| Objective: As a serious complications after trauma,amputation is a great challenge to clinicians,as well as patients and their relatives.Therefore,clinicians should get a comprehensive and objective understanding of traumatic amputation.Moreover,secondary vessel rupture of wound is one of important causes of amputation.So It should arouse the attention of clinicians,and such complications should be actively and effectively treated.To provide guidance for clinical work,we made detailed retrospective study to this kind of cases.Methods: Cases of traumatic amputation from January 2009 to December 2013 and cases of secondary vessel rupture of wound from January 2006 to July 2013 have been investigated detailed.Using medical records inquiry system to retrospectively investigate the cases with traumatic amputation during January 2009 to December 2013 in our medical center,but exclude amputation due to disease factors,such as cancer,peripheral vascular disease and congenital malformations etc.In addition,cases with digital and toe amputation should not be included.In the end,651 cases with 668 amputations met the inclusion criteria.We investigated these cases by age,sex,mechanism of injury,type of injury,the degree of injury,treatment time,the number of operations,hospitalization and amputation timing,location,and reasons,in order to analyze its epidemiological characteristics.Results: There were 71,569 cases of traumatic patients were treated in our hospital during January 2009 and December 2013,including 651 amputees with 668 amputation.The rate of amputation of traumatic patients was about 0.91%.During the group of 651 cases of amputees,525 cases(80.65%)were male,and other 126 cases(19.35%)were female,male to female ratio was 4.17:1.Ages ranged from 10 months to 77 years,with an average age of 39.02±15.12.All the patients were divided by 10 years of age to 8 groups.As shown in Table 2,it is easy to find that amputees in the group of 41-50 are the most.There are 234 upper extremities(35.63%)and 430 lower extremities(64.37%)in this group of 651 amputees with 668 amputation,in which the most common amputated positions of limbs are forearms and shanks.Half of amputees are brought about by traffic accidents(49.31%),and there are still some other causes of amputation,such as machine injury,crushing,blast injury,falling,etc.Obviously,the main causes of injury are very different in amputations of upper and lower extremities.The main cause in upper extremities are machine injury,but traffic accident in lower extremities.In this study,amputees of open injury are 614 cases,accounted for 94.32% of all cases.Gustilo typing and MESS were used to assess the severity of 528 cases of open injury,in which there are 86 cases excluded because these cases had been transferred from other hospitals or come to our hospital very late,which resulted in hard to access the severity of injury.During the Gustilo type of these cases,there are 1 case of 2A type,5 cases of 3A type,28 cases of 3B type and 494 cases of 3C type(95.45%).The MESS of amputees are shown in the following table,most of which are higher than 7,account for 95.45% of all cases,to which amputation is considered obliged.Although most cases of this group are patients with open injury,there are still 37 cases of closed injury,accounted for only 5.68% of all cases.The reason that cause amputation of these closed injury patients are mainly great vessels injury.15 cases are confirmed by angiography,7 of which are arteriorrhexis and 8 of which are arterial occlusion,8 cases are confirmed during the surgery and 3 cases of angiorrhexis after surgery.Furthermore,most of amputees with closed injury had been treated in other hospitals(30 cases),but only 6 had been diagnosed with vessels injury and treated,but failed.4 cases of amputees were sent to hospital over 12 hours after injury.The opportunity of amputation was divided into 3 kinds,? stage amputation means that the injured extremity was amputated instantly,? stage means amputation was operated after the attempt of salvage,? stage means that the patients left hospital with saved extremities,but due to some reasons like non-function,osteomyelitis,neuropathic ulceration,they had to undertake amputation to fit for prosthesis.391 lambs(58.53%)undertook ? stage amputation,258 lambs(38.62%)undertook ? stage amputation,and 20 limbs(2.58%)undertook ? stage amputation.We conduct the statistic analysis with the length of stay(LOS)and the number of operation in ? and ? stage amputees.There were 140 cases(20.96%)of open amputation and 528 cases(79.04%)of closed amputation in these 651 amputees with 668 amputation.For the control of confounding factors,we chose 632 cases of single amputation to compare LOS and the number of operation in different kinds of amputation statistically with the use of SPSS 19.0.Open amputees had more in either LOS or the number of operation than closed amputees.Conclusion: By studying amputees caused by trauma in five years(2009~2013),it can be roughly understood the epidemiological characteristics of traumatic amputation and its influencing factors,to provide reference for clinical prevention and treatment.However,due to severe and complex injuries,it's difficult to fully analyze the factors causing amputation,and this paper is a retrospective study,which will inevitably lead to errors.As a result,further investigation should be studied.Hemostatic method for secondary wound bleeding in three steps.The first step: oppression hemostasis of the wound immediately after bleeding.The second step: using effective hemostasis according nature,parts and MESS score of the bleeding.The third step: operation completely stop the bleeding. |
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