Combat Versus Civilian Open Tibia Fractures: The Effect of Blast Mechanism on Limb Salvage
Combat Versus Civilian Open Tibia Fractures: The Effect of Blast Mechanism on Limb Salvage
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DOI：
10.1097/ta.0b013e3182095b52
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发表时间：
2011-05-01
影响因子：
--
通讯作者：
Coimbra, Raul
中科院分区：
文献类型：
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作者：
Doucet, Jay J.;Galarneau, Michael R.;Coimbra, Raul
背景资料：本研究比较了美国海军和美国海军陆战队在当前冲突中的开放性胫骨骨折伤员与来自民用I级创伤中心的开放性胫骨骨折伤员，以分析爆炸机制对保肢率的影响。从1985年到2006年，来自加州圣地亚哥大学创伤登记处的28,646份记录的数据与2，2004年3月至2007年8月期间，美国海军和美国海军陆战队战斗创伤登记处远征医疗遭遇数据库中的282条记录。损伤按Gustilo-Anderson（G-A）开放性骨折分类进行分类。独立变量包括年龄、性别、损伤机制（包括爆炸机制）、休克、失血、院前时间、手术、损伤严重程度评分、住院时间和损伤严重程度评分（MESS）。因变量包括早期或晚期截肢和mortals.Results：平民组有850开放性胫骨骨折45截肢，军事组有21截肢患者（3双边）在115开放性胫骨骨折。军事组患者受伤更严重，更容易发生低血压，G-A IIIB和IIIC骨折的截肢率高于平民组患者。爆炸机制见于大多数军事组患者，在平民组中罕见。MESS评分的敏感性较差（0.46，95%置信区间：0.29-0.64）在预测截肢的平民组的需要;在军事组的敏感性更好（0.67，95%可信区间：0.43-0.85），但MESS评分>= 7时，大多数病例仍有可能成功保肢。尽管目前的治疗，保肢G-A IIIB级和IIIC级是明显较差的开放性胫骨骨折的爆炸伤的结果相比，典型的民用机制。MESS评分不能充分预测战斗中或平民开放性胫骨骨折保肢的可能性。
Background: This study compares open tibia fractures in US Navy and US Marine Corps casualties from the current conflicts with those from a civilian Level I trauma center to analyze the effect of blast mechanism on limb-salvage rates.Methods: Data from the 28,646 records in the University of California San Diego Trauma Registry from 1985 to 2006 was compared with 2,282 records from the US Navy and US Marine Corps Combat Trauma Registry Expeditionary Medical Encounter Database for the period of March 2004 to August 2007. Injuries were categorized by Gustilo-Anderson (G-A) open fracture classification. Independent variables included age, gender, mechanism of injury including blast mechanisms, shock, blood loss, prehospital time, procedures, Injury Severity Score, length of stay, and Mangled Extremity Severity Score (MESS). Dependent variables included early or late amputation and mortality.Results: The civilian group had 850 open tibia fractures with 45 amputations; the military group had 21 amputation patients (3 bilateral) in 115 open tibia fractures. Military group patients were more severely injured, more likely have hypotension, and had a higher amputation rate for G-A IIIB and IIIC fractures then civilian group patients. Blast mechanism was seen in the majority of military group patients and was rare in the civilian group. MESS scores had poor sensitivity (0.46, 95% confidence interval: 0.29-0.64) in predicting the need for amputation in the civilian group; in the military group sensitivity was better (0.67, 95% confidence interval: 0.43-0.85), but successful limb salvage was still possible in most cases with an MESS score of >= 7 when attempted.Conclusion: Despite current therapy, limb salvage for G-A IIIB and IIIC grades are significantly worse for open tibia fractures as a result of blast injury when compared with typical civilian mechanisms. MESS scores do not adequately predict likelihood of limb salvage in combat or civilian open tibia fractures.