骨关节多发性创伤的流行病学分析

目的探讨多发性骨关节损伤的流行病学特点,以提高创伤的防治认识和救治质量,减少死亡率。方法总结2002年1月1日～2004年12月31日间救治的346例多发性骨关节损伤患者资料,按蔡氏法分类,统计分析患者性别、年龄、伤因、部位、数量、并发伤及死亡率。结果346例患者中,男278例,女68例；年龄9个月～89岁,平均32．8岁。致伤原因：交通伤226例,重物压砸伤65例,坠落伤及跌伤52例。胫、腓骨干骨折159处,股骨干骨折96处,尺、桡骨干骨折87处,踝足骨折58处,胸部伤57处,髋和膝部伤分别为50处,骨盆区损伤49例,腕手部伤46处,肩部伤36处,颅骨骨折36处,肱骨干骨折33处,脊柱骨折23处,肘部伤17处。2处伤者242例,3处伤83例,4处伤20例,6处伤1例,平均受伤部位2．3处。闭合伤205例,开放伤141例；合并颅脑伤51例,胸部伤23例,腹部伤5例,泌尿系损伤3例,休克78例,神经血管伤21例,脂肪栓塞6例。死亡5例。结论近年来,多发性骨关节损伤患者有增多趋势,且伤情较重,男性青壮年居多；交通伤是主要致伤原因；四肢多发伤以下肢伤为多,容易发现及确诊,而脑、胸、腹、盆部的闭合伤多易漏误诊治；近年来死亡率明显减少；加强急救创伤救治培训和安全教育,进一步提高医疗质量,可减少残废和死亡率。

An epidemiological study on multiple-injuries of bone and joint

Objective To investigate the epidemiological characteristics of multiple-injuries of bone and joint in the belief that a better knowledge of such injuries may help their prevention and treatment. Methods A retrospective study was done on the data of 346 patients with multiple-injuries of bone and joint who had been ad- mitted to our department from January 2001 to December 2004. On the basis of CAI's classification, the following data were statistically analyzed: gender, age, cause of injury, injured part, number of injured parts, associated injuries and mortality. Results Of the 346 injured patients, there were 278 males and 68 females, with an av- erage age of 32.8 years (9months to 89 years). Two hundred and twenty-six cases resulted from traffic accidents, 65 from crush by a heavy object, and 52 from falling. There were 159 fractures of shaft of tibia and fibula, 96 fractures of femoral shaft, 87 fractures of shaft of ulna and radius, 58 fractures of ankle and foot, 57 chest injuries, 50 knee injuries, 50 hip injuries, 49 injuries at the pelvis region, 46 wrist and hand injuries, 36 injuries of shoulder, 36 skull fractures, 33 fractures of humeral shaft, 23 spinal fractures, and 17 elbow injuries. Two hundred and forty-two patients had two parts injured, 83 had three parts, 20 had four parts, and one had six parts. The average number of injured parts was 2.3. Two hundred and five patients suffered from close injuries, and 141 from open ones. The associated injuries included skull and brain injury in 51 cases, chest injury in 23, abdomen injury in five, urine system injury in three, nerve and vessel injury in 21, shock in 78, and fat embolism in six. Five patients died. Conclusions Male young people tend to be the majority of victims of multiple-injuries of bone and joint. Traffic accidents result in most of such injuries. Since multiple-injuries mostly involve lower limbs, they are easy to diagnose while the associated close injuries involving brain, chest, abdomen and pelvic are likely to be overlooked or misdiagnosed. Strengthening safety education and technical training of first aid is important to im- provement of treatment and to decrease of disability rate and mortality.