Tornetta P, Olson S A
Kings County Hospital Center, SUNY Health Science Center at Brooklyn, USA.
Instr Course Lect. 1997;46:511-8.
The decision to attempt salvage or to amputate a severely injured leg in among the most difficult that the orthopaedist must face. Even surgeons with tremendous trauma experience cannot agree on standard course of action. In the face of such injuries, physician consultation regarding the treatment decision, including all of those members of the team that are needed for a successful salvage, is necessary. In the best circumstances, the trauma surgeon, vascular surgeon, orthopaedist, and a soft-tissue specialist are all involved. From a psychological perspective, the timing of an amputation is important. Although each patient's case is unique, immediate amputation is often viewed by the patient and family as a result of the injury. Conversely, a delayed amputation may be viewed as a failure of treatment. It is imperative that the surgeon have a detailed discussion with the patient and the family whenever possible before making the decisions. Scoring systems are of some help in estimating the chances of a successful salvage. However, the ultimate decision to amputate or attempt salvage is based on such patient factors as preinjury function and social situation, and of associated injuries, surgeon experience, available resources, projected physical abilities, and the patient's projected physical requirements. These decisions are difficult and tax the judgment and emotions of the patient, family, and physician.
决定对严重受伤的腿部进行挽救性治疗还是截肢，是骨科医生必须面对的最困难的抉择之一。即使是有着丰富创伤治疗经验的外科医生，对于标准的治疗方案也无法达成一致。面对此类损伤，就治疗决策进行多学科会诊是必要的，会诊团队应包括所有成功实施挽救性治疗所需的成员。在最佳情况下，创伤外科医生、血管外科医生、骨科医生以及软组织专科医生都应参与其中。从心理学角度来看，截肢的时机很重要。尽管每个患者的情况都独一无二，但患者及其家属通常会将立即截肢视为损伤造成的后果。相反，延迟截肢可能会被视为治疗失败。外科医生在做出决定前，应尽可能与患者及其家属进行详细讨论。评分系统在评估挽救性治疗成功的可能性方面有一定帮助。然而，最终决定截肢还是尝试挽救性治疗，要基于患者伤前功能、社会状况、合并损伤、外科医生经验、可用资源、预计身体能力以及患者预计身体需求等因素。这些决定很艰难，会考验患者、家属及医生的判断力和情感。
