汶川地震596例骨折患者临床特点及早期治疗
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摘要
目的总结汶川地震596例骨折患者的临床特点及早期治疗的方法及效果。方法2008年5月12日-21日,收治地震致骨折患者596例。男283例,女313例;年龄1.9～102岁,中位年龄43岁。受伤至入院时间12 min～4 d。上肢骨折132例,下肢骨折496例,锁骨骨折10例,肩胛骨骨折16例,骨盆骨折23例,脊柱骨折59例。开放性骨折183例,闭合性骨折413例。多处骨折患者214例(35.9%)。肢体毁损挤压伤68例,按照碾压肢体严重度评分(mangled extremity severity score,MESS)标准进行评分为(6.84±2.48)分。骨折合并神经血管损伤36例。开放性骨折伤口均伴不同程度污染,无气性坏疽等特殊感染,行清创缝合(或不缝合)及切开复位内固定或外固定支架固定术。对闭合性骨折患者行小夹板或石膏、牵引外固定。对49例高度怀疑存在骨筋膜室综合征者,及时行切开减压术。对34例MESS评分>7.0分或毁损及挤压伤引起的全身症状已严重危及生命者行截肢处理。结果除34例截肢患者,460例患者通过手法复位骨折达功能复位,102例复位较差者经手术治疗也达到满意复位。术后289例患者陆续转入外院治疗,余307例患者中34例伤口感染严重,经多次清创、抗感染及皮瓣移植等治疗,伤口均愈合,其中Ⅰ期愈合16例,Ⅱ期愈合18例;其余231例患者,Ⅰ期愈合196例,Ⅱ期愈合35例。42例挤压综合征患者经切开减压、截肢等处理,伤口Ⅰ期愈合29例,Ⅱ期愈合13例。术后无下肢深静脉血栓及应激性溃疡发生,无死亡。结论针对地震所致的骨折特点,及时、专业地救治可取得较好的治疗效果。
Objective To summarize the clinical characteristics of 596 patients with fracture in Wenchuan earthquake and to investigate the therapeutic methods and e ects of early treatment.Methods From May 12th 2008 to May 21st 2008,596 patients with fracture caused by Wenchuan earthquake were treated,including 283 males and 313 females aged 1.9-102 years(median 43 years).The time from injury to hospitalization varied from 12 minutes to 4 days.There were 132 cases of upper extremity fracture,496 cases lower extremity fracture,10 cases clavicular fracture,16 cases scapular fracture,23 cases pelvis fracture,and 59 cases spinal fracture.Among them,183 cases were open fracture and 413 cases were closed fracture.And 214 cases had multiple fracture(35.9%) and 68 cases had crush injury in limbs which scored(6.84 ± 2.48) points according to the mangled extremity severity score(MESS).Thirty-six cases were combined with neurovascular injury.The wound of the open fracture was contaminated at di erent degrees,but no gas gangrene was observed.Open fracture was treated with suturing or no suturing after debridement,open reduction and internal or external xation.Closed fracture was xed with splints,cast and traction.Forty-nine patients whom were highly suspected as osseous fascia compartment syndrome received incision decompression timely,and 34 patients whose MESS were above 7.0 points or su ering from crush injury of life-threatening systemic symptoms received amputation.Results Apart from 34 patients receiving amputation,460 patients achieved functional reduction of fracture after manipulative reduction and 102 cases got satisfactory reduction after surgery.Postoperatively,289 patients were transferred to other hospitals.Among the rest 307 patients,34 with severe wound infection were healed after multiple debridement,anti-infection,and skin ap transplantation(16 cases healed by rst intention and 18 cases healed by second intention),42 cases with crush syndrome were treated with open decompression and amputation,and no deep venous thrombosis of lower limb,stress ulcer and death were observed after operation(29 cases healed by rst intention and 13 cases healed by second intention).Conclusion By aiming at the features of fracture caused by earthquake,the prompt and professional treatment can achieve good therapeutic e ects.
Objective To summarize the clinical characteristics of 596 patients with fracture in Wenchuan earthquake and to investigate the therapeutic methods and e ects of early treatment.Methods From May 12th 2008 to May 21st 2008,596 patients with fracture caused by Wenchuan earthquake were treated,including 283 males and 313 females aged 1.9-102 years(median 43 years).The time from injury to hospitalization varied from 12 minutes to 4 days.There were 132 cases of upper extremity fracture,496 cases lower extremity fracture,10 cases clavicular fracture,16 cases scapular fracture,23 cases pelvis fracture,and 59 cases spinal fracture.Among them,183 cases were open fracture and 413 cases were closed fracture.And 214 cases had multiple fracture(35.9%) and 68 cases had crush injury in limbs which scored(6.84 ± 2.48) points according to the mangled extremity severity score(MESS).Thirty-six cases were combined with neurovascular injury.The wound of the open fracture was contaminated at di erent degrees,but no gas gangrene was observed.Open fracture was treated with suturing or no suturing after debridement,open reduction and internal or external xation.Closed fracture was xed with splints,cast and traction.Forty-nine patients whom were highly suspected as osseous fascia compartment syndrome received incision decompression timely,and 34 patients whose MESS were above 7.0 points or su ering from crush injury of life-threatening systemic symptoms received amputation.Results Apart from 34 patients receiving amputation,460 patients achieved functional reduction of fracture after manipulative reduction and 102 cases got satisfactory reduction after surgery.Postoperatively,289 patients were transferred to other hospitals.Among the rest 307 patients,34 with severe wound infection were healed after multiple debridement,anti-infection,and skin ap transplantation(16 cases healed by rst intention and 18 cases healed by second intention),42 cases with crush syndrome were treated with open decompression and amputation,and no deep venous thrombosis of lower limb,stress ulcer and death were observed after operation(29 cases healed by rst intention and 13 cases healed by second intention).Conclusion By aiming at the features of fracture caused by earthquake,the prompt and professional treatment can achieve good therapeutic e ects.
