持久自由行动和伊拉克自由行动中的泌尿生殖系统损伤和四肢截肢：创伤结局和泌尿生殖健康 (TOUGH) 项目的早期发现。
Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom: Early findings from the Trauma Outcomes and Urogenital Health (TOUGH) project.
机构信息
From the US Army Institute of Surgical Research (N.S.N., J.C.J., J.C.R.), JBSA Fort Sam Houston, Texas; Urology Service, Department of Surgery (S.J.H.), and Department of Orthopaedics (J.C.R.), San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas; Technology Office (E.A.L.), Defence Equipment and Support, Ministry of Defence, Bristol, United Kingdom; Surgical Services (D.W.S.), San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas; Joint Trauma System (J.A.O.), US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas; Department of Epidemiology and Biostatistics (J.A.O.), University of Texas Health Science Center at San Antonio, San Antonio, Texas.
出版信息
J Trauma Acute Care Surg. 2016 Nov;81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S95-S99. doi: 10.1097/TA.0000000000001122.
BACKGROUND
In Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), genitourinary (GU) wounds have occurred in unprecedented numbers. Severe concomitant injuries, including extremity amputations, are common. The epidemiology of GU injury and extremity amputation in OEF/OIF has not been described.
MATERIALS AND METHODS
The Department of Defense Trauma Registry was queried from October 2001 through August 2013 to identify all surviving US male service members with GU injuries sustained in OEF/OIF. Genitourinary injury was defined as sustaining one or more injuries to any organ or structure within the genitourinary and/or reproductive system(s) based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was quantified based on Abbreviated Injury Scale scores and overall Injury Severity Scores. The incidence, nature, and severity of GU injuries and extremity amputations are described.
RESULTS
Of the 1,367 service members with GU injury included in this analysis, 433 (31.7%) had one or more extremity amputations. Most GU injuries were to the external genitalia [scrotum (55.6%), testes (33.0%), penis (31.0%), and urethra (9.1%)] vs. the kidneys (21.1%). Those with amputation(s) had greater GU injury severity (Abbreviated Injury Scale score ≥ 3) than those without amputations (50.1% vs. 30.5%, respectively; p < 0.0001). Approximately 3.4% of male service members with GU injury had an upper extremity amputation only, 8.9% had both lower and upper extremity amputation(s), and 19.4% had lower extremity amputation(s) only. Of the 387 patients with GU injury and lower extremity amputations, 87 (22.5%) had amputations below the knee and 300 (77.5%) had amputation(s) at/above the knee.
CONCLUSION
In OEF/OIF, concomitant GU injury and extremity amputation are common and have serious implications for health and quality of life. This wounding pattern presents new challenges to the military medical and research and development communities to prevent, mitigate, and treat these battlefield injuries.
LEVEL OF EVIDENCE
Epidemiologic/prognostic study, level III.
背景
在持久自由行动和伊拉克自由行动（OEF/OIF）中，泌尿生殖系统（GU）创伤的发生率前所未有。常见的严重合并伤包括四肢截肢。OEF/OIF 中 GU 损伤和四肢截肢的流行病学尚未描述。
材料与方法
从 2001 年 10 月至 2013 年 8 月，通过国防部创伤登记处查询所有在 OEF/OIF 中发生 GU 损伤的存活美国男性军人。根据国际疾病分类，第九版临床修正诊断代码，GU 损伤定义为任何泌尿生殖系统和/或生殖系统器官或结构的一处或多处损伤。损伤严重程度根据简明损伤量表评分和总体损伤严重程度评分进行量化。描述了 GU 损伤和四肢截肢的发生率、性质和严重程度。
结果
在纳入本分析的 1367 名 GU 损伤患者中，433 名（31.7%）有一处或多处四肢截肢。大多数 GU 损伤发生在外生殖器[阴囊（55.6%）、睾丸（33.0%）、阴茎（31.0%）和尿道（9.1%）]，而不是肾脏（21.1%）。有截肢的患者 GU 损伤严重程度更高（损伤严重程度评分≥3），而无截肢的患者严重程度较低（分别为 50.1%和 30.5%；p<0.0001）。大约 3.4%的 GU 损伤男性患者仅有上肢截肢，8.9%的患者有上下肢截肢，19.4%的患者仅有下肢截肢。在 387 名 GU 损伤合并下肢截肢的患者中，87 名（22.5%）截肢部位在膝关节以下，300 名（77.5%）截肢部位在膝关节以上。
结论
在 OEF/OIF 中，GU 损伤合并四肢截肢较为常见，对健康和生活质量有严重影响。这种创伤模式给军事医疗和研发界带来了新的挑战，需要预防、减轻和治疗这些战场损伤。
证据水平
流行病学/预后研究，III 级。
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