汶川大地震挤压伤特点与手术方式选择  

FEATURES OF CRUSH INJURY IN WENCHUAN EARTHQUAKE AND THE CORRESPONDING OPERATIONAL METHODS

作　　者：权毅[1] 潘显明[1] 邓少林[1] 卢世璧[2] 陶笙[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,成都610083 [2]解放军总医院骨科

出　　处：《中国修复重建外科杂志》2009年第5期549-551,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结5.12汶川大地震挤压伤特点和手术方式选择。方法2008年5月12日-6月18日,在汶川大地震救治过程中收治202例四肢软组织挤压伤伤员。男110例,女92例;年龄1岁7个月～16岁25例,17～60岁129例,61岁以上48例。挤压时间30min～154h。对60例开放性损伤者行清创包扎或缝合术;16例18侧肢体毁损者及6例8侧肢体因挤压综合征急性肾功能衰竭者行截肢术;32例42侧肢体发生筋膜间隙综合征危象者行筋膜腔切开解压术;15例行坏死肌肉切除术31次;9例挤压综合征急性肾功能衰竭伤员行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)。结果2例在CRRT治疗期间因肠道及颅内出血死亡,余200例伤口或创面全部愈合。其中198例于治疗后15～120d痊愈出院,2例8个月后治愈出院;平均住院53d。22例26侧肢体截肢术后3～6个月均安装假肢,功能良好。结论挤压伤治疗原则是"积极减压,慎重截肢",肌肉变硬及肌酸激酶、血钾增高是筋膜腔切开解压术的金指标,难以抉择时宁可早期减压;坏死肌肉切除不尽或坏死界限不清者应行开放性截肢。Objective To investigate the characteristics of patients with crush injury in Wenchuan earthquake and the corresponding operational methods.Methods From May 12th 2008 to June 18th 2008, 202 patients with crush injury of soft tissue were treated, including 110 males and 92 females.Twenty-ve patients aged 19 months to 16 years, 129 patients aged 17-60 years and 48 patients aged above 61 years.The crushed time was 30 minutes to 154 hours.Sixty cases of open injuries were treated by debridement and dressing or suture;16 cases of damaged extremities（18 limbs） and 6 cases of acute renal failure due to crush syndrome（8 limbs） received amputation;32 cases of interfascial space syndrome crisis（42 limbs） were treated by fascia cavity decompression;15 cases received the resection of necrotic muscle for 31 times;and 9 cases received continuous renal replacement therapy（CRRT）.Results All the wounds healed except 2 cases which died from intestinal bleeding and intracranial hemorrhage during the treatment of CRRT.Two cases were discharged 8 months after treatment, while the other 198 cases recovered and were discharged 15-120 days after treatment.The average hospitalization time was 53 days.Twenty-two cases（26 limbs） were xed with arti cial limbs 3-6 months after amputation and achieved good functional outcome.Conclusion The treatment principle of crush injury is＂be active to decompress and be prudent to amputate＂, the hardening muscle and the increasing level of creatine kinase and blood potassium are the golden indicators of fascia cavity decompression.Decompression at an earlier period is preferred when there is a dilemma to choose, and open amputation should be performed when the necrotic muscle is hard to clear or the necrosis boundary is not distinct.

关 键 词：汶川大地震 挤压伤 筋膜间隙综合征 截肢术 

分 类 号：R64[医药卫生—外科学] R687[医药卫生—临床医学]