下肢严重损伤的治疗分析

目的探讨下肢严重损伤患者的肢体保存与否的量化评定标准。方法本院自2001年2月至2009年10月收治567例下肢开放伤患者，除去创伤性离断，符合肢体损伤综合征患者97例。经MESI评分，〈7分保肢组22例，≥7分考虑I期截肢16例，7～10分者59例。结果保肢者22例，感染4例，感染率18．18％，伤口Ⅱ期清创符合愈合。I期截肢16例，感染2例，感染率12．5％。MESI评分7～10分者59例，作者对其中51例足底皮肤尚存或胫神经连续患者，I期经彻底清创，血管重建，封闭式负压引流（VSD），8—12d后无感染者，进行骨骼、肌腱，皮肤软组织重建。感染12例，感染率23．52％，并发。肾功能衰竭2例，呼吸衰竭4例，无死亡病例，再次截肢4例。结论用MESI的临界值20分来预测肢体损伤综合征患者是否截肢，有较高的准确率。为术前决策肢体损伤综合征患者是否截肢提供了一种简便、准确率高的量化评定标准，值得参照应用。

Objective To explore the quantization standard for the evaluation of body preservation during treatment of serious damages in lower extremity. Methods From February 2001 - October 2009, 567 patients with traumatic open wounds of lower extremities were treated, 97 patients of them were diagnosed as serious damages in lower extremity , they were divided according to the MESI score and received different treatment accordingly： 〈 7 limb -salvage group of 22 patients, acuity seven points, 16 eases 7 - 10 points considered issue amputation, 59 patients. Results 22 cases had limb - salvage, infection in 4 cases, infection rate 18.18% , I stage amputation in 16 cases with infection in 2 （ 12. 5% ）. For 59 cases with the MESI score 7 - 10, in 51 cases with remained thenar skin or tibial nerves continuous patient, thorough debridement, with vascular remodeling were applied , then the wounds were enclosed with the negative pressure drainage （ the data VSD ） , for those with no infection after 8 - 12 days, bone, tendons, skin soft- tissue reconstruction were taken. Infection happened in 12 cases, with the infection reate of 23.52%, 2 cases were complicated with renal failure and respiratory failure in 4 cases, no deaths, 4 cases had amputation again. Conclusion The critical MESI with 20 points to predict limb amputation is accurate for determining the need of amputation, and also easy to perform.