严重车柄撞击交通伤的特点和诊治策略

The characteristics and strategy of diagnosis and emergency treatment of handle collision injury in serious traffic accident

目的分析严重车柄撞击交通伤的特点，探讨其诊疗对策。方法对42例严重车柄撞击伤患者的临床资料进行回顾性分析。胸部损伤19例中肋骨骨折16例和／或胸骨骨折8例，合并心脏损伤9例，血气胸15例；腹部损伤23例中胰十二指肠损伤16例，合并脾脏损伤3例、空肠破裂2例、胃破裂和膈肌破裂1例，单纯膈肌损伤7例。结果24h内确诊23例，漏诊2例。全组急诊手术22例，延迟手术20例，其中二次手术1例。治愈40例，治愈率95．2％。死亡2例，死亡率4．8％。结论对遭受车柄严重撞击患者要特别警惕胸腹部损伤的隐匿性和危险性，其中心脏，胰十二指肠及膈肌损伤有极高的发生率，及时、准确地发现病情并积极手术治疗，可获得较高的救治成功率。

Objective To explore the characteristics and strategy of diagnosis and emergency treatment of handle collision injury in serious traffic accident. Methods The clinical data of 42 cases of handle collision injury in serious traffic accident were analyzed retrospectively. In the 19 cases with thorac- ic injury, 16 cases had rib fracture,8 had sternum fracture ,9 had cardiac trauma, and 15 had hemothorax. In the 23 cases of abdominal damage, 16 case had panereatoduodenal injury ,3 had spleen injury,2 had je- junum perforation, 1 had gastric and diaphragmatic rupture, and 7 had diaphragmatic rupture only. Results A total of 23 cases were made a definite diagnosis and 2 eases were missed diagnosis within 24 hours after admission. Emergency operation were carried out in 22 cases and selective operation in 20 cases. One case had operation for two times. As a result ,40 cases were cured and the cure rate was 95.2% ; 2 patients died and the mortality was 4.8%. Conclusion For patients with handle collision injury in serious traffic acci- dent, special emphasis should be laid on the hidden and threatening injury of the chest and abdomen. The incidence rates of heart, pancreatoduodenal and diaphragmatic injuries are high. The accurate, well-timed findings of patientg condition and active operation treatment can allow a higher success rate.