机动卫勤分队救治战伤骨折、骨缺损感染的策略探讨

Strategy for treating fracture and bone defect infection in war injury by mobile medical detachment

目的:探讨机动卫勤分队救治战伤骨折、骨缺损的策略,以降低感染率。方法:采用文献分析法,分析高能量战伤导致的开放性骨折、骨缺损感染的特点及治疗方法,并充分借鉴外军经验梳理我军现行条件下战术战伤救治阶段可行的治疗方案。结果:战伤骨折、骨缺损感染的致残率较高,为机动卫勤分队手术救治带来了挑战。传统的清创、缝合、外固定对于该伤情的处置尚有待提升,抗生素骨水泥在战伤开放性骨折、骨缺损救治中具有明显优势。结论:抗生素骨水泥占位器具有药物用量小、局部浓度高、维持时间长、药物毒副作用小等优点。骨水泥作为膜诱导技术的一环,在战伤开放性骨折、骨缺损清创后置入中起到了支撑骨折端“内稳定”的作用,为该领域战伤救治提供了有效方法。

Objective:To explore the strategy for treating fracture and bone defect infection in war injury by mobile medical detachment,and to reduce the infection rate.Methods:Through literature analysis method,the characteristics and treatment of open fracture and bone defect infection casued by high-energy combat injuries were analyzed.Drawing lessons from foreign experience,the feasible disposal scheme of tactical combat casualty care in our army under the current condition was sorted out.Results:The disability rate of fracture and bone defect infection was higher in war injury,which brought a challenge to the surgical treatment strategy of mobile medical detachment.Traditional treatment strategies of debridement,suture and external fixation still need to be improved.Antibiotic bone cement had obvious advantages in the treatment of open fractures and bone defect infection caused by war injuries.Conclusion:Antibiotics bone cement spacer has the adventages of small dosage of antibiotics,high local concentration,long maintaining time,low toxic and side effects.As part of an induced membrane technique,bone cement is placed after open fractures and bone defect debridement of war injury,which also plays a role of internal stability in supporting the fracture,and provide an effective method in treating combat casualty care.