Kumar R Siva, Singhi Prahalad Kumar, Chidambaram M
Department of Orthopaedics, Preethi Hospitals Pvt. Ltd., Madurai, Tamil Nadu, India.
J Orthop Case Rep. 2017 Jan-Feb;7(1):3-8. doi: 10.13107/jocr.2250-0685.662.
Mangled upper limb injuries are at surge because of industrialization, modernization, and severe motor vehicle accidents. The utility of various scoring systems are meant for decision making in mangled lower limb injuries, and the same have been extrapolated for mangled upper limb injuries to make a decision of salvage or amputation for the lack of separate scoring system.
We applied mangled extremity severity score (MESS) and mangled extremity syndrome index (MESI) scoring systems to 10 cases of mangled upper limb injuries during the period of November 2010 to September 2012 presented at our tertiary trauma care center. Average MESS score was 7.7 and MESI score was 18.1. Above elbow, amputation was needed in three patients, and salvage procedure was done in rest of the seven patients. All the patients were subjected to salvage procedure initially unless life threatening because of mangled limb injury. MESS scores over 7, MESI score over 20 is accepted for amputation in lower limbs, but could not be justified in our study for MESS whereas MESI was more reliable. Functional outcome was assessed using visual analog scale score and short form-36 (SF-36) score for all patients, which was satisfactory, elderly and diabetic patients were relatively less satisfied.
(a) Upper limb and lower limb mangled injuries cannot be considered same because of their anatomy. The upper limb has more rich vascularity and efficient collaterals, small muscle mass, so ischemia time is relatively more. Therefore, the different scoring systems are needed for both. (b) In our case series, MESI scoring was more reliable then MESS score, but this needs a large prospective study to validate it. (c) Salvage should be prime realistic aim influenced by several factors. Prosthesis for upper limb is very expensive and not well tolerated, so even a woody limb is well accepted in our patients.
由于工业化、现代化以及严重的机动车事故，上肢严重毁损伤呈上升趋势。各种评分系统用于下肢严重毁损伤的决策制定，由于缺乏针对上肢严重毁损伤的单独评分系统，这些评分系统已被外推用于上肢严重毁损伤，以决定保肢或截肢。
2010年11月至2012年9月期间，我们将肢体严重损伤严重程度评分（MESS）和肢体严重损伤综合征指数（MESI）评分系统应用于在我们三级创伤护理中心就诊的10例上肢严重毁损伤患者。平均MESS评分为7.7，MESI评分为18.1。3例患者需要进行肘部以上截肢，其余7例患者进行了保肢手术。除非因肢体严重损伤危及生命，所有患者最初均接受保肢手术。下肢截肢时MESS评分超过7分、MESI评分超过20分是被认可的，但在我们的研究中，MESS评分并不合理，而MESI更可靠。使用视觉模拟量表评分和简短健康调查问卷36（SF-36）评分对所有患者的功能结局进行评估，结果令人满意，老年患者和糖尿病患者相对不太满意。
（a）上肢和下肢严重毁损伤因其解剖结构不同，不能被视为相同情况。上肢血管更丰富、侧支循环更有效、肌肉量小，因此缺血时间相对更长。所以，两者需要不同的评分系统。（b）在我们的病例系列中，MESI评分比MESS评分更可靠，但这需要大规模前瞻性研究来验证。（c）保肢应是受多种因素影响的首要现实目标。上肢假肢非常昂贵且耐受性不佳，所以即使是残肢，我们的患者也能很好地接受。
