McNamara M G, Heckman J D, Corley F G
Department of Orthopaedics, University of Texas Health Science Center at San Antonio 78284-7774.
J Orthop Trauma. 1994;8(2):81-7. doi: 10.1097/00005131-199404000-00001.
Recent reports using the Mangled Extremity Severity Score (MESS) suggest that a score of > or = 7 is 100% accurate in predicting the need for amputation of severely injured lower extremities. To further evaluate the value of the MESS in predicting amputation, specifically with respect to type IIIB and type IIIC (Gustilo and Anderson) open fractures of the tibia, we retrospectively evaluated 24 patients with these injuries. A significant difference (p = 0.001) between MESS values of 13 salvaged (6.36 +/- 0.35 SEM) and 11 amputated limbs (6.36 +/- 0.54 SEM) was found. A MESS value of > or = 4 was most sensitive (100%); a MESS value of > or = 7 was most specific, and a MESS value of > or = 7 was found to have a positive predictive value of 100%. Subsequently, we addressed recent criticisms of the MESS by including nerve injury in the scoring system and by separating soft-tissue and skeletal injury components of the MESS. We modified the MESS with a score called the NISSSA and applied it retrospectively to our cases. After careful statistical comparison we found both the MESS and NISSSA to be highly accurate (p < 0.005) in predicting amputation. The NISSSA was found to be more sensitive (81.8% versus 63.6%) and more specific (92.3 versus 69.2%).
近期使用肢体严重损伤评分（MESS）的报告表明，评分≥7对于预测严重受伤下肢是否需要截肢的准确率为100%。为了进一步评估MESS在预测截肢方面的价值，特别是针对ⅢB型和ⅡIC型（ Gustilo和Anderson分型）胫骨开放性骨折，我们回顾性评估了24例此类损伤患者。结果发现，13例保肢肢体（平均标准误6.36±0.35）与11例截肢肢体（平均标准误6.36±0.54）的MESS值存在显著差异（p = 0.001）。MESS值≥4时最敏感（100%）；MESS值≥7时最具特异性，且MESS值≥7的阳性预测值为100%。随后，我们通过在评分系统中纳入神经损伤以及区分MESS中的软组织损伤和骨骼损伤成分，回应了近期对MESS的批评。我们用一种名为NISSSA的评分对MESS进行了修改，并将其回顾性应用于我们的病例。经过仔细的统计学比较，我们发现MESS和NISSSA在预测截肢方面都具有很高的准确性（p < 0.005）。结果发现NISSSA更敏感（81.8%对63.6%）且更具特异性（92.3对69.2%）。
