Inkellis Elizabeth, Low Eric Edison, Langhammer Christopher, Morshed Saam
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
University of California, San Francisco School of Medicine, San Francisco, California.
JB JS Open Access. 2018 Apr 24;3(2):e0038. doi: 10.2106/JBJS.OA.17.00038. eCollection 2018 Jun 28.
There are few recent data examining the epidemiology of severe upper-extremity trauma in non-military patients. We used the National Trauma Data Bank (NTDB) to investigate the epidemiology and descriptive characteristics of upper-extremity amputations in U.S. trauma centers.
We queried the 2009 to 2012 NTDB research datasets for patients undergoing major upper-extremity amputation and extracted characteristics of the patient population, injury distribution, and treating facilities. In addition, multivariable regression models were fit to identify correlates of reoperation, major in-hospital complications, duration of hospitalization, and in-hospital mortality.
A total of 1,386 patients underwent a major upper-extremity amputation secondary to a trauma-related upper-extremity injury, representing 46 per 100,000 NTDB trauma admissions from 2009 to 2012. The most frequent definitive procedures performed were amputations through the humerus (35%), forearm (30%), and hand (14%). The average duration of hospitalization for all amputees was 17 days. Thirty-one percent of patients underwent at least 1 reoperation. The rate of reoperation was significantly higher at university-associated hospitals compared with nonteaching or community hospitals (p < 0.0001). Patients who had at least 1 reoperation stayed in the hospital approximately 7 days longer than patients who did not undergo reoperation. The Injury Severity Score, hospital teaching status, concomitant neurovascular injury, and occurrence of a complication were significantly associated with reoperation.
The present study provides an updated report on the epidemiology and characteristics of trauma-related major upper-extremity amputation in the U.S. civilian population. Additional work is necessary to assess the long-term outcomes following attempted upper-extremity salvage. The population-level data provided by the present study may help to inform the design and implementation of future studies on the optimum treatment for this survivable but life-altering injury.
近期针对非军事患者严重上肢创伤流行病学的研究数据较少。我们利用国家创伤数据库（NTDB）调查了美国创伤中心上肢截肢的流行病学及描述性特征。
我们查询了2009年至2012年NTDB研究数据集，以获取接受主要上肢截肢手术的患者信息，并提取了患者群体特征、损伤分布及治疗机构信息。此外，还建立了多变量回归模型，以确定再次手术、主要院内并发症、住院时间及院内死亡率的相关因素。
共有1386例患者因创伤相关上肢损伤接受了主要上肢截肢手术，占2009年至2012年NTDB创伤入院患者的每10万人中有46例。最常见的确定性手术是肱骨截肢（35%）、前臂截肢（30%）和手部截肢（14%）。所有截肢患者的平均住院时间为17天。31%的患者至少接受了1次再次手术。与非教学医院或社区医院相比，大学附属医院的再次手术率显著更高（p<0.0001）。至少接受1次再次手术的患者住院时间比未接受再次手术的患者长约7天。损伤严重程度评分、医院教学状况、伴发的神经血管损伤及并发症的发生与再次手术显著相关。
本研究提供了关于美国平民创伤相关主要上肢截肢的流行病学及特征的最新报告。有必要开展更多工作来评估上肢保肢尝试后的长期预后。本研究提供的人群水平数据可能有助于为未来关于这种可存活但改变生活的损伤的最佳治疗研究的设计和实施提供信息。
