手部高压注射伤的诊断和治疗

目的 总结6例手部高压注射伤的诊治体会.方法 分析1997年5月-2007年10月,6例手部高压注射伤的病情特点和治疗效果.6例患者均为男性;受伤部位分别为示指2例,中指2例,拇指1例,手掌1例;注射物质均为油漆;就诊时间为伤后1 h至2 d.所有病例2～24 h给予清创治疗,2例直接闭合创口,3例清创2次,1例清创3次,后4例以逆行掌背动脉或骨间后动脉皮瓣覆盖创面.术后给予系统康复治疗.结果 6例术后随访7个月至6年,均未出现手指坏死.4例皮瓣完全存活,创口愈合时间为术后17～35 d.全部患者术后1～3年内伤指均有冷诱导综合征和指端感觉异常.4例重新回到了工作岗位,平均时间为术后1.7年.术后4年2例伤指及相邻手指掌指和指间关节僵硬,主、被动活动能力下降.结论 手部高压注射伤是一种严重的复杂损伤,此种损伤对手部未来的功能和重返工作有较为明显的影响.应依据伤情的严重程度制定规范性的个性化治疗方案.

Diagnosis and surgical treatment of high-pressure injection injuries(HPII)of the hand

Objective To analyze the diagnosis and surgical treatment of 6 cases of high-pressure injection injuries (HPII) of the hand. Methods Six cases of high-pressure injection injuries to the hand treated from May 1997 to October 2007 were reviewed. The characteristics and treatment outcome were analyzed. ALl of these patients were male. Injured sites included index finger in 2 cases, middle finger in 2 cases, thumb in 1 case, and palm in 1 case. Oil varnish was injected in all patients. The time of admission to the hospital after trauma was 1 hour to 2 days. All cases were given surgical debridement, 2 cases were treated with direct surgical suture, 3 with secondary debridement, 1 with a third debridement. The last 4 cases with skin defect were treated with the reverse island flap pedicled on dorsal metacarpal artery and posterior interosseous artery. All cases were given systemic rehabilitation after the operation. Results All cases were followed up for 7 months to 6 years. Necrosis of finger didnt occur in any patient, and all 4 flaps survived completely. The healing time was 17 -35 days. All the patients complained cold intolerance, hypersensitivity and paresthesia within 1 -3 years after the operation. Four patients returned to their previous employment at an average 1.7 years postoperatively. Joint stiffness of the affected finger and its neighboring fingers occurred in 2 patients at postoperative year 4. Conclusion This study confirms the fact that high- pressure injection injury to the hand is a significant problem. The injury has significant impact on future function and reintegration into the work force. Standardization of the treatment regimen should be designed based on the severity of HPII.