交通事故致肢体严重挤压伤的临床诊治分析  

Diagnosis and treatment for severe crush injuries of extremities caused by traffic crashes

作　　者：施建国[1] 侯振海[1] 叶虹[1] 倪志明[1] 姚远[1] 王军兵 周继红[3] 

机构地区：[1]解放军第117医院交通伤急救中心,浙江杭州310004 [2]玉环县红十字医院,浙江玉环317602 [3]第三军医大学大坪医院野战外科研究所交通医学研究所创伤烧伤和复合伤国家重点实验室,重庆400042

出　　处：《创伤外科杂志》2011年第3期205-207,共3页Journal of Traumatic Surgery

基　　金：军队十一五专项资助课题(08G097)

摘　　要：目的研究交通事故所致肢体挤压伤的临床特点及治疗方法。方法利用创伤数据库采集分析我院自2003年1月~2008年1月收治的交通伤病人诊治信息,统计分析其中挤压伤的发生特点、临床特点、救治方法与结果等。结果 5年共收治交通伤2 845例,肢体挤压伤82例,其中青壮年77例,占93.90%;发生部位分别为：小腿39例（47.56%）、大腿20例（24.39%）、臀部17例（20.73%）、肩背上肢6例（7.32%）;合并有骨折挤压伤57例（69.51%）;多发伤发生率为92.68%（76例）。主要的合并损伤和并发症为：胸腹伤36例（43.90%）,创伤性休克22例（26.83%）,颅脑伤21例（25.61%）,脊柱骨折15例（18.29%）。急性肾功能衰竭6例,发生率为7.32%;截肢手术5例（6.1%）。治愈48例（58.54%）,好转25例（30.49%）,未愈9例（10.98%）,治疗总有效率89.02%。结论交通伤所致肢体挤压伤下肢明显多于上肢,且多伴有骨折和深部组织的挫裂伤,多发伤发生率高、受累器官多、病情较重,治愈率较低。Objective To study the clinical characteristics and the treatment of severe crush injuries of extremities caused by traffic crashes.Methods Data of severe injuries in traffic crashes were collected from China Trauma Database（Jan.2003-Jan.2008） to analyze the occurrence characteristics,clinical features,treatments and outcomes of crush injuries.Results During the 5 years,2845 cases of traffic injuries were admitted,including 82 cases of crush injuries,among whom young adult accounted for 77 cases（93.90%）.Injured sites of crushes were as follows： lower leg in 39 cases（47.56%）,thigh in 20 cases（24.39%）,hip in 17 cases（20.73%）,upper limbs,shoulder and back in 6 cases（7.32%）.Crush injury associated with fractures happened on 57 patients（69.51%） and the multiple injuries rate was 92.68%（76 cases）.The major comorbidities and complications included abdominal injuries in 36 cases（43.90%）,traumatic shock in 22 cases（26.83%）,traumatic brain injury in 21 cases（25.61%）,spinal fractures in 15 cases（18.29%）.The incidence of acute renal failures was 6 cases（7.32%） and incidence of amputations was 5 cases（6.10%）.At the end,48 cases were cured（58.54%）,25 cases improved（30.49%）,and 9 cases uncured（10.98%）.The total effective rate was 89.02%.Conclusion Severe crush injuries of extremities caused by traffic crashes are more in lower limbs than those in upper limbs,and are often companied with fractrures,laceration of deep tissues,multiple injuries,multi-organ injuries,and with severe injuries and low cure rate.

关 键 词：交通事故 挤压伤 肢体损伤 截肢 

分 类 号：R642[医药卫生—外科学]