中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
Chinese Journal of Orthopaedic Trauma
2015年
11期
931-935
,共5页
刘峰%李占雨%刘浩宇%魏壮
劉峰%李佔雨%劉浩宇%魏壯
류봉%리점우%류호우%위장
腕%骨折%脱位%骨折固定术,内
腕%骨摺%脫位%骨摺固定術,內
완%골절%탈위%골절고정술,내
Wrist%Fractures,bone%Dislocation%Fracture fixation,internal
目的 探讨创伤性腕部轴向骨折与脱位的治疗、并发症及预后. 方法 回顾性分析2004年11月至2013年9月期间收治的7例创伤性腕部轴向骨折与脱位患者资料,男4例,女3例;年龄为34 ～ 48岁,平均38.1岁;左侧3例,右侧4例.致伤原因:挤压伤5例,压砸伤2例.根据Garcia-Elias 分型:尺侧轴向骨折与脱位4例(1例闭合性损伤,3例开放性损伤),桡侧轴向骨折与脱位3例(均为开放性损伤).1例闭合性损伤患者筋膜室行切开减张、神经减压、固定骨折与脱位;4例开放性损伤患者清创、固定骨折与脱位,一期修复肌腱、神经,其中2例二期应用皮瓣修复皮肤缺损;2例严重开放性损伤患者清创、固定骨折与脱位,一期修复肌腱、神经,二期由于感染等并发症而截肢. 结果 7例患者术后获7～113个月(平均77个月)随访.根据中华医学会手外科学会上肢部分功能评定试用标准评定疗效:优1例,良2例,可1例,差3例.结论 创伤性腕部轴向骨折与脱位是腕部损伤的一种特殊类型,其软组织损伤程度远大于骨与关节损伤程度.闭合性损伤应预防骨筋膜间隔综合征及腕管综合征的发生,开放性损伤应重视软组织损伤的处理.
目的 探討創傷性腕部軸嚮骨摺與脫位的治療、併髮癥及預後. 方法 迴顧性分析2004年11月至2013年9月期間收治的7例創傷性腕部軸嚮骨摺與脫位患者資料,男4例,女3例;年齡為34 ～ 48歲,平均38.1歲;左側3例,右側4例.緻傷原因:擠壓傷5例,壓砸傷2例.根據Garcia-Elias 分型:呎側軸嚮骨摺與脫位4例(1例閉閤性損傷,3例開放性損傷),橈側軸嚮骨摺與脫位3例(均為開放性損傷).1例閉閤性損傷患者觔膜室行切開減張、神經減壓、固定骨摺與脫位;4例開放性損傷患者清創、固定骨摺與脫位,一期脩複肌腱、神經,其中2例二期應用皮瓣脩複皮膚缺損;2例嚴重開放性損傷患者清創、固定骨摺與脫位,一期脩複肌腱、神經,二期由于感染等併髮癥而截肢. 結果 7例患者術後穫7～113箇月(平均77箇月)隨訪.根據中華醫學會手外科學會上肢部分功能評定試用標準評定療效:優1例,良2例,可1例,差3例.結論 創傷性腕部軸嚮骨摺與脫位是腕部損傷的一種特殊類型,其軟組織損傷程度遠大于骨與關節損傷程度.閉閤性損傷應預防骨觔膜間隔綜閤徵及腕管綜閤徵的髮生,開放性損傷應重視軟組織損傷的處理.
목적 탐토창상성완부축향골절여탈위적치료、병발증급예후. 방법 회고성분석2004년11월지2013년9월기간수치적7례창상성완부축향골절여탈위환자자료,남4례,녀3례;년령위34 ～ 48세,평균38.1세;좌측3례,우측4례.치상원인:제압상5례,압잡상2례.근거Garcia-Elias 분형:척측축향골절여탈위4례(1례폐합성손상,3례개방성손상),뇨측축향골절여탈위3례(균위개방성손상).1례폐합성손상환자근막실행절개감장、신경감압、고정골절여탈위;4례개방성손상환자청창、고정골절여탈위,일기수복기건、신경,기중2례이기응용피판수복피부결손;2례엄중개방성손상환자청창、고정골절여탈위,일기수복기건、신경,이기유우감염등병발증이절지. 결과 7례환자술후획7～113개월(평균77개월)수방.근거중화의학회수외과학회상지부분공능평정시용표준평정료효:우1례,량2례,가1례,차3례.결론 창상성완부축향골절여탈위시완부손상적일충특수류형,기연조직손상정도원대우골여관절손상정도.폐합성손상응예방골근막간격종합정급완관종합정적발생,개방성손상응중시연조직손상적처리.
Objective To discuss treatment, complications and prognosis of traumatic axial carpal fracture and dislocation.Methods A retrospective review was conducted of the 7 patients with traumatic axial carpal fracture and dislocation who had been treated from November 2004 to September 2013 at our department.They were 4 men and 3 women, aged from 34 to 48 years (mean, 38.1 years).Four of them had their right limb injured and 3 their left limb;5 had crushing injury and 2 crashing injury.According to the Garcia-Elias classification, 4 patients had axial ulnar injury (one closed and 3 open) and 3 patients open axial radial injury.One case of intact skin was treated by open reduction, internal fixation, nerve decompression and fasciotomy;4 cases of open injury underwent debridement, open reduction, internal fixation, one-stage repair of ligaments and nerves, 2 of whom needed an abdominal pedicle flap to resurface their defective skin;the other 2 cases of severe open injury had to receive secondary amputation due to complications after debridement, open reduction, internal fixation, one-stage repair of ligaments and nerves.Results Postoperative follow-ups ranged from 7 to 113 months (average, 77 months).According to the criteria proposed by the Hand Surgery Society of the Chinese Medical Association, functional recovery of the hand was rated as excellent in one case, good in 2 cases, moderate in one and poor in 3 cases.Conclusions Severity of soft tissue injury is much greater than that of bone and joint injury in traumatic axial carpal fracture and dislocation, a special type of wrist injury.Prevention of Osteofascial Compartment Syndrome and Carpal Tunnel Syndrome should be our first concern in the treatment of closed axial injury while our first attention should be paid to soft tissue injury in the treatment of open axial injury.
