326例儿童手外伤分析

Hand injury in children：a retrospective study of 326 cases

目的 了解本地区儿童手外伤的流行病学特征,为儿童手外伤的防治提供科学依据.方法 2004年6月至2009年6月4年间我院收治326例儿童手外伤患儿,对其病历资料及随访情况进行回顾性分析.结果 326例患儿中,男209例,女117例,男女比1.79：1.发病高峰年龄为幼儿期（1～3岁）,发病高峰时间为中午及16～20点.伤后8 h我院就诊率73.6%.受伤原因多为生活性,以锐器伤、挤压伤和砸伤为主,开放性损伤占92%.受伤部位以手指居多,掌部次之;受伤类型多以挫裂伤、擦挫伤为主.受累组织以单纯皮肤软组织受损及骨折多见,肌腱及神经受损次之.其中,行非手术治疗33例;单纯清创缝合的86例;骨折固定的81例;神经吻合的17例;行肌腱吻合的63例,植皮或者行皮瓣移植的28例;截肢或截指的12例;拔甲,甲床修补的45例;血管吻合的7例.术后感染率4.0%.治疗后优良率达91.2%.结论 儿童手外伤有其自身发病特点,幼儿期多发,生活性损伤多见,受伤程度大部分较轻,经早期恰当治疗预后多良好.应根据这些特点,加强监管,以降低发病率,同时重视儿童手外伤的及时恰当的治疗,可以获得较好的效果,提高生存质量.

Objective To review the epidemiology and therapeutics of hand injuries in children.Methods Between June 2004 and June 2009,the clinical data of 326 patients with hand injuries,who were admitted and treated in Chongqing Children＇s Hospital,were analyzed retrospectively.Results The 326 patients included 209 males and 117 females with a male to female ratio of 1.79.The majority of the patients were toddlers.Most injuries happened at noon or during 4pm to 8pm.Of these patients,73.6% visited hospital within 8 hours after injuries happened.Most accidents happened in daily life,such as sharp instrument injury,crush injury and bruise injury.Open injuries counted for 92% of all injuries.Fingers were mostly affected,and followed by palm.Laceration and Contusion were common injury patterns.Skin and soft tissue injury or bone fracture were more common than tendon or nerve injury.Of the 326 patients,33 underwent conservative treatments,86 underwent debridement and suturing,81 underwent bone fracture fixation surgery,17 underwent nerve anastomosis,63 underwent tendon anastomosis,28 underwent skin graft or skin flap transplantation,12 underwent limb or finger amputation,45 underwent nail removal surgery and nail bed reconstruction,7 underwent blood vessel anastomosis.Postoperative infection rate was 4.0%.Good outcomes were gained in 91.2% patients.Conclusions Children＇s hand injury has some unique epidemiological characteristics.Preventive actions should be carried out based on these characteristics to decrease the incidence of hand injury.Early treatments after injury are important to save more hand functions and improve patients＇life quality.