1990年，lJohansen等又提出毁损肢体严重程度评分(mangled1extremity1severity1score，lMESS)(见下表)，l总评分≥7分者应考虑截肢。他们认为，lMESS不仅可对肢体能否存活做出判断，l而且能预测肢体存活后功能。

引自：i

Johansen1K，lDaines1M，lHowey1T1et1al.19901Objective1criteria1accurately1predict1amputation1following1lower1extremity1trauma.J1Trauma，l30：i568～572

Helfet1DL，lHowey1T，lSanders1R1et1al.1990.Limb1sal-vage1versus1amputation：ipreliminary1results1of1the1mangled1extremity1severity1score.Clin1Orthop，l256：i80～86