足部挤压撕脱伤的治疗(附38例报告)

Treatment of Crush and Laceration of the Foot (Report of 38 Cases)

目的：强调足部挤压撕脱伤，特别是软组织损伤，早期及时正确处理的重要性．方法：系统回顾1994年1月～1996年10月间收治入院的足部挤压撕脱伤38例（41个足），15例应用克氏针内固定，3例做了2期游离皮片移植，9例做了截趾手术．结果：38例（41个足）创面意合，行走功能恢复，结论：足部挤压撕脱伤系由高速度、高冲击力所致的高能量损伤，伤情差异大，但也有其共同特点、共同病理特征，强调清创的及早和彻底，着重软组织愈合的重要性，选用最简单，创伤最小的克氏针做内固定，伤口闭合强调无张力性，对无法闭合的创面采用游离皮片移植，抗生素早期联合应用以防感染．

Object: To emphasize that early and correct treatment, especially soft-tissue management, of crush and laceration of the feet is important ot rebuild the function of the feet. Method:Between Jan. 1994 and Oct. 1996, 38 cases, with crush and laceration of the feet (41 feet ) were revewed. Of 41 feet, in 15 feet were used Kirschner wires to stabilize the fracture and dislocation. Skin grafting was done in 3 cases to close the wounds. One or several toes were cut because of necriosis.Result: Of 41 feet, the wounds of all feet healed and the function of the feet recovered. Conclusion:Crush and laceration of the foot is high-speed, high-impact, high-energy injury. The medical conditions of the patients are quite different, but they have common pathologic changes. Based on them. we emphasize that debridment must be early and correct. Internal fixation must be simple to avoid damaging the soft-tissues, and we think that Kirschner wire is the best choice. Primary closure must be done without tension. If too much tissue loss. free thickness skin graft is a good choice. And broad-spetrum antibiotics are necessary to reduce the infection rate.