MESS评分在GustiloⅢb、Ⅲc型下肢损伤截肢与保肢治疗中的临床意义

Clinical significance of MESS scoring system for the treatment option of amputation or salvage in Gustilo type Ⅲb,Ⅲc lower extremity injuries

[目的]探讨和评价损伤肢体严重程度评分(mangled extremity severity score,MESS)系统在GustiloⅢb、Ⅲc型严重下肢损伤截肢与保肢治疗中的临床意义。[方法]2007年10月～2011年2月,共收治严重下肢损伤患者65例68肢,男51肢,女17肢;年龄18～67岁,平均42.5岁。按照Gustilo和Anderson开放骨折的分类方法与MESS评分系统进行分类评分。对于MESS<7分的GustiloⅢb、Ⅲc型下肢损伤给予Ⅰ期保肢手术;MESS≥7分的GustiloⅢb、Ⅲc型下肢损伤以截肢治疗为主,同时根据软组织和血管损伤情况、患者体质情况及保肢意愿,试行保肢治疗。[结果]本组MESS<7分的病例中,GustiloⅢb型患肢均保肢成功,GustiloⅢc型保肢成功率为60%。本组MESS≥7分的病例中,GustiloⅢb型Ⅰ期、Ⅱ期总截肢率为20%,GustiloⅢc型Ⅰ期、Ⅱ期总截肢率为82.76%,两者比较差异有统计学意义(x2=4.46,P<0.05);GustiloⅢb型保肢成功率为92.31%,GustiloⅢc型保肢成功率为50%,两者比较差异有统计学意义(x2=5.26,P<0.05)。[结论]MESS评分系统对于GustiloⅢc型严重下肢损伤截肢或保肢治疗的决策较GustiloⅢb型损伤具有更强的临床指导意义,但不能作为判断截肢或保肢的唯一标准,还应结合患肢的热缺血时间、神经损伤情况、是否伴有严重的并发伤及患者年龄进行综合的分析评价。

[Objective]To discuss and evaluate the clinical significance of mangled extremity severity score（MESS） system for the treatment of amputation or salvage in Gustilo type Ⅲb,Ⅲc severe lower extremity injuries.[Method]From October 2007 to February 2011,65 patients（68 limbs） were admitted.Of these,51 limbs were males and 17 limbs were females,the mean age was 42.5 years.All the limbs were classified by the Gustilo and Anderson classification system,graded by MESS scoring system.The Gustilo type Ⅲb and Ⅲc limbs whose MESS scores were less than 7 point were treated with salvage operation.Among the Gustilo type Ⅲb and Ⅲc limbs whose MESS scores were equal or greater than 7 point,most of them were treated with one-stage amputation,and others were treated with salvage operation if the conditions of the patients were well.[Result]Among the limbs whose MESS scores were less than 7 point,all of Gustilo type Ⅲb limbs survived,and the survived ratio of Gustilo type Ⅲc limbs was 60%.Among the limbs whose MESS scores were equal or greater than 7 point,the total amputation ratio of Gustilo type Ⅲb limbs was 20%,and Gustilo type Ⅲc limbs was 82.76%.The difference was statistically significant（x2=4.46,P〈0.05）.The survived ratio of Gustilo type Ⅲb limbs was 92.31%,and Gustilo type Ⅲc limbs was 50%.The difference was statistically significant（x2=5.26,P〈0.05）.[Conclusion]The MESS scoring system has the greater clinical guiding significance for the Gustilo type Ⅲc injuries than the Gustilo type Ⅲb injuries,when we make operative plan for the severe lower extremity injuries.But it should not be unique index for the amputation or salvage operation,we should also notice the ischemia time,nerve injury,complication of important organ injury and the age.