开放骨折并发气性坏疽的诊治  

The diagnosis and treatment of gas gangrene associated with open fractures

作　　者：孙旭[1] 米萌[1] 朱仕文[1] 孙志坚 汤文杰[1] 杨帆[1] 李莹[1] 吴新宝[1] Sun Xu;Mi Meng;Zhu Shiwen;Sun Zhijian;Tang Wenjie;Yang Fan;Li Ying;Wu Xinbao(Department of Orthopedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院创伤骨科,北京100035

出　　处：《骨科临床与研究杂志》2018年第4期230-234,共5页Journal Of Clinical Orthopedics And Research

摘　　要：目的探讨开放骨折并发气性坏疽的发病特点和诊治方法。方法回顾分析2014年1月至2017年6月北京积水潭医院收治的4例开放骨折并发气性坏疽患者的病历资料。4例患者均为男性,平均年龄46.5岁(28～55岁)。其中交通事故损伤3例,农用机械损伤1例。4例患者均为下肢开放性损伤,GustiloⅢB型损伤2例,GustiloⅢC型损伤2例。结果平均随访时间9个月(6～12个月)。4例患者均存活,其中1例保肢成功,1例一期高位截肢,2例二期高位截肢。3例直接闭合创面,1例行皮瓣转移后闭合创面。2例发生严重的感染中毒性休克,1例轻度感染中毒性休克。截肢患者6 min步行能力差。结论气性坏疽一经确诊,需立即开展积极的治疗,早期可尝试保肢治疗,若病情严重需尽快高位截肢,以提高患者的生存质量。针对性的药物治疗和全身支持治疗十分重要。Objective To summarize the characteristics,diagnosis and treatment of gas gangrene associated with open fractures. Methods A total of 4 patients with gas gangrene associated with open fractures from January 2014 to June 2017 in Beijing Jishuitan Hospital were retrospectively analyzed. All the patients were male and the average age was 46. 5 years（ 28-55 years old）. Three cases were injured in traffic accident and one case was injured by farm machinery. All the open fractures were lower limbs. Two cases were GustiloⅢB,and 2 cases were Gustilo ⅢC. Results The average follow-up was 9 months（ 6-12 months）. No death occurred. One case was preserved limb and one case was amputated above the knee at the emergency. Two cases were amputated at the second surgery. Wounds were directly closed in 3 cases and was closed after flap transfer in one case. Severe toxic shock occurred in 2 cases,mild toxic shock in one case. The 6 minutes walking function was poor in amputation patients. Conclusion Positive treatment should be initiated immediately after diagnosis of gas gangrene. Limb preservation could be considered only if the general condition was permission. If the condition is serious,it is necessary to amputate the limb as soon as possible. Appropriate medication and systemic supportting therapy are very important.

关 键 词：骨折 开放性 气性坏疽 感染 休克 创伤性 截肢 创伤性 

分 类 号：R633.2[医药卫生—外科学]