CAJ | 학술논문

目的探讨地震所致肢体挤压伤的软组织损伤特点和救治方法. 方法分析我院收治的202例肢体地震挤压伤的伤情特点,讨论治疗过程中的困难和问题,提出相应的处理措施. 结果本组肢体挤压毁损伤16例(7.9%),开放性损伤60例(29.7%),闭合性损伤126例(62.4%).根据ISS评分,轻度损伤98例(34.7%),中度损伤54例(17.1%),重度损伤36例(44.9%),极重度损伤14例(3.3%),用SPSS 10.0软件对挤压时间与ISS评分的相关性进行秩和检验,差异有统计学意义(P<0.05).行筋膜腔切开减压32例,坏死肌肉切除术15例31次.8肢进行了14次残端清创术. 结论地震软组织挤压伤伤情严重,挤压伤程度与打压重量和挤压缺血时间有关.肌肉坏死特点是坏死范围广泛而界限不清;同一块肌肉的坏死肌肉束与正常肌肉束交织在一起,坏死面积表面小深层大,肌肉深层坏死较浅层严重.坏死肌肉需多次手术切除,CRRT治疗对挤压伤创面处理与预后有明显的影响.
목적 탐토지진소치지체제압상적연조직손상특점화구치방법. 방법분석아원수치적202례지체지진제압상적상정특점,토론치료과정중적곤난화문제,제출상응적처리조시. 결과 본조지체제압훼손상16례(7.9%),개방성손상60례(29.7%),폐합성손상126례(62.4%).근거ISS평분,경도손상98례(34.7%),중도손상54례(17.1%),중도손상36례(44.9%),겁중도손상14례(3.3%),용SPSS 10.0연건대제압시간여ISS평분적상관성진행질화검험,차이유통계학의의(P<0.05).행근막강절개감압32례,배사기육절제술15례31차.8지진행료14차잔단청창술. 결론 지진연조직제압상상정엄중,제압상정도여타압중량화제압결혈시간유관.기육배사특점시배사범위엄범이계한불청;동일괴기육적배사기육속여정상기육속교직재일기,배사면적표면소심층대,기육심층배사교천층엄중.배사기육수다차수술절제,CRRT치료대제압상창면처리여예후유명현적영향.
Objective To investigate the characteristics and treatment methods of crush injury of extremities caused by the Wenehuan earthquake. Methods We retrospectively analyzed the 202 cases of the Wenchuan earthquake casualties who had been hospitalized in our hospital for extremity crush injury. Wound characteristics, difficulties, problems and treatments were summarized. Results There were 16 cases (7.9%) of smashed crush wound, 60 cases (29.7%) of open injury, and 126 cases (62.4%) of closed injury. By injury severity score (ISS), there were 98 (34. 7% ) cases of mild injury, 54 cases (17.1%) of moderate injury, 36 (44.9%) cases of severe injury, and 14 cases (3.3%) of extremely severe injury. Decompressive fasciotomy was performed for 32 cases, 31 procedures of excising necrotic muscle for 15 cases, and 14 procedures of stump debridement for 8 extremities. SPSS 10.0 software was used to inves-tigate the correlation between crush time and ISS scores, and the rank sum test revealed a significant dif-ference (P < 0.05) . Conclusions The severity of crush injury is related to crushing power and is-chemic time. Necrosis is usually massive and indistinctly defined. Necrotic muscle bundles are interlaced with normal ones. Necrosis is usually wider and more severe in the deeper layer. Multiple excisions are needed to remove the necrotic tissues. Continuous renal replacement treatment is helpful for dealing with raw wounds and prognosis of crush injury.