SEVERE OPEN FRACTURES OF THE LOWER-EXTREMITY - A RETROSPECTIVE EVALUATION OF THE MANGLED EXTREMITY SEVERITY SCORE (MESS)

被引：181

作者：

MCNAMARA, MG ^{[1
]}

HECKMAN, JD ^{[1
]}

CORLEY, FG ^{[1
]}

机构：

[1] UNIV TEXAS,HLTH SCI CTR,DEPT ORTHOPAED,7703 FLOYD CURL DR,SAN ANTONIO,TX 78284

来源：

JOURNAL OF ORTHOPAEDIC TRAUMA | 1994年 / 8卷 / 02期

关键词：

OPEN FRACTURE; MANGLED EXTREMITY; MESS;

D O I：

10.1097/00005131-199404000-00001

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Recent reports using the Mangled Extremity Severity Score (MESS) suggest that a score of greater-than-or-equal-to 7 is 100% accurate in predicting the need for amputation of severely injured lower extremities. To further evaluate the value of the MESS in predicting amputation, specifically with respect to type IIIB and type IIIC (Gustilo and Anderson) open fractures of the tibia, we retrospectively evaluated 24 patients with these injuries. A significant difference (p = 0.001) between MESS values of 13 salvaged (6.36 +/- 0.35 SEM) and 11 amputated limbs (6.36 +/- 0.54 SEM) was found. A MESS value of greater-than-or-equal-to 4 was most sensitive (100%); a MESS value of greater-than-or-equal-to 7 was most specific, and a MESS value of greater-than-or-equal-to 7 was found to have a positive predictive value of 100%. Subsequently, we addressed recent criticisms of the MESS by including nerve injury in the scoring system and by separating soft-tissue and skeletal injury components of the MESS. We modified the MESS with a score called the NISSSA and applied it retrospectively to our cases. After careful statistical comparison we found both the MESS and NISSSA to be highly accurate (p < 0.005) in predicting amputation. The NISSSA was found to be more sensitive (81.8% versus 63.6%) and more specific (92.3 versus 69.2%).

引用

页码：81 / 87

页数：7

共 19 条

[1]

Bondurant F.J., Cotier H.B., Buckle R., Miller-Crotchett P., Browner B.D., The medical and economic impact of severely injured lower extremities, J Trauma, 28, pp. 1270-1273, (1988)

[2]

Caudle R.J., Stern P.J., Severe open fractures of the tibia, J Bone Joint Surg [Am], 69, pp. 801-807, (1987)

[3]

Edwards C.C., Simmons S.C., Browner B.D., Weigel M.C., Severe open tibial fractures: Results treating 202 injuries with external fixation, Clin Orthop, 230, pp. 98-115, (1988)

[4]

Gregory R.T., Gould R.J., Peclet M., Et al., The mangled extremity syndrome (MES): A severity grading system for multisystem injury of the extremity, J Trauma, 25, pp. 1147-1150, (1985)

[5]

Gustilo R.B., Erson J.T., Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones, J Bone Joint Surg [Am], 58, pp. 453-458, (1976)

[6]

Gustilo R.B., Mendoza R.M., Williams D.N., Problems in the management of type III (Severe) open fractures: A new classification of type III open fractures, J Trauma, 24, pp. 742-746, (1984)

[7]

Hansen S.T., The type IIIC tibial fracture. Salvage or amputation [Editorial], J Bone Joint Surg [Am], 69, pp. 799-800, (1987)

[8]

Hansen S.T., Overview of the severely traumatized lower limb: Reconstruction versus amputation, Clin Orthop, 243, pp. 17-19, (1989)

[9]

Helfet C.K., Howey T., Sanders R., Johansen K., Limb salvage versus amputation: Preliminary results of the mangled extremity severity score, Clin Orthop, 256, (1990)

[10]

Howe H.R., Poole C.V., Hansen K.J., Clark T., Plonk G.W., Koman L.A., Pennell T.C., Salvage of lower extremities following combined orthopedic and vascular trauma: A predictive salvage index, Am Surg, 53, pp. 205-208, (1987)

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