肢体严重创伤为骨科常见急诊，截肢或保肢选择常困扰以肢体功能恢复为最高追求的临床医师。国内外学者不断探索截肢或保肢的量化标准，但每种评分系统都在临床决策选取中具有其局限性；随着创面修复技术及显微外科技术的发展，临床医师对此类疾病的治疗有了新的认识。现结合近年来临床报告，分析大面积软组织缺损、主干动脉损伤、骨筋膜室综合症晚期等不同肢体严重创伤保肢或截肢治疗关键点，以增进对此类疾病的进一步认识，选择更加合理的治疗方案。“,”Severe limb trauma is one of the mostcommon orthopaedic emergencies,andthe choice betweenamputation andlimb salvage always plagues the clinicians who regardbody function recovery as their highest pursuit.Medical experts at home and abroad have continuously explored standards of amputa-tion or limb salvage,but each kind of scoring system has its own limitation in clinical decision.With the development of wound repair technology and microsurgical technology,clinicians have new understandings of the treatment about these diseases.This paperintegrates related clinical reports in recent yearsand analy-zes the key points of amputation or limb salvage for severe limb trauma,such as large defects of soft tis-sues,main arterial injury,and terminal osteofascial compartment syndrome.It may improve theunderstand-ingsfor these diseases and help clinicians choose more reasonable treatment plans.