CAJ | 학술논문

目的探讨损害控制在严重多发伤伴手指离断伤患者中的临床应用.方法多发伤患者2例,严重度评分(ISS) ≥25分,病例1:左顶部硬膜下血肿,左顶骨骨折,气颅,左顶部头皮缺损,左示、中指指深浅屈肌腱断裂,左前臂背伸肌群断裂,左手拇指、环指、前臂多处皮肤挫裂伤;右尺骨上段开放性骨折,右前臂背伸肌群断裂,右尺神经损伤伴右拇指离断伤.病例2:左侧肺挫伤伴血气胸,左侧多发肋骨骨折,颈7椎体骨折,右手毁损伤,头皮挫裂.2例患者在损伤早期均采用损害控制理念,多科协作进行抢救,离断指体无菌纱布包扎后放入无菌手套内置于2℃ ～4℃冰箱保存.病例1于伤后63 h试行原位再植;病例2于伤后103 h试行中指移位至拇指、环指移位至示指再植.结果病例1再植指完全存活,半年后复查右拇指伸屈良好,痛觉、触觉迟钝.病例2移位再植指存活,近端部分皮肤坏死,经坏死皮肤切除、换药、植皮,最终创面愈合,但伸屈功能欠佳.结论损害控制可有效提高严重多发伤患者的早期抢救成功率,提高生存率,延期再植和移位再植可有效降低严重多发伤伴手指离断伤患者的致残率.
목적 탐토손해공제재엄중다발상반수지리단상환자중적림상응용.방법 다발상환자2례,엄중도평분(ISS) ≥25분,병례1:좌정부경막하혈종,좌정골골절,기로,좌정부두피결손,좌시、중지지심천굴기건단렬,좌전비배신기군단렬,좌수무지、배지、전비다처피부좌렬상;우척골상단개방성골절,우전비배신기군단렬,우척신경손상반우무지리단상.병례2:좌측폐좌상반혈기흉,좌측다발륵골골절,경7추체골절,우수훼손상,두피좌렬.2례환자재손상조기균채용손해공제이념,다과협작진행창구,리단지체무균사포포찰후방입무균수투내치우2℃ ～4℃빙상보존.병례1우상후63 h시행원위재식;병례2우상후103 h시행중지이위지무지、배지이위지시지재식.결과 병례1재식지완전존활,반년후복사우무지신굴량호,통각、촉각지둔.병례2이위재식지존활,근단부분피부배사,경배사피부절제、환약、식피,최종창면유합,단신굴공능흠가.결론 손해공제가유효제고엄중다발상환자적조기창구성공솔,제고생존솔,연기재식화이위재식가유효강저엄중다발상반수지리단상환자적치잔솔.
Objective To investigate the clinical application of damage control in severe multiple trauma with amputation injury at fingers.Methods Two cases of multi-trauma were included in this study,with ISS (Injury Severity Score) higher than 25.In case 1,the patient was diagnosed as left parietal subdural hematoma,left parietal bone fractures,intracranial pneumatosis,scalp defect in the left parietal area,rupture of superficial and deep flexor tendon of the left index and middle finger,rupture of the left extensor muscle,right ulnar nerve injury and amputation injury on the right thumb.In case 2,the patient were diagnosed as the left pulmonary contusion with hemopneumothorax,multiple rib fractures,the 7th cervical spine fracture,injuries on the right hand and scalp laceration.Both patients were treated under damage control and multi-department cooperation.Severed digits were preserved with sterile gauze sterile gloves at 2℃ to 4℃.The first patient was treated with in situ replantation within 63 hours after the injury.The second patient was treated with shifted replantation within 103 hours,the middle finger was shifted to reconstruct the thumb and the ring finger was shifted to reconstruct the index finger.Results All the fingers in case 1 survived,with satisfying flexion and extension function but unsatisfying sense of pain and touch.The shifted fingers all survived in case 2.Necrosis occurred partly on the proximal margin of the shifted fingers,while the defect healed after debridement and skin grafting.Recovery of finger flexion and extension was unsatisfying.Conclusion Damage control could raise the early rescue success rate of severe multiple injury and survival rate effectively.Delayed replantation and shifted replantation could reduce disability rate of patients with severe multiple trauma with severed finger injury.