肢体毁损伤要截肢还是保肢  

Amputation or salvage for mangled extremity

作　　者：李绍光[1] 何红英 张建政[1] LI Shao-guang;HE Hong-ying;ZHANG Jian-zheng(Microsurgery Department of Senior Department of Orthopedics,The Fourth Medical Center of PLA General Hospital,Beijing,100048,China)

机构地区：[1]解放军总医院第四医学中心骨科医学部显微外科,北京100048

出　　处：《中国骨与关节杂志》2021年第12期881-884,共4页Chinese Journal of Bone and Joint

基　　金：军队后勤科研重点项目(BLJ18J006)。

摘　　要：肢体毁损伤多为车祸、机器碾压等高能损伤所致,20世纪90年代以前因技术和条件限制,截肢率较高。近年来,随着显微外科为基础的创面修复与肢体功能重建技术的发展,很多以往需要截肢的肢体避免了截肢[1-2]。仅从治疗技术来说,目前对于大部分患者可以做到保证肢体的成活,但是从治疗目的来说选择保肢绝不仅仅是要保留肢体,而要着眼于重建一个无痛、有功能且具有一定保护性感觉的肢体。因此,基于不同医师立足点、经验及教训的不同,对于严重肢体毁损伤是截肢还是保肢这一问题,可谓仁者见仁,智者见智,答案也完全不一样,成为困扰创伤骨科医师的一个问题。Focusing on the concerns of surgeons,this article reviews the latest research progress on the amputation or salvage for mangled extremity.The concept of mangled extremity injury needs to be further standardized and clarified.There are no significant differences in functional prognosis between extremity salvage and amputation,but the latter is more in line with the expectations of patients.The satisfaction and psychological quality of extremitysalvaged patients are higher than those of amputation.With the progress of technology,extremity salvage treatment shows a better prospect.The economic cost and psychological diseases after injury of patients with extremity salvage or amputation are basically the same in the long run.The existing injury evaluating systems have certain reference value to judge the prognosis of extremity salvage treatment,but exact guiding significance for the choice of treatment scheme is still in need.In addition to the injury,social and economic factors of the patients also have an important impact on the treatment results,which should be comprehensively considered when selecting the treatment plan.Meanwhile,the overall treatment ability of hospitals and doctors must be considered.It is very important to send patients with mangled extremity to an experienced and capable team in time.

关 键 词：创伤和损伤 截肢术 保肢 

分 类 号：R683.4[医药卫生—骨科学]