Retrospective study of 70 cases of severe frostbite lesions: a proposed new classification scheme
Retrospective study of 70 cases of severe frostbite lesions: a proposed new classification scheme
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DOI：
10.1580/1080-6032(2001)012
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发表时间：
2001-12-01
影响因子：
1.4
通讯作者：
Marsigny, B
中科院分区：
文献类型：
--
作者：
Cauchy, E;Chetaille, E;Marsigny, B
客观。-以前的冻伤分类主要基于回顾性诊断，大多数情况下，不能用于预测病变的最终结果，特别是截肢的可能性及其水平。本研究的目的是主要根据病变的地形和早期骨扫描结果提出第0天的新分类，这在预测冻伤的最终结果方面更方便、更准确。方法。-对1985年至1999年因四肢严重冻伤在Chamonix医院（Mont-Blanc Massif）住院的70例患者的临床病史进行回顾性研究，使我们能够对第0天的初始病变进行分类，并将其与最终结局进行比较。发现病变程度与每个手指或脚趾的结果之间存在很强的相关性。当初始病变位于远端指骨时，截骨的概率约为1%，中节指骨为31%，近节指骨为67%，掌骨/跖骨为98%，腕骨/跗骨为100%。基于这些临床结果和骨扫描结果（先前已验证），提出了第0天冻伤严重程度的新分类。定义了四种严重程度：一级，导致恢复;二级，导致软组织截肢;三级，导致骨截肢;四级，导致大截肢伴全身效应。
Objective.-Previous frostbite classifications were mainly based on retrospective diagnosis and, most of the time, could not be used to predict the final outcome of the lesions and especially the probability of an amputation and its level. The aim of this study was to suggest a new classification at day 0 based mainly on the topography of the lesions and on early bone scan results, which are more convenient and accurate in predicting the final outcome of frostbites.Methods.-The retrospective study of the clinical histories of 70 patients hospitalized at Chamonix Hospital (Mont-Blanc Massif) from 1985 to 1999 for severe frostbite injuries of the extremities has allowed us to classify the aspects of the initial lesions on day 0 and to compare them with final outcomes.Results.-A strong correlation was found between the extent of the lesion and the outcome of each finger or toe. When the initial lesion was on the distal phalanx, the probability of bone amputation was around 1% for the digit, 31% for the middle phalanx, 67% for the proximal phalanx, 98% for the metacarpal/metatarsal, and 100% for the carpal/tarsal.Conclusions.-Based on these clinical results and on the results of bone scans (previously validated), a new classification of frostbite severity at day 0 is proposed. Four degrees of severity are defined: first degree, leading to recovery; second degree, leading to soft tissue amputation; third degree, leading to bone amputation, and fourth degree, leading to large amputation with systemic effects.