Franco Sarah R, Eskridge Susan L, Goldman Stephen M, Dearth Christopher L
Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA.
Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
J Clin Med. 2025 May 15;14(10):3472. doi: 10.3390/jcm14103472.
Musculoskeletal trauma involving the lower extremities is an unfortunately prevalent injury pattern in contemporary warfare, and the secondary health conditions (SHCs) associated with these injuries remain largely unexplored. U.S. Service members (SMs) with combat-related lower extremity injuries between 2004 and 2014 were categorized into primary amputation (PA), limb salvage (LS), and non-threatened limb trauma (NTLT) cohorts. The LS cohort was further divided into those with secondary amputation (LS-SA) and those without (LS-NA). The prevalence and incidence of 12 SHCs were analyzed across cohorts to test the hypotheses that (1) the prevalence of deleterious SHCs would differ among SMs with PA, LS, or NTLT, and (2) LS-SA would exhibit a greater prevalence of SHCs compared to LS-NA. The prevalence of SHCs varied significantly across cohorts. Mental health disorders, nonspecific pain, and movement abnormalities were more prevalent in the PA cohort, while osteoarthritis, internal derangement of the knee, joint pain, and late-effect musculoskeletal injury were more prevalent in the LS cohort, specifically in the LS-SA subpopulation. The LS cohort had a higher prevalence of several SHCs than the NTLT cohort. Osteoarthritis incidence increased over time in all cohorts except NTLT, while unspecified back disorders decreased. Notable incidence differences were observed for late-effect musculoskeletal injury and other soft tissue disorders. This study characterizes SHCs associated with combat-related extremity trauma, emphasizing the need for tailored interventions and follow-up care based on specific injury management. Future research should explore underlying mechanisms and evaluate targeted interventions to minimize SHCs' impact on patient outcomes.
涉及下肢的肌肉骨骼创伤在当代战争中是一种不幸普遍存在的损伤模式，而与这些损伤相关的继发性健康状况（SHCs）在很大程度上仍未得到充分研究。2004年至2014年间患有与战斗相关下肢损伤的美国军人（SMs）被分为初次截肢（PA）、保肢（LS）和未受威胁肢体创伤（NTLT）队列。LS队列进一步分为二次截肢者（LS-SA）和未二次截肢者（LS-NA）。分析了各队列中12种SHCs的患病率和发病率，以检验以下假设：（1）PA、LS或NTLT的美国军人中有害SHCs的患病率会有所不同；（2）与LS-NA相比，LS-SA的SHCs患病率会更高。各队列中SHCs的患病率差异显著。心理健康障碍、非特异性疼痛和运动异常在PA队列中更为普遍，而骨关节炎、膝关节内部紊乱、关节疼痛和迟发性肌肉骨骼损伤在LS队列中更为普遍，特别是在LS-SA亚组中。LS队列中几种SHCs的患病率高于NTLT队列。除NTLT外，所有队列中骨关节炎的发病率随时间增加，而未明确的背部疾病则减少。在迟发性肌肉骨骼损伤和其他软组织疾病方面观察到显著的发病率差异。本研究描述了与战斗相关的肢体创伤相关的SHCs，强调了基于特定损伤管理进行针对性干预和后续护理的必要性。未来的研究应探索潜在机制，并评估针对性干预措施，以尽量减少SHCs对患者预后的影响。
