小儿下肢严重损伤截肢与保留的临床计量分析

Quantitative clinical analysis of lower limb amputation or salvage following severe injuries in children

目的 建立小儿下肢损伤严重程度判定评分表和判别方程 ,制订截肢分值区间、保肢分值区间和留观灰色区间。方法 采用回顾性方法分析 89例下肢严重损伤患儿治疗情况 ,应用评分方法 ,根据受伤时患儿休克程度、伤口污染程度、皮肤、肌肉和肌腱、骨关节、血管及神经组织损伤程度等7项指标进行多因素两类判别分析 ,并对伤肢进行计量。结果 截肢组平均分为 2 2 .6 6± 2 .0 7分 ,保肢组平均分为 15 .35± 3.31分。判别方程为Z =1.4 8X1+1.4 3X2 +1.6 3X3 +5 .84X4+5 .0 9X5+4.34X6+2 .19X7,分析各因素对方程的影响率 ,以肌肉严重损伤对伤肢威胁最大 ,其次为骨关节损伤和血管损伤。截肢组Z值范围为 79.2 0± 13.77;保肢组Z值范围为 5 4 .5 5± 15 .2 1,Z截肢组 =79.2 0 ;Z保肢组 =5 4 .5 5 ,Z中间值 =6 6 .2 2。结论 小儿下肢损伤严重程度判定评分表和判别方程对小儿下肢损伤伤情判断有重要作用 ,初步制订急诊截肢伤肢分值必须大于 79.2 0分 ,79.2 0～ 6 6 .2

Objective To establish a score scale and discriminatory equation in judging injury severity of low limbs in children. Methods The clinical data of 89 children with severe low limb injury were analyzed retrospectively. Multi factor quantitative assessment was made according to the severity their shock, wound contamination and the injuries to the skin, muscle/tendon, bone/joint, blood vessel and nerve tissue. Results The average score was 22.66 ± 2.07 for the amputation and 15.35 ± 3.31 for the salvage group, respectively. The discriminatory equation was Z= 1.48 X 1+ 1.43 X 2+ 1.63 X 3+ 5.84 X 4+ 5.09 X 5+ 4.34 X 6+ 2.19 X 7. Z value was 79.20 ± 13.77 for the amputation and 54.55 ± 15.21 for the salvage group. The mid value was 66.22 . Among these factors, the severe muscle injury was the most devastating factor for the limb salvage and followed by the bone and joint injury and blood vessel damage. Conclusions The score scale and discriminatory equation are of great value in determining injury severity of lower limbs in children. The recommended score for an emergent amputation is above 79.20 in Z value. The patient with a Z value between 79.20 and 66.22 should be carefully observed.