严重碾挫挤压伤肢体超出救治时限的处理策略及疗效

The treatment strategy and effect of severe crushing injury of limbs beyond the treatment time limit

目的探讨缺血超出救治时限(≥8 h)的严重碾挫挤压伤患肢的治疗对策和疗效。方法保肢救治20例严重碾挫挤压伤肢体缺血时间超出救治时限的患者,记录保肢情况以及伤肢功能恢复情况。结果19例患者保肢成功,1例截肢。患者均获得随访,时间20~36个月。19例保肢成功的患者中,末次随访时10例创面皮肤感觉及相邻关节活动良好,9例遗留不同程度的功能障碍。9例合并关节损伤的患者中,末次随访时5例关节功能良好,4例遗留不同程度的功能障碍。结论对于缺血超出救治时限的严重碾挫挤压伤患肢在注重维系患者生命体征稳定安全的前提下应行保肢治疗。延迟性修复血管损伤的同时,还应处理好神经、复杂软组织损伤、骨折等,尤其注意预防骨筋膜室综合征的发生,才可获得肢体功能较好康复。

Objective To investigate the therapeutic strategies and effects of severe crushing injury of affected limbs with ischemia beyond the time limit of treatment(≥8 h).Methods The 20 patients who were suffered from severe crushing of affected limbs with ischemia beyond the time limit of treatment were treated with limb salvage,and the condition of limbs salvage,functional recovery of injured limbs were recorded.Results The 19 patients were successfully rescued and 1 patient was amputated.All patients were followed up for 20~36 months.At the last follow-up,among the 19 patients with successful limb salvage,10 cases had good skin sensation and adjacent joint movement and 9 cases had different degree of dysfunction.Of the 9 patients with joint site injuries,5 cases had good joint function at the last follow-up,and 4 cases had different degree of dysfunction.Conclusions On the premise of maintaining the stability and safety of patients′vital signs,limb salvage therapy should be performed for patients of the defected limbs severe crushing injury with ischemia beyond the treatment time.At the same time of delayed repairing of vascular injury,nerve,complex soft tissue injury and fracture should be well treated,especially to prevent the occurrence of osteofascial compartment syndrome,the better limb function recovery can be obtained.