手部外伤性异物的治疗体会

目的探讨手部外伤性异物取出术中易忽略的几个问题。方法 10年来对126例手部外伤性异物患者进行了异物取出术。术前、术后均行X线检查,部分患者术前行B超检查。术后随访时间为1~8个月。结果 65例甲下异物患者中,18例行拔甲后,新生指甲欠平整,外形欠佳;47例采用了指甲部分切除,术后指甲生长良好。1例鱼刺伤异物取出(2枚)术后X线复查,仍可见1枚异物残留。1例患者长期(2年以上)针状异物存留,致生锈,取出时断裂。15例仙人掌刺伤异物患者,取出术后有5例局部仍有红肿症状。2例火药爆炸伤患者中,有1例术后经X线复查仍有部分异物残留并导致局部感染。结论甲下异物取出时应尽量避免拔甲,以免甲床长期暴露而变得毛糙,造成指甲畸形;金属异物存留时间较长时间者,取出时应尽可能与周围软组织同时切除,避免异物断裂;对于仙人掌刺存留患者,术中应扩大切除范围;火药爆炸伤应清创彻底。

The Clinical Experience in Treatment of Traumatic Foreign Bodies on Hands

Objective To investigate some neglected problems in treatment of traumatic foreign bodies on hands. Methods Foreign bodies were removed on 126 cases which were checked by X-ray before and after operation in recent ten years. Some were checked by ultrasound before operation. All the patients were followed for 1 to 8 months. Results There were 65 cases with foreign bodies under nail. Among them, 18 cases had rough nails after nail extraction and others had good shaped nails after partial resection of nail. Foreign body with foreign body-fish bones was remained after extraction in 1 case. One needle foreign body remaining over 2 years and getting rusty was fractured in operation. In the 15 cases punctured by cactus, 5 cases got swelling after operation. One of two explosive injury cases remained some foreign bodies after operation and caused infection. Conclusion Cases with foreign bodies under nail should avoid nail extraction in case of crude nail bed and deformation nail. Metallic foreign bodies with long persistence should be removed with surrounding soft tissue in case of fracture of metallic foreign body. A wide debridement is necessary when the hand was punctured by cactus and a thorough debridement is needed after explosive injury by gunpowder.