甘加医院开放性损伤严重程度评分作为乌干达 Gustilo III A 型和 B 型胫骨骨折保肢早期失败的预测指标：一项前瞻性队列研究。
Ganga hospital open injury severity score as a predictor of early failure of limb salvage among gustilo type III A and B tibia fractures in Uganda: a prospective cohort study.
作者信息
Okuku Maxwel Dancan, Kabuye Umaru, Khadolwa Stephen Angira, Aweis Abubakar Mohamed, Xaviour Okedi Francis, Abraha Demoz, Quealee Charles, Olasinde Anthony Ayotunde, Usman Ibe Michael
机构信息
Department of Surgery, Kampala International University Western Campus, Bushenyi, Uganda.
Department of Nursing, Mountains of the Moon University, Fort Portal, Uganda.
出版信息
BMC Surg. 2025 Feb 21;25(1):77. doi: 10.1186/s12893-025-02811-1.
BACKGROUND
Despite advances in antibiotic therapy and microsurgery, the management of Gustilo and Anderson type IIIA and B open tibia fractures continues to pose a considerable challenge in developing countries. This has evolved from historical immediate amputation to modern approaches that prioritize both aesthetics and functional outcomes. Nonetheless, a consensus on limb salvage versus amputation remains elusive, prompting the development of prognostic limb scoring systems. Our study assessed the predictive accuracy of the Ganga Hospital Open Injury Severity Score (GHOISS) for early failure of limb salvage in Gustilo type IIIA and B tibia injuries.
METHODS
This was a prospective study that examined open tibia fractures at two tertiary hospitals in the emergency and orthopaedic units between June and October 2023. Fifty-three (26 IIIB and 27 IIIA) satisfied the study inclusion and exclusion criteria. Four injuries (type IIIA) in paediatric patients that had met the inclusion criteria were excluded from analysis to ensure homogeneity and generalizability of the results due to their small numbers. The severity of injury for each Gustilo type III A and B tibia fracture was determined using the GHOISS, and limb salvage decisions were made irrespective of the GHOISS. Follow-up was extended for up to fourteen days to assess the necessity of secondary amputation in salvaged limbs.
RESULTS
Among 49 Gustilo type IIIA and B tibia fractures, 43 were successfully salvaged, while 6 necessitated amputation (4 primary, 2 secondary). A GHOISS of 13 demonstrated maximum specificity (90.7%) and sensitivity (83.3%) in predicting amputation, with an AUC of 0.923 (95% CI 0.804-0.977), indicating strong discriminatory accuracy.
CONCLUSION
The GHOISS reliably predicted outcomes in patients with Gustilo type IIIA and B tibia fractures, with a score of 13 demonstrating optimal sensitivity and specificity above which early failure of limb salvage is anticipated.
背景
尽管抗生素治疗和显微外科技术取得了进展，但在发展中国家，处理 Gustilo 和 Anderson IIIA 型和 IIIB 型开放性胫骨骨折仍然是一项相当大的挑战。这已从历史上的立即截肢发展到优先考虑美学和功能结果的现代方法。尽管如此，关于保肢与截肢的共识仍然难以达成，这促使了预后肢体评分系统的发展。我们的研究评估了 Ganga 医院开放性损伤严重程度评分（GHOISS）对 Gustilo IIIA 型和 IIIB 型胫骨损伤保肢早期失败的预测准确性。
方法
这是一项前瞻性研究，于 2023 年 6 月至 10 月在两家三级医院的急诊科和骨科对开放性胫骨骨折进行了检查。53 例（26 例 IIIB 型和 27 例 IIIA 型）符合研究纳入和排除标准。为确保结果的同质性和普遍性，将 4 例符合纳入标准的儿科患者（IIIA 型）排除在分析之外，因为其数量较少。使用 GHOISS 确定每例 Gustilo IIIA 型和 IIIB 型胫骨骨折的损伤严重程度，且保肢决策与 GHOISS 无关。随访延长至 14 天，以评估保肢后二次截肢的必要性。
结果
在 49 例 Gustilo IIIA 型和 IIIB 型胫骨骨折中，43 例成功保肢，6 例需要截肢（4 例一期截肢，2 例二期截肢）。GHOISS 为 13 时，在预测截肢方面显示出最大特异性（90.7%）和敏感性（83.3%），曲线下面积为 0.923（95%可信区间 0.804 - 0.977），表明具有很强的鉴别准确性。
结论
GHOISS 可靠地预测了 Gustilo IIIA 型和 IIIB 型胫骨骨折患者的预后，评分为 13 时显示出最佳的敏感性和特异性，高于此评分预计保肢会早期失败。
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