Patients with severe leg injuries fare equally well - or poorly - whether they have reconstructive surgery or lose their damaged limbs to amputation, says a study published today.

The sobering truth, said doctors in Baltimore and elsewhere, is that 40 percent of patients remain severely disabled two years after their injuries, and half do not return to work, no matter which route they take.

"If you have reconstruction, you're going to have more surgery, more hospitalizations and are at risk for complications of those surgeries," said Dr. Alan L. Jones, chief of orthopedic surgery at the University of Maryland Shock Trauma Center. "But your chance of being able to work and your level of function is going to be about the same."

New techniques have enabled surgeons to rebuild the crushed and mangled legs of accident victims that were once considered unsalvageable, leading to fewer amputations in recent years. These techniques - which might involve connecting blood vessels or grafting skin, bone or tendons - have made reconstruction the treatment of choice in major trauma centers.

But at the same time, surgeons have questioned whether they are doing patients more harm than good by subjecting them to numerous operations - and often, a longer and more painful recovery.

Such concerns led to a study at eight trauma centers, including Maryland Shock Trauma, in which 384 patients who had reconstructive surgery were compared to 161 who had amputations.

The federally funded study, published in today's New England Journal of Medicine, was coordinated by the Johns Hopkins Bloomberg School of Public Health. Though the patients have been followed for six years, the article contains data from only the first two years of their recovery.

About 30 percent of the patients were involved in car accidents, and about 22 percent were in motorcycle crashes. The rest were struck by vehicles, or were involved in industrial or other accidents.

Given the choice, most patients opt for surgery to save their leg. But researchers said yesterday that all patients should be given better physical therapy, psychological counseling and vocational training to prepare them for the difficult road ahead.

"Regardless of how they are treated, every single person's life is completely and forever changed," Jones said. "No experienced trauma surgeon can say you're going to be normal, that you're not going to have impairment."

Ellen J. MacKenzie, director of the Hopkins Center for Injury Research, said the study should reassure doctors that they are not necessarily sacrificing a patient's health by offering reconstructive surgery. At the same time, they may be satisfying the patient's desire to remain physically intact at all costs.

But nobody, she said, should underestimate the struggles that patients might face no matter what choice they make. The lasting disabilities include pain and difficulty bearing weight and walking. The psychological stresses can be just as great.

Not surprisingly, patients with financial resources and strong families are more likely to overcome their injuries. But MacKenzie said many balk at asking friends and relatives for help.