手指高压注射伤的显微外科治疗
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摘要
目的总结手部高压注射伤的显微外科治疗方法及疗效。方法回顾性分析2017年1月-2018年4月收治的18例手指高压注射伤患者的临床资料,急诊于臂丛神经阻滞麻醉下行切开引流、显微镜下血管外膜彻底清创、创面敞开引流,术后预防感染,创面Ⅱ期直接缝合或皮瓣修复,早期行患指康复训练。结果术后患指成活14例,其中1例行腹部皮瓣修复创面,余13例伤口Ⅱ期直接缝合;4例患指感染坏死,行残端修整术。随访6～12个月,末次随访按TAM系统评定法评定患指功能,优9例,良3例,可1例,差1例。结论手部高压注射伤是临床相对少见的损伤,治疗困难,预后相对较差,早期经显微镜外科清创治疗,可提高患指成活率,促进患指功能的恢复。
Objective To summarize the microsurgical treatment method and its curative effect on high pressure injections injuries of fingers. Methods A retrospective analysis was made on the medical records of 18 cases of digital high pressure injection injury in our hospital from January 2017 to April 2018.Under braclial plexus anesthesia, incision and drainage, microscopic though debridement of adventitia were done during emergency treatment, post operative anti-infection was done, the wounds were sutured directly or repaired by flap traneplantation in the 2 nd stage and the early functional training was done. Results Fourteen cases survived after operation, one of them was repaired with abdominal skin flaps, the other thirteen were directly sutured in the second stage, and four cases had infection and necrosis, and the remnant was repaired. During the last follow-up period of 6 ～12 months, the function of the affected finger was assessed by TAM system evaluation method. The results were excellent in 9 cases, good in 3 cases, fair in 1 case and poor in 1 case. Conclusion High-pressure injection injury of hand is a relatively rare injury in clinic. It is difficult to treat and the prognosis is relatively poor. Early debridement by microsurgical debridement can improve the survival rate of the affected finger and promote the recovery of the function of the affected finger.
Objective To summarize the microsurgical treatment method and its curative effect on high pressure injections injuries of fingers. Methods A retrospective analysis was made on the medical records of 18 cases of digital high pressure injection injury in our hospital from January 2017 to April 2018.Under braclial plexus anesthesia, incision and drainage, microscopic though debridement of adventitia were done during emergency treatment, post operative anti-infection was done, the wounds were sutured directly or repaired by flap traneplantation in the 2 nd stage and the early functional training was done. Results Fourteen cases survived after operation, one of them was repaired with abdominal skin flaps, the other thirteen were directly sutured in the second stage, and four cases had infection and necrosis, and the remnant was repaired. During the last follow-up period of 6 ～12 months, the function of the affected finger was assessed by TAM system evaluation method. The results were excellent in 9 cases, good in 3 cases, fair in 1 case and poor in 1 case. Conclusion High-pressure injection injury of hand is a relatively rare injury in clinic. It is difficult to treat and the prognosis is relatively poor. Early debridement by microsurgical debridement can improve the survival rate of the affected finger and promote the recovery of the function of the affected finger.
引文
[1]齐伟亚,郑大伟,张旭阳,等.玉米剥皮机致手外伤的分型与治疗[J].实用手外科杂志,2018,32(1):26-28.
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[7]江起庭,王钰,张孝全,等.手外科临床实用技术的改进(附六点报告)[J].实用手外科杂志,2017,31(2):143-146.
[8]潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准[J].中华手外科杂志,2000,16(3):130-135.
[9]田芙蓉,李崇杰.小腿骨筋膜室综合征四室与二室切开减张的疗效比较[J].实用手外科杂志,2015,29(1):102-103.
[10]朱新红,黄飞,陶德刚.高能量损伤致下肢严重开放性毁损伤保肢治疗[J].实用手外科杂志,2017,31(3):306-309.
[2]李桂石,齐晓军,王光达,等.关节镜下修复无回缩肩袖全层撕裂的术后疗效[J].实用手外科杂志,2017,31(2):174-179.
[3]刘学光,孙振中,许亚军,等.以小鱼际为供区的皮片移植修复指腹皮肤缺损的临床研究[J].实用手外科杂志,2017,31(3):281-282,285.
[4]李磊,聂兰军.手部高压热塑料液体注射性损伤一例[J].中华烧伤杂志,2017,33(7):460-461.
[5]Pinto MR,Turkula-Pinto LD,Cooney WP.Hish-pressure in jectioninjuries of the hand:review of 25 patients managed by open woundtechnique[J].Hand Surg(Am),1993,18(1):125-130.
[6]梁启善,郭小惠,张咸中,等.指动脉皮瓣与超薄腹部皮瓣在末节指再造中的联合应用[J].实用手外科杂志,2012,26(2):109-111.
[7]江起庭,王钰,张孝全,等.手外科临床实用技术的改进(附六点报告)[J].实用手外科杂志,2017,31(2):143-146.
[8]潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准[J].中华手外科杂志,2000,16(3):130-135.
[9]田芙蓉,李崇杰.小腿骨筋膜室综合征四室与二室切开减张的疗效比较[J].实用手外科杂志,2015,29(1):102-103.
[10]朱新红,黄飞,陶德刚.高能量损伤致下肢严重开放性毁损伤保肢治疗[J].实用手外科杂志,2017,31(3):306-309.