应用显微外科技术治疗手部高压注射伤

Treatment of hand high pressure injection injury by microsurgery

目的探讨急诊手术治疗、显微镜下清创及早期功能训练对手部高压注射伤治疗的重要性。方法回顾性分析2018年7月-2019年7月收治的12例手部高压注射伤患者的临床资料,均为高压枪或泵等高压设备注射致伤。行急诊手术治疗、显微镜下彻底清创,术后应用抗生素预防感染,术后2 d进行早期功能训练。结果10例伤口平均18 d愈合,1例术后不可控制的感染导致软组织坏死、缺损,行腹部皮瓣修复创面;1例就诊时已为伤后2 d,术后指体坏死,行残端修整术。随访6~18个月,末次随访依据手指总体主动活动度(TAM)系统评定法评价患指功能:优7例,良2例,可1例,差2例。结论高压注射伤因注射物质及注射量不同造成临床疗效差异较大,争取及时就诊、显微外科手术治疗、彻底清创及早期功能训练是治疗效果的关键。

Objective To explore the importance of emergency surgery,microscopic debridement and early exercise for the treatment of high-pressure injection injuries to the hand.Methods A retrospective analysis was made on the medical records of 12 patients with hand high-pressure injection injuries treated in our department from July 2018 to July 2019,all were injured by injection of high-pressure equipment such as high-pressure guns or pumps.Provided them emergency surgery and thorough debridement under the microscope,used of antibiotics to prevent infection after surgery,guided patients to perform early functional exercise 2 days after surgery.Results The wounds of 10 patients healed on average of 18 days,and the other 2 cases:1 case of uncontrollable infection caused soft tissue necrosis and defect,which was repaired with abdominal flap;1 case was treated 2 days after injury,Finger had necrosis after surgery,given Amputation.Follow-up was conducted for 6 to 18 months.The last follow-ups were based on the evaluation of the total active movement of the fingers(TAM)system to evaluate the function of the affected fingers:excellent in 8 cases,good in 3 cases,fair in 1 case and poor in 2 cases.Conclusion Large clinical differences are caused by high-pressure injection substance and injection volume.Going to the hospital as soon as possible,thorough debridement of microsurgical operation and early functional exercise are the key to the treatment effect.