MESI评分法预测四肢损伤性截肢（回顾性验证93例报告）

TheMESI:aGradingMethodfortheDeterminationofAmputationinTraumaticInjuryofthe

严重四肢损伤早期截肢与否，国内尚缺少量化的评定标准．肢体损伤综合征指数（ＭＥＳＩ）评分法是根据肢体的皮肤、骨骼、血管、神经和肢体以外的全身损伤严重度评分（ＩＳＳ）结合延迟时间、原有疾病、年龄、休克而制定的评分标准．本组９３例肢体损伤综合征（ＭＥＳ）住院患者的回顾性验证表明：５１例截肢者，４２例保肢者，两者ＭＥＳＩ均值差异有高度显著性（Ｐ值＜０．０１）．ＭＥＳＩ≥２０的４６例中，初期截肢４０例，延期截肢６例；ＭＥＳＩ＜２０的４７例中，４２例保肢成功，５例延期截肢．用ＭＥＳＩ的临界值２０分来预测截肢结果１００％准确；预测保肢则为８９．１５％．因此，作者认为：ＭＥＳＩ评分法为我们提供了一种预测ＭＥＳ患者早期是否应截肢的准确率高的量化标准．当ＭＥＳＩ≥２０时应予早期截肢；ＭＥＳＩ＜２０时可予保肢．

Thereareveryfewquantitativecriteriatodeterminewhetherearlyamputationinsevere-lyinjuriedextremitiesisnecessary.Mangledextremitysyndromeindex(MESI)isagradingmethodbasedontheinjuryseverityoftheskin,thebones,thebloodvessels,thenervesandthesystemiccondi-tionofthepatient.Injuriesnotafectingtheextremitieswereclassifiedaccordingtoinjuryseverityscore(ISS)andadditionaldatainvolvingthelagtime,pre-existingdisease,theageofthepatientandthepresenceofshock.Retrospectivestudyofmangledextremitysyndrome(MES)in93in-patientsshowedasignificantdiferencebetweenMESIvaluesfor51limbamputations(mean,21.73±4.80),andtheval-uesfor42non-amputatedcases(mean,11.49±4.22)(P<0.01).The46patientshavingtheirlimbsamputatedhadMESIscores≥20,40wereprimarilyamputatedand6haddelayedamputation.Ofalthe47patientswithscores<20,42patientshadtheirlimbssuccessfulysalvagedand5ultimatelyrequiredsecondaryamputation.Theaccuracyofpredictingtheindicationofamputationsbyusingthecriticalval-ue(20)was100%,andthatofthenon-amputationcaseswas89.15%.ThegradingmethodoftheMESIisahighlyaccuratequantitativecriteriatodetermineearlyamputationversussalvageofthelimbinvic-timssustainedMES.Theauthorsbelievethat,whenthepatientsMESIscorewas≥20,earlyamputa-tionshouldbecarriedout,andwhenthescorewas<20,limbsalvagecouldbeexpected.