成年人手腕部高压电击伤的治疗

发布时间：2018-09-01 14:27

【摘要】：目的探讨采用早期预防性切开减张、负压引流等方法治疗手腕部高压电击伤的临床效果。方法选取2010年2月至2012年11月入住吉林大学第一医院烧伤外科的15例手腕部电击伤患者,年龄为16~60岁,均伴有不同程度的肌腱、神经、血管、骨骼损伤或外露,对15例伴有严重皮肤缺损的高压电击伤创面进行适当清创,早期切开减张,一期采用自制负压封闭式引流技术结合高渗糖,控制感染,伤后10~28 d,二期行刃厚皮游离移植修复创面。评价指标:多普勒超声检查桡动脉、尺动脉血流;感觉评价;腕关节功能评价。结果 11例患者创面肉芽组织新鲜,行刃厚皮游离移植修复创面。4例患者刃厚皮游离移植后部分成活,经7~14 d换药后创面修复。15例患者经多普勒超声检查桡动脉、尺动脉血流通畅,与健侧无明显差异;根据感觉评价标准,5例患者手部感觉评定为S3~S3+,10例患者为S3+~S4;根据腕关节功能评价标准,本组7例患者手部功能评价为良,8例患者为优。结论手腕部高压电击伤创面早期预防性切开减张,结合自制负压封闭式引流,通过自体刃厚皮游离移植治疗后能够较好地修复创面,提高手腕部功能。
[Abstract]:Objective to investigate the clinical effect of early preventive incision and negative pressure drainage in the treatment of high voltage electric shock injury of wrist. Methods from February 2010 to November 2012, 15 patients with electric wrist injuries, aged 16 to 60 years, were admitted to the Department of Burn surgery in the first Hospital of Jilin University. All patients were accompanied with tendon, nerve, blood vessel, bone injury or exposure to different degrees. 15 cases of high pressure electric shock wound with severe skin defect were treated with proper debridement, early incision and reduction of tension. The infection was controlled by self-made closed drainage with negative pressure combined with hyperosmotic sugar in one stage. Ten and twenty eight days after injury, the second stage was treated with free grafts of blade and thick skin to repair the wounds. Evaluation measures: Doppler ultrasound examination radial artery, ulnar artery blood flow; sensory evaluation; wrist function evaluation. Results the granulation tissue of 11 patients was fresh, and the partial survival of free grafts was observed in 4 patients. After 714 days of dressing change, the radial artery was examined by Doppler ultrasound in 15 patients. The blood flow of ulnar artery was patency, and there was no significant difference between the normal side and ulnar artery, according to the sensory evaluation criteria, 5 cases were assessed as S3~S3 and 10 cases as S3 S4, according to the wrist function evaluation standard, 8 cases of good hand function were excellent according to the evaluation criteria of wrist joint function. Conclusion early prophylactic incision and tension reduction combined with self-made negative pressure closed drainage can repair the wound and improve the function of wrist after the treatment of free autogenous skin grafting.
【作者单位】：吉林大学第一医院烧伤外科;
【基金】：吉林省科技发展计划项目(200905132)
【分类号】：R647

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