肢体高压注射伤的临床治疗

The treatment of high-pressure injection injures （HPII） of the extremity

目的 分析肢体高压注射伤的治疗和临床效果.方法 2011年6月-2013年1月,对4例肢体高压注射伤患者.均在伤后4h内给予清创,1例清创两次,以交臂皮瓣覆盖创面;1例清创三次,以游离植皮覆盖创面;1例清创一期闭合创口,术后创口感染皮肤缺损,以局部转移皮瓣覆盖创面;1例直接闭合创口.术后均给予系统康复治疗.结果 4例患者术后随访时间为5～24个月,均未出现肢体坏死,皮瓣及植皮全部成活.2例手部高压油漆注射伤患者术后均存在冷诱导综合征和指端感觉异常,按TAM系统法评定：优1指,良2指.2例足部高压水枪注射伤患者术后下肢负重、走路无异常,已重新回到工作岗位.结论 肢体高压注射伤是一种特殊类型的损伤,需要有经验的临床医师依据具体病情制定相应的治疗方案,要积极早期清创,及早闭创,早期进行康复治疗,降低肢体伤残率.

Objective To analyze the theatment and effect of 4 cases with high-pressure injection injures （HPII） of the extremity.Methods Four cases with HPII of the extremity were followed up.All cases were given surgical debridement in 4 hours.1 case was treated with secondary debridement and the skin defect was treated with cross arm flap.1 case was treated with third debridement and the skin defect was treated with free skin graft.2 case was treated with direct surgical sutrue,but 1 case with infected wound after sutrue,and was treated wih local transfer flap.All cases were given systemic rehabilitation after the operation.Results 4 cases were followed up for 4 months to 2 years.There were no limb necrosis.2 cases with HPII on hand complained cold intolerance and hypersensitivity.According to the ATM system,1 case was graded excellent,in 2 cases good.Conclusion HPII of the extremity was a special type of injury.It needs appropriate treatment programs developed by experinced clinicians according to specific conditions,positive early debirdement,early wound closure,and early rehabilitation therapy to reduce limb disability rate.