四肢异物显微镜下取出术

目的探讨四肢异物伤的特点并介绍显微镜下异物取出术。方法对四肢异物伤122例，通过X线摄片检查、采集病史和查体等明确诊断，分别采用直接取出术、切开取出术和显微镜下异物取出术三种方法治疗。结果122例153个异物均顺利取出，用时5～220min，平均用时58min。3例同时行断指再植术，再植指均成活。显微镜下异物弹道及周围组织分为弹道口、弹道区和异物区，由中心向外周弹道区可见组织断裂带、出血区、充血区和正常组织；异物区可见异物、出血区、充血区和正常组织。结论四肢异物伤经诊断明确均应考虑取出；非陈旧性和未探查过的四肢异物适用显微镜下异物取出术。

Removal of the foreign bodies in the extremities under microscope

Objective To explore the feature of the foreign body injury of the extremity and introduce the method of removal of the foreign body under microscope. Methods One hundred and twenty two cases of foreign body injury of the extremity ,from June 2000 to August 2005 ,were diagnosed by X-ray, disease history and physical examination. The foreign bodies were taken out directly, incised or under microscope, respectively. Results One hundred and fifty three foreign bodies of 122 cases were taken out successfully,the duration of operation ranged from 5 min to 220 min, mean 58 min. Fingers of 3 cases were replanted at the same time and all survived. Under microscope ,the trajectory of the foreign bodies consisted of a ballistic door, a ballistic area and a foreign body area. From center to side,the ballistic area included a splitting band, a bleeding area ,a hyperaemic area and normal tissue,while the foreign body area included the foreign body,a bleeding area, a hyperaemic area and normal tissue. Conclusion The foreign body in the extremity should be taken out as soon as the diagnosis is conformed. Microscope is suitable for the removal of foreign body in extremity which has not been wounded or incised before.