a technical possibility, the question is often raised whether the end result will also be functional and what treatment would lead to the best patient outcome. The road to salvage is often prolonged with significant morbidity, reoperations, financial costs, and even mortality in some instances. Numerous factors have been implicated in the outcome of these injuries, and a number of scoring systems have been designed in an attempt to help guide the treating surgeon in the acute phase. However, much controversy remains on the ability of these grading systems to predict successful salvage of the mangled extremity. In this review, we discuss the mechanisms of injury, various available scoring systems, initial management, outcome and specific differences between lower and upper extremity trauma injuries.
严重毁损肢体的处理仍然是一个存在争议的问题。随着创伤复苏、微血管组织移植和骨折固定等现代技术的进步，以往通常会被截肢的严重创伤性肢体损伤现在常常得以挽救。即使保留严重毁损的肢体在技术上是可行的，但人们常常会提出这样的问题：最终结果是否也能恢复功能，以及何种治疗方法能为患者带来最佳预后。挽救肢体的过程往往漫长，会带来严重的并发症、再次手术、经济成本，甚至在某些情况下还会导致死亡。许多因素与这些损伤的预后相关，并且已经设计了一些评分系统，试图在急性期帮助指导外科医生进行治疗。然而，这些分级系统预测严重毁损肢体能否成功挽救的能力仍存在诸多争议。在本综述中，我们讨论了损伤机制、各种可用的评分系统、初始处理、预后以及下肢和上肢创伤损伤之间的具体差异。
