Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Harvard Medical School, Boston, MA, 02115, USA.
Eur J Orthop Surg Traumatol. 2021 May;31(4):621-625. doi: 10.1007/s00590-020-02818-9. Epub 2020 Oct 23.
Limb amputation and death are devastating sequelae of acute compartment syndrome (ACS), and have been posited to result either from the initial injury burden or from pathophysiologic sequelae, such as rhabdomyolysis leading to acute renal failure. We aimed to test the hypothesis that severity of trauma is associated with limb amputation and death in patients with traumatic leg ACS.
We retrospectively reviewed 302 patients with ACS of 302 legs treated with fasciotomies from 2000 to 2015 at two tertiary trauma centers. Our response variables were death and limb amputation during inpatient hospital admission. Three common trauma severity scores, injury severity score (ISS), revised trauma score (RTS), and Glasgow coma scale (GCS), were studied. Patient- and injury-related explanatory variables were studied. Bivariate analyses were used to identify factors associated with limb amputation and death.
Of 302 patients, 13 (4%) underwent limb amputation and 10 (3%) died during the inpatient admission. Only one of 10 patients who expired died secondary to acute renal failure. ISS and GCS were significantly associated with limb amputation, and RTS was marginally associated. ISS, RTS, and GCS were significantly associated with death. Moreover, smoking and open fracture were significantly associated with limb amputation, and diabetes mellitus, presence of fracture, closed head injury, and chest or abdominal injury were associated with death.
Trauma severity scores are associated with both limb amputation and death during inpatient admission for traumatic leg ACS. These adverse sequelae of leg ACS are likely driven by the initial injury burden.
肢体截肢和死亡是急性筋膜间室综合征（ACS）的严重后果，其发生原因可能是初始损伤负担，也可能是横纹肌溶解导致急性肾衰竭等病理生理后果。我们旨在检验这样一个假设，即创伤严重程度与创伤性腿部 ACS 患者的截肢和死亡有关。
我们回顾性分析了 2000 年至 2015 年在两个三级创伤中心接受筋膜切开术治疗的 302 例 302 例 ACS 患者。我们的反应变量是住院期间的死亡和肢体截肢。研究了三种常见的创伤严重程度评分，即损伤严重程度评分（ISS）、修订创伤评分（RTS）和格拉斯哥昏迷评分（GCS）。研究了患者和损伤相关的解释变量。使用双变量分析来确定与肢体截肢和死亡相关的因素。
在 302 例患者中，有 13 例（4%）接受了肢体截肢，有 10 例（3%）在住院期间死亡。在 10 例死亡患者中，只有 1 例死于急性肾衰竭。ISS 和 GCS 与肢体截肢显著相关，RTS 则略有相关。ISS、RTS 和 GCS 与死亡显著相关。此外，吸烟和开放性骨折与肢体截肢显著相关，糖尿病、骨折存在、闭合性头部损伤和胸部或腹部损伤与死亡相关。
创伤严重程度评分与创伤性腿部 ACS 患者住院期间的肢体截肢和死亡均相关。这些腿部 ACS 的不良后果可能是由初始损伤负担引起的。
