Eskridge Susan L, Huang Benjamin, McQuade Aidan, Goldman Stephen M, Dearth Christopher L
Leidos, San Diego, CA 20190, USA.
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
J Clin Med. 2025 Jun 3;14(11):3923. doi: 10.3390/jcm14113923.
: This study examined the incidence of acute complications within the first year following combat-related lower extremity injuries in United States (U.S.) Service members (SMs). The research compared outcomes between primary amputation (PA), limb salvage (LS), and non-threatening limb trauma (NTLT) groups, and conducted a subgroup analysis within the LS group, differentiating between SM who underwent a secondary amputation (LS-SA) and those who did not (LS-NA). : A retrospective analysis of combat-related lower extremity injuries sustained between January 2001 and October 2015 was performed using data from the Military Health System Medical Data Repository. Chi-square tests and adjusted logistic regression analysis were used to compare complication frequencies by injury severity. The analysis of the 4275 SM revealed that 21% had undergone PA, 47% LS (with 13% experiencing LS-SA and 87% LS-NA), and NTLT was observed in 32% of cases. The PA group exhibited higher rates of most acute complications compared to other groups, with three exceptions-i.e., non-union fractures, compartment syndrome, and orthopedic device complications were more prevalent in the LS group than the PA group. The LS-SA group had higher complication rates than the LS-NA group for most complications. Notably, the PA group was associated with the highest rates of post-hemorrhagic anemia and heterotopic ossification, while the LS-SA group exhibited the highest rates of osteomyelitis, non-union fractures, non-healing wounds, and compartment syndrome. : Individuals with amputation (PA or LS-SA) were more likely to experience acute complications compared to their counterparts (PA vs. LS and NTLT; LS-SA vs. LS-NA), with the exception of non-union fractures, which were more frequent in the LS group than the PA group. These findings highlight the need for close monitoring and targeted interventions to address post-surgical complications in Service members with limb salvage.
本研究调查了美国现役军人与战斗相关的下肢损伤后第一年内急性并发症的发生率。该研究比较了一期截肢（PA）、保肢（LS）和非威胁肢体创伤（NTLT）组之间的结果，并在LS组内进行了亚组分析，区分了接受二期截肢的军人（LS-SA）和未接受二期截肢的军人（LS-NA）。：利用军事卫生系统医疗数据存储库的数据，对2001年1月至2015年10月期间发生的与战斗相关的下肢损伤进行了回顾性分析。采用卡方检验和调整后的逻辑回归分析按损伤严重程度比较并发症发生率。对4275名现役军人的分析显示，21%的人接受了PA，47%的人接受了LS（其中13%经历了LS-SA，87%经历了LS-NA），32%的病例观察到NTLT。与其他组相比，PA组大多数急性并发症的发生率更高，但有三个例外，即骨不连骨折、骨筋膜室综合征和骨科器械并发症在LS组中比PA组更普遍。对于大多数并发症，LS-SA组的并发症发生率高于LS-NA组。值得注意的是，PA组出血后贫血和异位骨化的发生率最高，而LS-SA组骨髓炎、骨不连骨折、伤口不愈合和骨筋膜室综合征的发生率最高。与未截肢者相比，截肢者（PA或LS-SA）更有可能发生急性并发症（PA组与LS组和NTLT组相比；LS-SA组与LS-NA组相比），但骨不连骨折除外，骨不连骨折在LS组中比PA组更常见。这些发现凸显了对保肢的现役军人术后并发症进行密切监测和针对性干预的必要性。
