Howe H R, Poole G V, Hansen K J, Clark T, Plonk G W, Koman L A, Pennell T C
Am Surg. 1987 Apr;53(4):205-8.
A retrospective review of 676 tibial-fibular fractures and 985 femoral fractures treated over a 71-month period yielded associated major vascular trauma in 12 (1.7%) tibial-fibular fractures and in five (0.5%) femoral fractures. Vascular trauma combined with orthopedic trauma was also identified in four other cases--two disruptions of the pubic symphysis and two dislocations of the knee without fracture. Nine (43%) of the 21 involved limbs were eventually amputated. Limb survival was not related to the temporal relationship of vessel repair to skeletal stabilization; the presence or absence of shock on admission; the presence of associated but repaired venous injury; or the presence of unrelated injuries. Limb survival was related to the interval from injury to arrival in the operating room; the level of arterial injury; and the quantitative degree of muscle, bone, and skin injury. By combining these variables a limb salvage index was established that identified lower extremities likely to require amputation after combined orthopedic and vascular trauma (sensitivity 78%, specificity 100%). Use of this predictive salvage index may prevent the trauma surgeon from attempting to salvage a doomed or useless lower extremity and may thus permit early prosthetic rehabilitation to follow definitive primary amputation.
对71个月内治疗的676例胫腓骨骨折和985例股骨骨折进行回顾性研究发现，12例（1.7%）胫腓骨骨折和5例（0.5%）股骨骨折伴有主要血管损伤。另外4例还发现血管损伤合并骨科创伤，其中2例耻骨联合分离，2例无骨折的膝关节脱位。21例受累肢体中有9例（43%）最终截肢。肢体存活与血管修复和骨骼固定的时间关系、入院时是否存在休克、是否存在相关但已修复的静脉损伤或是否存在无关损伤无关。肢体存活与受伤至进入手术室的时间间隔、动脉损伤程度以及肌肉、骨骼和皮肤损伤的量化程度有关。通过综合这些变量，建立了一个肢体挽救指数，该指数可识别在骨科和血管联合创伤后可能需要截肢的下肢（敏感性78%，特异性100%）。使用这种预测性挽救指数可以防止创伤外科医生试图挽救注定要截肢或无用的下肢，从而可以在确定性一期截肢后尽早进行假肢康复。
