Chappell J E, Mitra A, Weinberger J, Walsh L
Temple University Hospital, the Department of Surgery, Philadelphia, PA 19140, USA.
Ann Plast Surg. 1999 Apr;42(4):418-23. doi: 10.1097/00000637-199904000-00012.
Low-velocity firearms represent the majority of civilian gunshot wounds to the hand, yet much of the literature is based on high-velocity injuries. The authors reviewed their treatment regimen for civilian gunshot wounds to the hand and offer a treatment algorithm that emphasizes early debridement and fracture stabilization. They also address the economic impact on society. The authors reviewed 121 fractures in 90 patients with gunshot wounds to the hand treated at an urban trauma center during the last 5 years. All patients were managed with irrigation and debridement, elevation, intravenous antibiotics, and early fracture stabilization. Sixty fractures were managed with rigid internal or external fixation: Kirshner wires (26%), miniplates (16%), and external fixation (8%). Fifty-six fractures were managed with closed reduction. Five fractures required amputation. There was one subsequent infection and two late amputations. The cost of hospitalization and operative care was more than $1.7 million. For gunshot wounds to the hand the authors advocate immediate irrigation and debridement, intravenous antibiotics, early fracture stabilization, and a low threshold for internal fixation. This regimen is supported by their low infection and complication rates.
低速火器伤占手部平民枪伤的大多数，但许多文献是基于高速损伤的。作者回顾了他们对手部平民枪伤的治疗方案，并提供了一种强调早期清创和骨折固定的治疗算法。他们还探讨了对社会的经济影响。作者回顾了过去5年在一家城市创伤中心治疗的90例手部枪伤患者的121处骨折。所有患者均接受冲洗清创、抬高患肢、静脉使用抗生素以及早期骨折固定治疗。60处骨折采用坚强内固定或外固定治疗：克氏针（26%）、微型钢板（16%）和外固定（8%）。56处骨折采用闭合复位治疗。5处骨折需要截肢。有1例继发感染和2例晚期截肢。住院和手术治疗费用超过170万美元。对于手部枪伤，作者主张立即冲洗清创、静脉使用抗生素、早期骨折固定以及较低的内固定阈值。他们的低感染率和并发症发生率支持了这一治疗方案。
