四肢血管砂枪伤的早期诊断及治疗

Early diagnosis and treatment of shotgun vascular wound in extremities

目的 探讨砂枪致四肢血管损伤的早期诊断及治疗。 方法 2 1例四肢血管砂枪伤中腋部损伤 1例 ,上臂部损伤 2例 ,大腿部损伤 12例 ,膝部损伤 6例。枪伤射击距离在 0 .5～ 3m之间。伤后至入院时间除 1例为 6h外 ,其余均为 0 .5～ 2h。其中有 15例出现休克。 13例损伤后有典型的血管损伤表现 ,8例损伤后无典型血管损伤表现。全组进行彻底清创后 ,7例血管行端端吻合术 ,14例血管行自体静脉移植修复术。 结果 2 1例患者无一死亡 ,除 1例截肢外 ,其余 2 0例平均随访 2年 6个月 ,肢体均存活 ,仅 1例肢体后遗缺血性肌挛缩。 结论 四肢血管砂枪伤损伤严重 。

Objective To explore the early diagnosis and treatment of shotgun vascular wound in extremities. Methods Among 21 cases of gunshot vascular wound, the axillary wound was in one case, brachial wound in 2 cases, thigh wound in 12 cases, and knee wound in 6 cases. The firing distance was between 0.5 3 m. The time from injury to admission was between 0.5 2 h. Fifteen patients complicated by shock. Thirteen patients presented with the typical manifestation of vascular injury. After through debridement, 7 patients were treated by end to end anastomosis of the injured vessels, 14 by auto veins graft and repair. Results There was no death in this series. Except one patient who underwent amputation, the remaining 20 patients' limbs were alive after the average 2 years and 6 months of follow up. One patient had a sequela of myoarophy. Conclusions Shotgun vascular wound in extremities is severe and needs early management.