CAJ | 학술논문

目的：本研究应用原有评定指标综合分析，初步探讨创伤性截肢手术适应证以及手术方法的实施。方法本研究对自2005年8月~2013年12月来本院81例肢体严重创伤骨折患者的病史、年龄、体检、治疗时间及方法进行综合性分析。患者入院后急诊行全面体检以及X线片检查。81例伤者中，累及右侧肢体52例，左侧肢体29例，单纯损伤23例，复合损伤58例。开放伤按Gustilo等的分类标准，在本组中Ⅲa型骨折2例，Ⅲb型骨折18例，Ⅲc型骨折61例，合并休克10例，均有不同程度的足背动脉及胫后动脉搏动减弱或消失。结果根据Gregory的MESI评分法观点，评分>20是截肢的相关指征。本组患者评分>20者患肢52肢，截肢46例，截肢率为88.5%；评分<20者患肢29肢，截肢3肢，截肢率为10.3%，两者一比较差异有统计学意义（P<0.01）。49例截肢MESS值7~13分，平均9.095分，留肢组MESS值2~7分，平均3.892分，截肢组与留肢组经统计学处理，有显著差异，P<0.01。61肢ⅢC型开放性骨折患肢有47肢截肢，截肢率为77.0%。结论截肢虽是一种破坏性手术，但是当肢体损伤必须截肢时，严格创伤截肢的标准，认真周密地设计和组织处理，掌握截肢的手术原则和指征，有助于患者身心康复。目前的各类分型方法及评分标准可做为参考，但却也无法做为截肢的绝对标准，截肢的判断需要多方面综合考虑分型和评分，更为严谨的截肢适应症标准有待进一步研究。
목적：본연구응용원유평정지표종합분석，초보탐토창상성절지수술괄응증이급수술방법적실시。방법본연구대자2005년8월~2013년12월래본원81례지체엄중창상골절환자적병사、년령、체검、치료시간급방법진행종합성분석。환자입원후급진행전면체검이급X선편검사。81례상자중，루급우측지체52례，좌측지체29례，단순손상23례，복합손상58례。개방상안Gustilo등적분류표준，재본조중Ⅲa형골절2례，Ⅲb형골절18례，Ⅲc형골절61례，합병휴극10례，균유불동정도적족배동맥급경후동맥박동감약혹소실。결과근거Gregory적MESI평분법관점，평분>20시절지적상관지정。본조환자평분>20자환지52지，절지46례，절지솔위88.5%；평분<20자환지29지，절지3지，절지솔위10.3%，량자일비교차이유통계학의의（P<0.01）。49례절지MESS치7~13분，평균9.095분，류지조MESS치2~7분，평균3.892분，절지조여류지조경통계학처리，유현저차이，P<0.01。61지ⅢC형개방성골절환지유47지절지，절지솔위77.0%。결론절지수시일충파배성수술，단시당지체손상필수절지시，엄격창상절지적표준，인진주밀지설계화조직처리，장악절지적수술원칙화지정，유조우환자신심강복。목전적각류분형방법급평분표준가주위삼고，단각야무법주위절지적절대표준，절지적판단수요다방면종합고필분형화평분，경위엄근적절지괄응증표준유대진일보연구。
Objective To set a clear instruction on limb valuation method to determine whether an amputation is in need. Methods A comprehensive analysis was performed on the clinical data of 81 cases collected of severe traumatic patients with open fracture in between August 2005 and December 2013. The analysis included their respective clinical history, age, physical examination, treatment time and methods. Of the 81 cases, there were 52 cases of right limb injuries and 29 cases of left limb injuries, reflecting 23 cases of single injury, and 58 cases of multiple injuries. The standard Gustilo classification was adopted in categorizing the open wound in this study-2 cases of fracture in the group ofⅢa type, 18 cases inⅢtype B fractures, 61 cases of typeⅢc fracture, 10 cases with shock. They all carried with dorsalis pedis artery and the posterior tibial artery pulses to weakness or disappearance in different degree. Results In compliance with Gregory MESI score system which indicated an amputation if the score>20. In the group of 52 cases of which the patients’score>20, there were 46 cases of amputation (88.5%);In the group of 29 cases of which the patients’s score<20, there were 3 cases of amputation (10.3%), carrying out a significant difference (P<0.01). In the 49 cases of amputation, their MESS value was 7-13, with an average of 9.095 points, and the non-amputation group reflected MESS 2~7, with an average of 3.892 points;there is statistically significant difference in between the limb amputation group and the non-amputation group with P value<0.01. 47 limb amputation took place in a total of 61 cases of leg typeⅢC open fracture of limb, with an amputation rate of 77%. Conclusion Even though amputation is considered as a destructive operation, it has to be done when necessary with scientific standard. Not only such an operation helps save the patients’life but restore their physical and mental rehabilitation. Referring to all kinds of standards for amputation, all the factors have to be given full consideration before the operation.