Altomare Michele, Granieri Stefano, Cioffi Stefano Piero Bernardo, Spota Andrea, Basilicò Silvia Azisa, Chiara Osvaldo, Cimbanassi Stefania
Acute Care Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.
Life (Basel). 2021 Nov 12;11(11):1226. doi: 10.3390/life11111226.
(1) Background: The Gustilo-Anderson (G/A) grading system is a universally accepted tool used to classify high-grade limb open fractures. The purpose of this study is to find early independent predictors of amputation in emergency settings. (2) Methods: A retrospective analysis involving patients treated at our center between 2010 and 2016 was conducted. Patients with at least one G/A grade III fracture or post-traumatic amputation were included. Three groups were identified: G/A IIIA (A group), G/A IIIB-C (BC group), and Amputation group (AMP group). Each group was further divided into two subgroups considering timing of coverage (early vs. delayed). Univariate and multivariate logistic regression models were developed to identify independent predictors of the limb's outcome. (3) Results: One-hundred-six patients with G/A III A-B-C fractures or amputation of the affected limb were selected from the Niguarda Hospital Trauma Registry. The patients were divided into the A group (26), BC group (66), and AMP group (14). The rate of infectious complications following early or delayed coverage was evaluated: A group, 9.1% vs. 66.7% ( > 0.05); BC group, 32% vs. 63.6% ( = 0.03); and AMP group, 22% vs. 18.5% ( > 0.05). After further recategorization, the BC subgroups were analyzed: multivariate logistic regression model identified systolic blood pressure (SBP) <90 mmHg ( = 0.03) and Mangled Extremity Severity Score MESS ≥ 7 ( = 0.001) were determined to be independent predictors of limb amputation. (4) Conclusion: MESS and SBP serve as predictors of amputation. Based on the results, we propose a new management algorithm for mangled extremities. Early coverage is related to lower rates of infectious complications. Referral to high-volume centers with specific expertise is mandatory to guarantee the best results.
(1) 背景： Gustilo-Anderson（G/A）分级系统是用于对高等级肢体开放性骨折进行分类的普遍接受的工具。本研究的目的是找出急诊情况下截肢的早期独立预测因素。(2) 方法：对2010年至2016年在我们中心接受治疗的患者进行回顾性分析。纳入至少有一处G/A III级骨折或创伤后截肢的患者。确定了三组：G/A IIIA（A组）、G/A IIIB-C（BC组）和截肢组（AMP组）。考虑覆盖时间（早期与延迟），每组进一步分为两个亚组。建立单变量和多变量逻辑回归模型以确定肢体结局的独立预测因素。(3) 结果：从Niguarda医院创伤登记处选取106例患有G/A III A-B-C骨折或患肢截肢的患者。患者分为A组（26例）、BC组（66例）和AMP组（14例）。评估早期或延迟覆盖后的感染并发症发生率：A组，9.1%对66.7%（>0.05）；BC组，32%对63.6%（=0.03）；AMP组，22%对18.5%（>0.05）。进一步重新分类后，对BC亚组进行分析：多变量逻辑回归模型确定收缩压（SBP）<90 mmHg（=0.03）和肢体损伤严重程度评分（MESS）≥7（=0.001）是肢体截肢的独立预测因素。(4) 结论：MESS和SBP可作为截肢预测指标。基于这些结果，我们提出了一种针对严重损伤肢体的新管理算法。早期覆盖与较低的感染并发症发生率相关。必须转诊至具有特定专业知识的大容量中心以确保最佳结果。
