Seekamp A, Regel G, Ruffert S, Ziegler M, Tscherne H
Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Unfallchirurg. 1998 May;101(5):360-9. doi: 10.1007/s001130050281.
In IIIB and IIIC type open tibial fractures (according to Gustilo) the primary decision that has to be made regarding therapy is wether or not the limb can be salvaged. To standardize the criteria for amputation different salvage scores have been established in recent years. In this study the Hannover Fracture Scale (HFS), the Predictive Salvage Index (PSI), the Mangled Extremity Severity Score (MESS) and the NISSSA score were evaluated regarding their clinical relevance. When ROC Analysis was performed for all these scores in our patients the HFS revealed the highest sensitivity (0.91), but low specificity (0.71). The highest specificity was noted for the MESS (0.97), which in parallel showed the lowest sensitivity (0.59). In general it seems to be essential to make the right decision initially in order to avoid secondary amputation. All the scores mentioned here appear to be helpful in decision making. Salvaged limbs in IIIB and IIIC fractures presented a comparable good outcome, whereas salvaged IIIC injuries with a high score presented an outcome which was as bad as in secondary amputations. Secondary amputated patients required not only significant longer hospitalization but also resulted in poor outcome compared with the patients having received reconstruction or primary amputation.
在ⅢB型和ⅡIC型开放性胫骨骨折（根据 Gustilo 分类法）中，关于治疗必须做出的首要决定是肢体是否能够得以挽救。近年来，为了规范截肢标准，已经建立了不同的挽救评分系统。在本研究中，对汉诺威骨折量表（HFS）、预测挽救指数（PSI）、肢体损伤严重程度评分（MESS）和 NISSSA 评分的临床相关性进行了评估。当对我们患者的所有这些评分进行 ROC 分析时，HFS 显示出最高的敏感性（0.91），但特异性较低（0.71）。MESS 的特异性最高（0.97），同时其敏感性最低（0.59）。一般来说，为避免二次截肢，最初做出正确的决定似乎至关重要。这里提到的所有评分在决策中似乎都有帮助。ⅢB型和ⅡIC型骨折中得以挽救的肢体呈现出相当好的结果，而高评分的ⅡIC型损伤得以挽救后的结果与二次截肢的结果一样差。与接受重建或一期截肢的患者相比，二次截肢的患者不仅住院时间显著更长，而且预后也很差。
