对地震灾害中下肢严重损伤进行保肢治疗的若干思考

Thoughts after limb salvage in treatment of serious injury to lower limbs in Wenchuan earthquake

作出保肢还是截肢的决定仍然是一个高度个体化的方案，需权衡肢体和生命的关系，综合考虑肢体损伤程度、全身情况、伤员心理、年龄、潜在的疾病和职业要求以及医疗技术、社会经济等多方面的因素。在抗震救灾的特殊环境下，伤员转运至后方将失去宝贵的治疗“时间窗”，因而进行保肢尝试的危险性极大，不得不早期施行截肢术以保全生命。而在具备医疗技术与设备的前方医疗机构，应尽量保全伤员肢体。

In treatment of serious injury to lower limbs caused by the Wenchuan earthquake, whether the strategy of limb salvage or amputation should be decided is highly dependent on individual cases. Limb salvage and life rescue must be weighed seriously, depending not only on injury severity, systematic condition, psychology, age, underlying diseases of the patients but also on their career needs, medical techniques, social and economic factors. In a special situation of combating earthquake and disaster relief, the golden period of time for the emergency treatment might be missed in transportation of the casualties. Because of the deficiency of vital medical materials and techniques in the frontier, it is usually highly risky to save the limbs, and amputations are obliged to be performed for the sake of lives. On the contrary, when the needed materials and techniques are available we should do our best to save limbs of the patients as well as their lives.