Yeh Hsuan-Keng, Fang Frank, Lin Yu-Te, Lin Cheng-Hung, Lin Chih-Hung, Hsu Chung-Chen
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University, Taiwan.
Injury. 2016 Oct;47(10):2127-2130. doi: 10.1016/j.injury.2016.05.023. Epub 2016 Jun 7.
Mangled lower extremity with Mangled extremity severity score (MESS) more than 7 are considered unsalvageable. We are looking for a factor helps us predicting the salvage potential in the patient with MESS score between 7 and 9.
We reviewed the patients with lower extremities open fracture type IIIB or IIIC and received salvaged procedure or amputation in CGMH between 2002/01 and 2010/09. The patients are subgroup according to their MESS score. ISS score, Gustilo open fracture classification were compared between patient with successful salvage and patient with delay amputation. Logistic regression and stepwise modeling were used to determine the effect of each covariate.
242 patients were enrolled in the study. 33 patients had primary amputation, 160 patients had successfully salvaged limbs and 49 patients received delay amputation. Among patients with MESS score less than 7, 116 patients had successful salvage limbs and 7 patients received delay amputation. Among patient with MESS between 7 and 9, 44 patients discharged with salvaged limbs and 39 patients were failed to salvage their limbs. Successful salvaged patients in this group had significant lower ISS score in compare to delay amputated patients. Patients with ISS score more than 18 in this group has higher delay amputated rate (P value=0.01).
Systemic injury severity score can help us tell potentially salvaged patient from potentially amputated patient. In patients with MESS score between 7 and 9 concurrently have ISS score less then 17 are potentially salvageable. Level of Evidence & Study Type: Level 3 Retrospective cohort study/prognostic study.
下肢严重毁损伤且毁损伤严重程度评分（MESS）大于7分者被认为无法挽救。我们正在寻找一个因素来帮助预测MESS评分在7至9分之间患者的挽救潜力。
我们回顾了2002年1月至2010年9月期间在高雄医学大学附设中和纪念医院接受III B型或III C型下肢开放性骨折并接受挽救手术或截肢的患者。根据他们的MESS评分对患者进行亚组划分。比较成功挽救患者和延迟截肢患者的损伤严重度评分（ISS）、 Gustilo开放性骨折分类。采用逻辑回归和逐步建模来确定每个协变量的作用。
242例患者纳入研究。33例患者接受一期截肢，160例患者肢体成功挽救，49例患者接受延迟截肢。在MESS评分小于7分的患者中，116例患者肢体成功挽救，7例患者接受延迟截肢。在MESS评分在7至9分之间的患者中，44例患者出院时肢体得到挽救，39例患者肢体挽救失败。该组中成功挽救的患者与延迟截肢的患者相比，ISS评分显著更低。该组中ISS评分大于18分的患者延迟截肢率更高（P值 = 0.01）。
全身损伤严重程度评分可以帮助我们区分潜在可挽救的患者和潜在需截肢的患者。MESS评分在7至9分且同时ISS评分小于17分的患者有潜在挽救可能。证据水平和研究类型：3级回顾性队列研究/预后研究。
