动脉损伤致军事下肢创伤截肢的预测因素和时间。
Predictors and timing of amputations in military lower extremity trauma with arterial injury.
机构信息
From the Department of Surgery, San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas (S.B.T., D.W.S.); United States Army Institute of Surgical Research, Military Health System, JBSA Fort Sam Houston, Texas (T.J.W.); Vascular Surgery Service, San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas (D.S.K.); and Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland (D.S.K.).
出版信息
J Trauma Acute Care Surg. 2019 Jul;87(1S Suppl 1):S172-S177. doi: 10.1097/TA.0000000000002185.
INTRODUCTION
Military lower extremity arterial injuries present threats to life and limb. These injuries are common and limb salvage is a trauma system priority. Understanding the timing and predictors of amputation through the phases of casualty evacuation can help inform future limb salvage efforts. This study characterizes limbs undergoing amputation at different operationally relevant time points.
METHODS
A retrospective cohort study of casualties with lower extremity arterial injuries undergoing initial vascular limb salvage in Iraq and Afghanistan was undertaken. Amputations were grouped as having been performed early (in theater at Role 2 or 3) or late (after evacuation to Role 4 or 5). Further distinction was made between late and delayed (after discharge from initial hospitalization) amputations.
RESULTS
Four hundred fifty-five casualties met inclusion criteria with 103 amputations (23%). Twenty-one (20%) were performed in theater and 82 (80%) were performed following overseas evacuation. Twenty-one (26% of late amputations) were delayed, a median of 359 days from injury (interquartile range, 176-582). Most amputations were performed in the first 4 days following injury. Amputation incidence was highest in popliteal injuries (28%). Overall, amputation was predicted by higher incidence of blast mechanism and fracture and greater limb and casualty injury severity. Early amputations had higher limb injury severity than late amputations. Delayed amputations had greater incidence of motor and sensory loss and contracture than early amputations.
CONCLUSION
Casualty and limb injury severity predict predictors and timing of amputation in military lower extremity arterial injury. Amputation following overseas evacuation was more common than in-theater amputation, and functional loss is associated with delayed amputation. Future limb salvage efforts should focus on postevacuation and rehabilitative care.
LEVEL OF EVIDENCE
Epidemiologic study, level III.
简介
军事下肢动脉损伤对生命和肢体构成威胁。这些损伤很常见，保肢是创伤系统的优先事项。了解伤员在伤员后送过程中不同阶段截肢的时间和预测因素，有助于为未来的保肢工作提供信息。本研究对在伊拉克和阿富汗进行初始血管性保肢的下肢动脉损伤伤员的肢体进行了分析，以确定不同手术相关时间点进行截肢的特点。
方法
对在伊拉克和阿富汗进行初始血管性保肢的下肢动脉损伤伤员进行了回顾性队列研究。将截肢分为早期（在 2 级或 3 级战地进行）和晚期（在 4 级或 5 级战地后进行）。晚期截肢进一步分为延迟（在初始住院后出院后进行）。
结果
符合纳入标准的 455 名伤员中有 103 例（23%）进行了截肢。21 例（20%）在战地进行，82 例（80%）在海外后送后进行。21 例（晚期截肢的 26%）为延迟截肢，自损伤后中位数为 359 天（四分位距 176-582）。大多数截肢发生在受伤后 4 天内。腘动脉损伤的截肢发生率最高（28%）。总体而言，截肢与爆炸机制、骨折发生率以及肢体和伤员损伤严重程度较高有关。早期截肢的肢体损伤严重程度高于晚期截肢。与早期截肢相比，延迟截肢的运动和感觉丧失以及挛缩发生率更高。
结论
伤员和肢体损伤严重程度是预测军事下肢动脉损伤截肢的因素和时间。海外后送后的截肢比战地截肢更为常见，功能丧失与延迟截肢有关。未来的保肢工作应侧重于后送和康复治疗。
证据等级
流行病学研究，III 级。
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