农业旋耕机的致伤特点及治疗策略  

Characteristics and treatment of injury caused by an agriculture rototiller

作　　者：刘刚[1] 王军[1] 王陶[1] 谢明锐 李宗原[1] 康斌[1] 石波[1] 唐诗添[1] 

机构地区：[1]四川省绵阳市中心医院骨科,621000

出　　处：《中华创伤骨科杂志》2015年第7期570-574,共5页Chinese Journal of Orthopaedic Trauma

基　　金：四川省绵阳市卫生局科研课题（201244）

摘　　要：【摘要】目的探讨农业旋耕机的致伤特点及治疗策略。方法回顾性分析2008年1月至2014年3月收治的89例旋耕机致伤患者资料，男76例，女13例；年龄21。58岁，平均46岁。开放性骨折按照Gustilo分型：Ⅰ型2例，Ⅱ型8例，Ⅲ型79例（111a型34例、Ⅲb型20例、Ⅲc型25例）。合并伤：休克69例，骨盆骨折12例，脊椎骨折8例，胸部损伤26例，腹部损伤15例，泌尿生殖系统损伤9例，颅脑损伤2例，骨筋膜间隔综合征5例，气性坏疽2例。遵循创伤生命支持系统原则，早期清创，修复血管、神经损伤。随访复查关节x线片，末次随访时采用Puno功能评分进行功能评定。结果5例患者因创伤失血性休克死亡，另有3例患者因合并严重感染死亡，7例患者失访。74例患者术后获1～6年（平均3．6年）随访。50例患者保肢成功，24例患者均有不同程度肢体残缺，其中22例患者安置假肢。主要并发症包括软组织缺损35例，慢性骨髓炎6例，关节非功能位僵直2例，肢体神经功能丧失8例。末次随访时患者下肢Puno功能评分平均为73．0分（62～95分）。结论旋耕机致伤是一种创伤严重、病情复杂、致残率及致死率极高的疾病，早期出血控制、诊治复合伤、保肢治疗以及后期创面感染控制、消灭创面、改善肢体功能是治疗的关键。Objective To investigate the characteristics and treatment of injury caused by an agricultural rototiller. Methods A retrospective study was performed of the 89 patients who had been treated at our department from January 2008 through March 2014 for injury caused by an agricultural rototiller. They were 76 men and 13 women, aged from 21 to 58 years （average, 46 year） . According to Gu^tilo classifi- cation, 2 patients had type Ⅰ fracture, 8 type Ⅱ, and 79 type Ⅲ （34 cases of type Ⅲa, 20 cases of type Ⅲb, and 25 cases of type Ⅲ c）. Shock was complicated in 69 patients, pelvic fracture in 12, vertebral fracture in 8, chest injury in 26, abdominal injury in 15, urogenital injury in 9, eranioeerebral injury in 2, osteo-fascial compartment syndrome in 5, and gas gangrene in 2. According to the advanced trauma life support system, life-saving was first, followed by limb salvage and wound treatment. Vascular and neural injuries were repaired after early debridement. X-rays and Puno functional scores were used to evaluate the function during the fol- low-ups. Results Seventy-four patients were followed up for 1 to 6 years （average, 3.6 years） . Five patients died from hemorrhagic shock, 3 died from severe infection, and 7 were lost to the follow-up. Limb salvage was successful in 50 patients, but limb mutilation to different degrees was inevitable in 24, of whom 22 received prosthesis. The main complications included soft tissue defects in 35 cases, chronic osteomyelitis in 6, stiff joint in 2, and neurologie deficits in 8. At the final follow-up, the mean Puno functional score was 73.0 （range, from 62 to 95）. Conclusions Injury caused by an agricultural rototiller is characterized by severe trauma, complexity, and high rates of mutilation and lethality. Early hemorrhage control, management of combined lesions, limb salvage, later control of wound infection, wound healing, improvement of limb function are the keys to treatment of injury caused by an agricultural rototiller.

关 键 词：创伤与损伤 临床方案 预后 旋耕机 致伤特点 

分 类 号：R683[医药卫生—骨科学]