汶川地震所致四肢骨与软组织开放损伤的处置体会

On-the-spot management of open trauma of bones and soft tissues in extremities: experience from Wenchuan earthquake

目的探讨在地震灾区现场处理地震所致四肢骨与软组织开放损伤的适当方法。方法在四川汶川地震灾区处理地震所致四肢骨与软组织开放损伤41例(49肢):Gustilo-Anderson I型3例(4肢),Gustilo-Anderson II型35例(41肢),Gustilo-Anderso IIIa型1例(2肢),Gustilo-Anderson IIIb型1例(1肢),Gustilo-Anderson IIIc型1例(1肢)。Gustilo-Anderson IIIa型及以下的伤口经双氧水-生理盐水-碘伏清洗,静脉点滴头孢曲松钠,石膏夹制动,分泌物消失后清创闭合伤口,12天后拆线。Gustilo-Anderson IIIb型及以上伤口经清洗、消毒、制动后转院。结果47例Gustilo-AndersonIIIa型及以下的伤口均愈合;2例Gustilo-Anderson IIIb型及以上伤口伤员失访。结论地震现场处理开放性骨和软组织伤口往往失去最佳处理时机。彻底清创和消毒伤口非常重要。针对具体情况采取适当措施能取得良好效果。

Objective To explore the proper on-the-spot management of open trauma of bones and soft tissues in extremities in earthquake disaster area. Methods 41 patients with open trauma of bones and soft tissues in 49 extremities caused by earthquake in Wenchuan, Sichuan province, 4 being Gustilo-Anderson type I, 41 being Gustilo-Anderson type Ⅱ, 2 being Gustilo-Anderson type Ⅲa, 1 being Gustilo-Anderson type Ⅲb , and 1 being Gustilo-Anderson type Ⅲc, were treated in the earthquake sites. Infusion route was established. The patients with Gustilo-Anderson types I, Ⅱ, and Ⅲa underwent cleansing with hydrogen peroxide-normal saline-povidone iodine, intravenous drip of ceftriazone, and gypsum fixation. Thorough debridement and suture were conducted after the disappearance of secretion. The stitches were removed in 12 days. Two limbs with wounds over Gustilo-Anderson type Ⅲb underwent cleansing, sterilization, bandaging, and gypsum fixation, and then the patients were referred to the hospitals nearby. Resu Its The 47 limbs with the wounds under Gustilo-Anderson type Ⅲb were all healed. The 2 limbs with the wounds over Gustilo-Anderson type Ⅲ were lost to follow-up. Conclusion The best opportunity to manage the open wounds in extremities is often missed in the earthquake area. Thorough debridement and sterilization are very important. Proper managements in accordance with the specific conditions of the wounded achieve good effects.