地震所致肢体软组织挤压损伤的特点与治疗分析  

Clinical characteristics and treatment of soft tissue crush injury caused by an earthquake

作　　者：权毅[1] 潘显明[1] 邓少林[1] 陶笙[2] 卢世璧[2] 周劲松[1] 邓冰[1] 伍红桦[1] 黄刚[1] 马泽辉[1] 蒋凯[1] 屈波[1] 谢庆云[1] 康夏[1] 

机构地区：[1]成都军区总医院骨科,610083 [2]解放军总医院骨科

出　　处：《中华创伤骨科杂志》2009年第3期221-224,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨地震所致肢体挤压伤的软组织损伤特点和救治方法。方法分析我院收治的202例肢体地震挤压伤的伤情特点，讨论治疗过程中的困难和问题，提出相应的处理措施。结果本组肢体挤压毁损伤16例（7．9％），开放性损伤60例（29．7％），闭合性损伤126例（62．4％）。根据ISS评分，轻度损伤98例（34．7％），中度损伤54例（17．1％），重度损伤36例（44．9％），极重度损伤14例（3．3％），用SPSS10．0软件对挤压时间与ISS评分的相关性进行秩和检验，差异有统计学意义（P〈0．05）。行筋膜腔切开减压32例，坏死肌肉切除术15例31次。8肢进行了14次残端清创术。结论地震软组织挤压伤伤情严重，挤压伤程度与打压重量和挤压缺血时间有关。肌肉坏死特点是坏死范围广泛而界限不清；同一块肌肉的坏死肌肉束与正常肌肉束交织在一起，坏死面积表面小深层大，肌肉深层坏死较浅层严重。坏死肌肉需多次手术切除，CRRT治疗对挤压伤创面处理与预后有明显的影响。Objective To investigate the characteristics and treatment methods of crush injury of extremities caused by the Wenchuan earthquake. Methods We retrospectively analyzed the 202 cases of the Wenchuan earthquake casualties who had been hospitalized in our hospital for extremity crush injury. Wound characteristics, difficulties, problems and treatments were summarized. Results There were 16 cases （7.9%） of smashed crush wound, 60 cases （29. 7% ） of open injury, and 126 cases （62.4%） of closed injury. By injury severity score （ISS）, there were 98 （34.7%） cases of mild injury, 54 cases （17.1%） of moderate injury, 36 （44. 9% ） cases of severe injury, and 14 cases （3.3%） of extremely severe injury. Decompressive fasciotomy was performed for 32 cases, 31 procedures of excising necrotic muscle for 15 cases, and 14 procedures of stump debridement for 8 extremities. SPSS 10.0 software was used to investigate the correlation between crush time and ISS scores, and the rank sum test revealed a significant difference （ P 〈 0. 05 ） . Conclusions The severity of crush injury is related to crushing power and ischemic time. Necrosis is usually massive and indistinctly defined. Necrotic muscle bundles are interlaced with normal ones. Necrosis is usually wider and more severe in the deeper layer. Multiple excisions are needed to remove the necrotic tissues. Continuous renal replacement treatment is helpful for dealing with raw wounds and prognosis of crush injury.

关 键 词：地震 挤压伤 软组织 连续性肾脏替代治疗 

分 类 号：R686[医药卫生—骨科学]