四川汶川大地震骨科伤员的早期救治
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摘要
[目的]"5.12"四川汶川大地震发生后,本院野战医疗所紧急赶赴极重灾区安县(紧临极重灾区北川县),1周内作者所在的医疗分队共处理284例骨科伤员,本文初步探讨大地震骨科伤员早期紧急救治的经验和体会。[方法]对284例骨科伤员的救治情况进行回顾、分析。[结果]骨科伤员包括脊柱四肢骨折脱位、手足外伤、周围神经损伤和四肢软组织伤。年龄11～92岁,平均49.3岁。男133例,占46.8%,女151例,占53.2%。骨折脱位伤员188例,其中上肢骨折85例,下肢骨折73例,脊柱骨折23例,肩或髋关节脱位7例。手足外伤、周围神经损伤和四肢软组织伤96例。开放性创伤67例,其余为闭合性创伤。131例经过治疗痊愈出院,其余患者病情稳定后转送至后方医院继续治疗。术后X线复查,21例外固定架术后的患者骨折复位固定满意,肩或髋关节脱位均成功复位,一期缝合患者无伤口感染,也未发现其它手术并发症。[结论]正确判断伤情,采取科学合理的治疗措施,严格把握手术适应证,不做确定性骨折内固定治疗,外固定架固定四肢骨折是地震伤员紧急救治中一个简便有效的治疗方法。
[Objective]On May 12,2008,an over 8.0-magnitude earthquake occurred in Wenchuan county,Sichuan province,China.The anthor's field hospital was deployed to An county,which arrived on the 3rd day after the disaster.During the first week of the deployment,284 victims with musculoskeletal injuries received orthopedic management.The objective of this article is to highlight the experience gained by this author's medical assistance team,focusing on the orthopedic care in the early part of the post-disaster relief activities.[Method]Records of 284 patients who underwent orthopedic management were reviewed retrospectively.[Result]There were a large number of musculoskeletal injuries amongst the survivors in the acute phase of the disaster,including spinal trauma,fractures and dislocations,peripheral nerve injuries and soft tissue injuries.The average age was 49.3 years(range,11 to 92 years) with 133 men and 151 women.The patients with upper extremity fracture were 85,with lower extremity fracture 73,with spinal fracture 23,with shoulder or hip dislocation 7.The patients with hand or foot injuries,peripheral nerve injuries and soft tissue injuries were 96.Open injuries were 67,the remaining were closed injuries.Totally 131 patients recovered,and the rest were transferred to the rear hospital for further management.The X-ray postoperatively showed that 21 open fractures were reduced functionally by means of external fixator,and the shoulder or hip dislocations were reduced anatomically.The wounds with primary suture had no infection.There were no other complications.[Conclusion]Correct diagnsis of the injuries,providing scientific and resonable therapeutic measures,and correct operative indication should be emphasized for early orllopedic care.Definitive surgeries such as open reduction and internal fixation are not recommended strongly.External fixation for post-earthquake open fractures is simple and effective,allowing simple approach to wound care and transferring to rear hospital during the whole period of fixation.
[Objective]On May 12,2008,an over 8.0-magnitude earthquake occurred in Wenchuan county,Sichuan province,China.The anthor's field hospital was deployed to An county,which arrived on the 3rd day after the disaster.During the first week of the deployment,284 victims with musculoskeletal injuries received orthopedic management.The objective of this article is to highlight the experience gained by this author's medical assistance team,focusing on the orthopedic care in the early part of the post-disaster relief activities.[Method]Records of 284 patients who underwent orthopedic management were reviewed retrospectively.[Result]There were a large number of musculoskeletal injuries amongst the survivors in the acute phase of the disaster,including spinal trauma,fractures and dislocations,peripheral nerve injuries and soft tissue injuries.The average age was 49.3 years(range,11 to 92 years) with 133 men and 151 women.The patients with upper extremity fracture were 85,with lower extremity fracture 73,with spinal fracture 23,with shoulder or hip dislocation 7.The patients with hand or foot injuries,peripheral nerve injuries and soft tissue injuries were 96.Open injuries were 67,the remaining were closed injuries.Totally 131 patients recovered,and the rest were transferred to the rear hospital for further management.The X-ray postoperatively showed that 21 open fractures were reduced functionally by means of external fixator,and the shoulder or hip dislocations were reduced anatomically.The wounds with primary suture had no infection.There were no other complications.[Conclusion]Correct diagnsis of the injuries,providing scientific and resonable therapeutic measures,and correct operative indication should be emphasized for early orllopedic care.Definitive surgeries such as open reduction and internal fixation are not recommended strongly.External fixation for post-earthquake open fractures is simple and effective,allowing simple approach to wound care and transferring to rear hospital during the whole period of fixation.
引文
[1]中国确定汶川地震10个极重灾区、41个重灾区[OL].http://hi.people.com.cn/2008/07/13/390152.html.
[2]唐甫斌,浦金辉,张璧,等.地震伤员的处理原则[J].创伤外科杂志,2007,9:210.
[3]郭征,王臻,朱锦宇,等.地震灾区骨科医生面对的问题与对策[J].中华创伤骨科杂志,2008,10:513-515.
[4]Sechriest VF2nd,Lhowe DW.Orthopaedic care aboard the USNS Mercy during operation unified assistance after the2004Asian Tsu-nami.A case series[J].J Bone Joint Surg(Am),2008,90:849-861.
[2]唐甫斌,浦金辉,张璧,等.地震伤员的处理原则[J].创伤外科杂志,2007,9:210.
[3]郭征,王臻,朱锦宇,等.地震灾区骨科医生面对的问题与对策[J].中华创伤骨科杂志,2008,10:513-515.
[4]Sechriest VF2nd,Lhowe DW.Orthopaedic care aboard the USNS Mercy during operation unified assistance after the2004Asian Tsu-nami.A case series[J].J Bone Joint Surg(Am),2008,90:849-861.
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