Covey D C, Lurate R B, Hatton C T
Department of Orthopaedic Surgery, Naval Hospital, Bremerton, Washington 98312-1898, USA.
J Orthop Trauma. 2000 May;14(4):278-86; discussion 277. doi: 10.1097/00005131-200005000-00010.
The spectrum of wounding and treatment of forty-one patients with musculoskeletal blast injuries at a U.S. military field hospital in the former Yugoslavia was reviewed. Patients underwent wound exploration, irrigation, debridement, broad-spectrum antibiotic therapy, early fracture stabilization, and appropriate reconstructive surgery. Four patients developed wound infections. Two patients died as a result of their injuries (overall mortality 5 percent). There were three below-knee amputations and five other amputations (above-knee, ankle, midtarsal, partial forefoot, and finger). Three patients sustained lumbar burst fractures from mines that exploded under their vehicles, resulting in paraplegia in one case. Our patients underwent 112 surgical procedures, an average of 2.1 per patient. Twenty-two patients (54 percent) had other injuries or conditions in addition to their orthopaedic wounds. There were wide variations in the bone and soft tissue injuries caused by detonating ordnance, and the tissue damage was qualitatively different from that caused by gunshot wounds. Early debridement, leaving wounds open, and treatment with broad-spectrum antibiotics were important factors in wound healing to allow subsequent successful reconstructive surgery in an austere field setting.
对前南斯拉夫一家美国军事野战医院收治的41例肌肉骨骼爆炸伤患者的创伤情况及治疗过程进行了回顾。患者接受了伤口探查、冲洗、清创、广谱抗生素治疗、早期骨折固定以及适当的重建手术。4例患者发生伤口感染。2例患者因伤死亡（总死亡率5%）。有3例膝下截肢以及5例其他截肢（膝上、踝关节、中跗骨、部分前足和手指）。3例患者因车辆下方地雷爆炸导致腰椎爆裂骨折，其中1例导致截瘫。我们的患者共接受了112次外科手术，平均每位患者2.1次。22例患者（54%）除了骨科伤口外还伴有其他损伤或病症。爆炸弹药造成的骨骼和软组织损伤差异很大，且组织损伤在性质上与枪伤所致不同。早期清创、伤口开放以及广谱抗生素治疗是伤口愈合的重要因素，以便在艰苦的野战环境中后续能够成功进行重建手术。
