汶川地震伤中开放性骨折原因分析及治疗策略
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摘要
目的:探讨汶川地震伤中开放性骨折原因分析及治疗策略。方法:回顾性分析280例汶川地震中开放性骨折患者病例,总结骨折原因及治疗方法。结果:患者压砸伤266例,占95%,其他受伤方式约占5%。治疗上急诊行内固定手术者88例,占31%,行外支架固定者69例,占24%,单纯石膏外固定者60例,占21%,截肢患者63例,占22%,63例截肢患者中40例为肢端缺血坏死引起,占14%,15例为肢体毁损引起,占5%,8例为气性坏疽引起,占2%。结论:汶川地震伤中开放性骨折原因多为压砸伤,治疗首先考虑全身治疗,抢救生命,骨折治疗根据Gustilo分度及肢体有无气性坏疽或坏死而进行相应的治疗。又因为地震伤有受伤人群多,受伤时间长,感染严重及救治困难等特点,故应根据病情采取相应的特殊救治方法。
Objective:To research the cause and therapy of open fracture on earthquake in Wenchuan.Methods:To anlalyze 280 open fracture patients on earthquake in Wenchuan.and to summarize the cause and therapy of open fracture.Results:The pression wounds number are 266,about 95% in all.About 5% wounds patients suffer in injuries in other way.88 patients(31%)have internal fixation of emergency treatment.69 patients(24%) have external fixation of emergency treatment.60 patients(21%) have simple plaster external fixation.63 patients(22%) have amputation.40(14%) of the 63 patients are suffered from limb ischemia.15(5%) patients suffered from limb mutilation.8(2%) patients suffered from gas gangrene.Conclusion:The cause of open fracture on earthquake in Wenchuan is pression woundes.The most important therapy is from head to foot,save the life.The therapy way of fracture is according to the Gustilo standard and the existion of the gas gangrene.Because thera are many characters of earthquake wound such as crowdy,long time,infection and difficult to cure,we should adopt homologous special way according to patient's condition.
Objective:To research the cause and therapy of open fracture on earthquake in Wenchuan.Methods:To anlalyze 280 open fracture patients on earthquake in Wenchuan.and to summarize the cause and therapy of open fracture.Results:The pression wounds number are 266,about 95% in all.About 5% wounds patients suffer in injuries in other way.88 patients(31%)have internal fixation of emergency treatment.69 patients(24%) have external fixation of emergency treatment.60 patients(21%) have simple plaster external fixation.63 patients(22%) have amputation.40(14%) of the 63 patients are suffered from limb ischemia.15(5%) patients suffered from limb mutilation.8(2%) patients suffered from gas gangrene.Conclusion:The cause of open fracture on earthquake in Wenchuan is pression woundes.The most important therapy is from head to foot,save the life.The therapy way of fracture is according to the Gustilo standard and the existion of the gas gangrene.Because thera are many characters of earthquake wound such as crowdy,long time,infection and difficult to cure,we should adopt homologous special way according to patient's condition.
引文
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[12]史占彪,张建新.心理咨询师在危机于预中的作用.心理科学进展,2003,31(4):393.399.
[2]ROY N,SHAH H,PATEL V,et al.Surgical and psychosocia-loutcomes in the rural injured:a follow-up study of the2001earthquake victi ms[J].Injury,2005,36(8):927-934.
[3]S.Terry Canale主编,卢世璧,王继芳主译.坎贝尔骨科手术学.第9版.济南:山东科学技术出版社,2001,2:2323-2330.
[4]张英泽,孔志刚,王锡民,等.张北地震灾区骨科伤员救治经验与教训[J].中国骨伤,2000,13(7):400.
[5]王明新,汪茜,匡正达,等.印尼日惹地震救援中骨折患者手术治疗的研究和探讨[J].武警医学,2006,17(10):790-791.
[6]刘大雄.开放性骨折内固定治疗中的几个问题.骨与关节损伤杂志,2003,18(3):145.
[7]朱通伯.处理开放性骨折及关节创伤的新观点.中华骨科杂志,骨科教程1,1996,241.
[8]蒲丹,乔甫,张卫东,等.67例疑似气性坏疽地震伤员院内交叉感染控制分析.中国循证医学杂志,2008,8(8):620-622.
[9]王正国.灾害和事故的创伤救治[M].北京:人民卫生出版社,2005,336.
[10]冯国勋.地震灾害所致创伤后感染的治疗体会.空军总医院学报,2008,24(3):165,167.
[11]BAKER SP,O NEILL B,HADDON W,et al.Theinjury severi-ty score:amethodfor describing patients with multipleinjuries and evaluatingemergency care.J Trauma,1974,14:187-196.
[12]史占彪,张建新.心理咨询师在危机于预中的作用.心理科学进展,2003,31(4):393.399.
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