摘要
目的探讨玉米剥皮机致手外伤的临床分型与治疗体会。方法回顾性分析解放军第285医院手外科2013年9月—2015年11月收治的玉米剥皮机致手部复杂损伤79例患者的治疗效果,男性68例,女性11例;年龄16～58岁,平均28. 0岁;一期闭合创面28例、二期闭合创面51例;单纯皮肤撕裂脱套伤7例、伴有皮肤缺损9例,合并有指掌骨单纯骨折5例,合并指掌骨粉碎性骨折19例,合并神经血管损伤39例;损伤至手术时间2～8h,平均4. 7h。从损伤程度、创面闭合时机、手术治疗方法、感染发生和治疗等方面分析影响治疗效果的因素。结果 79例中出现继发性手指坏死行截指术13例,感染38例,其中二期闭合伤口发生感染率41. 2%,较一期60. 7%低;Ⅲ型和Ⅳ型损伤者发生感染率较Ⅰ型和Ⅱ型者高,实施皮瓣转移术后出现部分坏死8例,住院时间2周～4个月,平均34. 0d。术后随访56例,失访12例,随访时间2-10个月,平均6个月;在随访时伤口均愈合,肿胀消退,所有病例均存在肌腱粘连及关节僵硬,合并肌腱缺失5例,合并有复合性区域疼痛综合征(complex regional pain syndrome,CRPS)者9例。结论损伤分型对临床治疗有较好的指导意义,治疗上应多种方法结合,早期清创、延期闭合伤口有助于降低感染率,提高临床治疗效果。
Objective To investigate the clinical classification and treatment experience of hand injury caused by corn husker machine. Methods Totally 79 patients with complicated hand injuries caused by corn husker machine were treated in our department from Sep. 2013 to Nov. 2015. There were 68 males and 11 females,with an average age of 28（16-58） years. There were 28 cases of one-stage closed wounds,and 51 cases of secondary closed wounds; there were 7 cases of simple skin avulsion and degloving injury,9 cases of skin defect,5 cases complicated of simple metacarpal fracture,19 cases of comminuted metacarpal fracture and 39 cases of neurovascular injury. The time from injury to operation was 2-8h,with an average of 4.7h. The factors influencing the therapeutic effect were analyzed from the aspects of injury degree,wound closure time,surgical treatment,infection occurrence and treatment. Results Among the 79 cases,13 cases had secondary finger necrosis and 38 cases had infection. The infection rate of secondary closed wound was 41.2%,which was lower than one stage wound （60.7%）. The infection rates of type III and type IV injuries were higher than those of type I and type II. There were 8 cases of necrosis after skin flap transfer. The hospital stay was 2 weeks-4 months, and the average hospitalization was 34.0d.Totally 56 cases were followed up,12 cases were lost,and the follow-up time was from 2 to 10 months（average of 6 months）. In follow-up,the wounds healed up and swelling subsided in all patients. Tendon adhesion and joint stiffness were found in all cases,with tendon loss in 5 cases,and complex regional pain syndrome in 9 cases. Conclusion Damage classification has a good guiding significance for clinical treatment. Many methods should be combined in the treatment. Early debridement and delayed closure of wounds are helpful to reduce the infection rate and improve the clinical effect.
作者
章雪松
庞超见
郭建
杨洋
ZHANG Xue-song;PANG Chao-jian;GUO Jian;YANG Yang(Department of Hand Surgery,the 285th Hospital of PLA,Handan,Hebei 056001,China)
出处
《创伤外科杂志》
2018年第11期832-834,839,共4页
Journal of Traumatic Surgery
关键词
手部损伤
截指
感染
清创
hand injuries
intercepting fingers
infection
debridement
