70例四肢砂枪伤的临床特点及救治体会

The Clinical Feature and Treatment Experience of 70 Cases of Patients with wounded Extremities By Sand-Gun

目的 研究砂枪伤的临床特点及不同于其它枪伤的损伤机制 ,探讨其救治方法。方法 选择 70例四肢砂枪伤合并血管、神经、骨骼、肌肉损伤者 ,复习总结其诊疗经验。结果 骨折合并血管神经损伤者 ,尽量争取一期坚强内固定 (2 2例 ,31.42 %)。血管损伤一期修复 ,予行修复或血管移植 (2 8例 ,40 %)。尽可能一期修复神经 (16例 ,2 2 .85 %)。取得了较好的临床效果。同时发现其临床经过凶险 ,救治困难、致残率高 ,死亡率高。 17例截肢 (2 4.2 8%) ,8例死亡 (11.42 %)。结论 笔者提出了“叠加损伤”概念解释不同于其它单一火器伤的临床特点。治疗上应尽快手术、固定骨折、修复血管。同时应遵循救命第一、保肢第二的原则。缩短手术时间 ,而术后功能锻炼及心理治疗亦十分重要。

Objective Study on the clinical feature of the wound by sand-gun and on the mechanisms of injures between the wound by sand-gun and others guns.Methods 70 cases of patients with the wound by sand-gun companied with injures of blood vessels,nerves,skeletens and muscles were selected in order to review and experience.Results The patients with fracture companied with injures of blood vessels and nerves were fixed in the first repair(22 cases,22.85%),the patients with the blood vessels injures in the first repair by repaired blood vessels transplantation(28 cases,40%),and the patients with nerves wound in the first repair(16 cases,22.85%).A good clinical effect was achieved.At the same time it was found that the patients were in a very dangerous state with difficult cure,highly disableand and high death rate.In the end 17 cases were amputated and 8 patients died.Conclusion 'Superposition injure'raised by the writer explains that the wound differs from pure one kind of firearm-wound.In treatment operation,fracture fixation and blood vessels repair should be made as soon as possible.At one time the principle'Save the life first,keep extremities second'should be carried out.Shortening the operation time,functional training after operation and mental treatment are very important.