MESS评分在肢体严重软组织损伤治疗中的应用评估

目的:探讨MESS评分在治疗肢体严重软组织损伤中的应用价值。方法:回顾性分析我科2010年8月至2014年5月收治的50例肢体严重软组织损伤患者的临床资料,其中男34例,女16例,年龄23~53岁,平均38岁。所有患者入院时均采用MESS评分表进行评分,根据病情给予清创、保肢或截肢以及创面修复等系列治疗,并随访3个月~3年。按照治疗结果将患者分为保肢组、Ⅰ期截肢组和Ⅱ期截肢组,分析和比较三组的MESS分值、住院天数、手术次数、并发症的发生率及患者满意率。结果:保肢组32例,MESS评分6-11分,平均8.63±1.26分。截肢组18例,MESS评分11-14分,其中Ⅰ期截肢组10例,平均12.60±0.97分;Ⅱ期截肢组8例,平均12.88±0.83分。保肢组患者的MESS分值显著低于Ⅰ期截肢组(P0.05)和Ⅱ期截肢组(P0.05)。此外,保肢组患者满意率显著高于Ⅰ期截肢组(P0.05)和Ⅱ期截肢组(P0.05)。而Ⅰ期截肢组的住院时间、手术次数和并发症发生率均短于或少于Ⅱ期截肢组,患者满意率高于Ⅱ期截肢组(P0.05)。结论:对于MESS评分11分的患者行保肢治疗可收到满意的效果,而对MESS评分11分的患者,采取Ⅰ期截肢的治疗效果优于Ⅱ期截肢。

A Retrospective Assessment of the Application Value of MESS in the Treatment of Severe Limb Soft Tissue Injuries

Objective:To investigate the application value of MESS in the treatment of severe limb soft tissue injuries.Methods:The clinical data of 50 cases of patients with severe extremity soft tissue injuries who were treated in our division from August 2010 to May 2014 were retrospectively analyzed, including 34 males and 16 females, aged 23-53, with the average of 38. Each case was scored ac- cording to the protocol of MESS, and received debridement, limb salvage or amputation operation and repair operation according to his or her specific condition. The patients were followed up for 3 months to 3 years. All the cases were grouped according to their outcomes to limb-salvage group, first stage amputation group and secondary amputation group. The MESS score, hospital stay, operation times, incidence rate of complications and satisfaction rate were compared among the three groups.Results:32 patients in limb-salvage group had MESS score of 6-11 (8.63 ± 1.26). 18 cases received amputation surgery had MESS score of 11-14, including 10 cases of first stage amputation group (MESS 12.60± 0.97) and 8 cases of secondary amputation group (12.88± 0.83). MESS score of limb-salvage group was significantly lower than that of the first stage amputation group (P<0.05) and the secondary amputation group (P<0.05). In addition, the satisfaction rate of limb-salvage group was higher than that of the first stage amputation group (P<0.05) and the secondary amputation group (P<0.05). The hospital stay, operation times and incidence rate of complications of first stage amputation group were all lower than those of the secondary amputation group. The patients'' satisfaction rate of first stage amputation group was higher than that of the secondary amputation group (P<0.05).Conclusion:Severe limb soft tissue injuries patients with the MESS score<11 points got satisfactory results with the limb salvage operations. While for patients with the MESS score> 11 points, first stage amputation could have better results than that of the secondary amputation.