严重多发锐器伤伴断肢（指）损伤的控制治疗

Damage control of severe limb（finger） with multiple injuries

目的探讨损伤控制原则在严重多发锐器伤伴断肢（指）救治中的临床应用。方法对多发伤损伤40例．严重度评分（ISS）≥16分者，其中伴断腕11例、断掌9例、断指9例、前臂离断8例、肘部离断3例。在多科协作积极救治多发伤的同时，清创离断肢（指）体，一期行断肢（指）再植，术后待病情稳定后，早期进行肌腱修复。结果临床治疗40例，再植肢（指）全部成活，术后随访0．5～3．0年，根据断肢再植功能评定标准评定：优8例，良21例，中7例，差4例，优良率为72．5％。结论多科合作、早期救治多发伤，应用显微外科技术是提高多发伤伴断肢（指）再植成功率的关键。

Objective To explore the strategy of damage control in clinic treatment of severe limb （finger） with muhiple injuries. Methods Severe muhiple injuries patients with ISS evaluation more than 16 points were chosen for this study. Simple replatations of severed limb （finger） were perfored in 40 patients while their multiple injuries were actively treated. Results Among the 40 cases, all cases survived. 1-3 years follow-up showed that the results were excellet in 8, good in 21, middle in 7, and poor in 4, with an excellent or good rate of 72.5 percent. Conclusion Multiple specialties cooperation, early treatment of multiple injuries and experienced microsurgery operation are the keys to improve success rate of replantation of severed limb（linger） with multiple injuries.