引文
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13 Lavelle WF,Uhl R,Krieves M,et al.Management of open fractures in pediatric patients:current teaching in Accreditation Council for Graduate Medical Education(ACGME)accredited residency programs.J Pediatr Orthop B,2008,17(1):1-6.
14 Rathore FA,Farooq F,Muzammil S,et al.Spinal cord injury manage-ment and rehabilitation:highlights and shortcomings from the 2005 earthquake in Pakistan.Arch Phys Med Rehabil,2008,89(3):579-585.
15张本,王学义,孙贺祥,等.唐山大地震对人类心身健康的远期影响.中国心理卫生杂志,1998,12(4):200-202.
16张本,王学义,孙贺祥,等.唐山大地震所致截瘫患者远期心身健康状况调查研究.中国心理卫生杂志,2002,16(1):23-25.
17 Roy N,Shah H,Patel V,et al.The Gujarat earthquake(2001)experi-ence in a seismically unprepared area:community hospital medical response.Prehosp Disaster Med,2002,17(4):186-195.
18 Roy N,Shah H,Patel V,et al.Surgical and psychosocial outcomes in the rural injured—a follow-up study of the 2001 earthquake victims.Injury,2005,36(8):927-934.
2 Johansen K,Daines M,Howey T,et al.Objective criteria accurately predict amputation following lower extremity trauma.J Trauma,1990,30(5):568-573.
3 Sagha nia M,Araghizade H,Na ssi N,et al.Treatment management in disaster:a review of the Bam earthquake experience.Prehosp Disas-ter Med,2007,22(6):517-521.
4 Papadopoulos IN,Kanakaris N,Trianta llidis A,et al.Autopsy nd-ings from 111 deaths in the 1999 Athens earthquake as a basis for au-diting the emergency response.Br J Surg,2004,91(12):1633-1640.
5 Sariszen B,Durak K.Extremity injuries in children resulting from the 1999 Marmara earthquake:an epidemiologic study.J Pediatr Orthop B,2003,12(4):288-291.
6 Bhatti SH,Ahmed I,Qureshi NA,et al.Head trauma due to earth-quake October,2005-experience of 300 cases at the Combined Military Hospital Rawalpindi.J Coll Physicians Surg Pak,2008,18(1):22-26.
7 Kuwagata Y,Oda J,Tanaka H,et al.Analysis of 2,702 traumatized patients in the 1995 Hanshin-Awaji earthquake.J Trauma,1997,43(3):427-432.
8 Tahmasebi MN,Kiani K,Mazlouman SJ,et al.Musculoskeletal injuries associated with earthquake.A report of injuries of Iran’s December 26,2003 Bam earthquake casualties managed in tertiary referral centers.Injury,2005,36(1):27-32.
9 Bozkurt M,Ocguder A,Turktas U,et al.The evaluation of trauma patients in Turkish Red Crescent Field Hospital following the Pakistan earthquake in 2005.Injury,2007,38(3):290-297.
10刘爱兵,王海燕,郝钦芳,等.从疾病谱变化规律划分灾难医学救援阶段及其意义.中华急诊医学杂志,2006,15(12):1063-1066.
11 Kazzi AA,Langdorf MI,Handly N,et al.Earthquake epidemiology:the 1994 Los Angeles Earthquake emergency department experience at a community hospital.Prehosp Disaster Med,2000,15(1):12-19.
12 Bulut M,Fedakar R,Akkose S,et al.Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake.Emerg Med J,2005,22(7):494-498.
13 Lavelle WF,Uhl R,Krieves M,et al.Management of open fractures in pediatric patients:current teaching in Accreditation Council for Graduate Medical Education(ACGME)accredited residency programs.J Pediatr Orthop B,2008,17(1):1-6.
14 Rathore FA,Farooq F,Muzammil S,et al.Spinal cord injury manage-ment and rehabilitation:highlights and shortcomings from the 2005 earthquake in Pakistan.Arch Phys Med Rehabil,2008,89(3):579-585.
15张本,王学义,孙贺祥,等.唐山大地震对人类心身健康的远期影响.中国心理卫生杂志,1998,12(4):200-202.
16张本,王学义,孙贺祥,等.唐山大地震所致截瘫患者远期心身健康状况调查研究.中国心理卫生杂志,2002,16(1):23-25.
17 Roy N,Shah H,Patel V,et al.The Gujarat earthquake(2001)experi-ence in a seismically unprepared area:community hospital medical response.Prehosp Disaster Med,2002,17(4):186-195.
18 Roy N,Shah H,Patel V,et al.Surgical and psychosocial outcomes in the rural injured—a follow-up study of the 2001 earthquake victims.Injury,2005,36(8):927-934.
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