创伤性截肢的适应证与手术原则探讨

截肢是肢体严重损伤时的一个重要治疗方法，在决定截肢与肢体挽救时受到多方面因素的影响，但在相当程度取决于原发损伤的严重性。目前还没有一个明确的截肢适应证标准，需要一个客观的对肢体估价的方法以明确是否行截肢术，损毁肢体严重程度评分MESS（mangled extremity security score）有较大的临床指导意义。截肢虽是一种破坏性手术，也是一种重建与修复手术，同样遵守矫形外科手术的基本原则。当肢体损伤必须截肢时，要认真周密地设计、仔细地组织处理，在满足治疗的前提下，合理保存肢体长度，最大限度地保留患肢功能，获得较为理想的残肢，以使装配的假肢发挥最佳的功能。严格创伤截肢的标准，掌握截肢的手术原则，了解假肢的安装要求，与患者及家属的积极沟通，进行必要的会诊，是截肢手术医生必须要做到的。

The Discussion of Adaptation and Surgery Principle for Traumatic Amputation

Amputation is an important choice for the serious limb injury, it is influenced by many factors in deciding to preserve the limb or amputation, but mainly based on the degree of primary injury. There was not any accurate criteria for amputation, the scores MESS （mangled extremity security score）based on the severity of the injured limb is important in the choice. Though it is a destruction operation, the amputation is a reconstruction and rehabilitation process at the same time, it is abided to the orthopaedics＇ basic principles. We should design carefully, treat the tissue precisely before operation, we should do our best to save the length and function of the limb, so can the patient obtained a perfect stump for the good function of artificial limb. The operator should live up to the serious standard for amputation, grasp the principle of operation, understand the requirement of fitting artificial limb, keep communication with patients and their household, perform consultation conference if it is necessary.