Ingari John V, Powell Elisha
Tripler Army Medical Center Honolulu, Hawaii, USA.
Tech Hand Up Extrem Surg. 2007 Jun;11(2):130-4. doi: 10.1097/bth.0b013e3180312738.
This study is a retrospective analysis of the orthopaedic care rendered to Iraqi citizens, both military and civilian, and detainees in Balad, Iraq, at an Air Force theater hospital. Defining the scope of care for this patient group and emphasizing the differences in care provided for the endemic population in contrast to the rapidly air-evacuated Coalition injured combatant are the primary focus of the study. Approximately 50% of more than 1600 trauma/combat-related injury admissions to Air Force Theater Hospital in Balad, Iraq, from the period of September 2, 2005 through January 18, 2006, were Iraqi citizens and detainees. The care rendered to this population differed from the care given to a rapidly air-evacuated patient in that definitive care of all combat wounds, including fracture care and soft tissue management, was the responsibility of the deployed surgeons. Open reduction and internal fixation, definitive debridement, Wound VAC placement (Vacuum-Assisted Closure Device; KCI International, San Antonio, Tex), and final soft tissue management were performed at Air Force Theater Hospital. All patients were treated according to their injuries, including detainees, who received the same level of care as any other injured patient. This article will depict examples of the civilian and detainee orthopaedic care available and performed in a war zone and how that care differed from that rendered to a rapidly evacuated American combatant. Injured Coalition combatants received high-level damage control orthopaedic care and initial debridements, with external fixation as the single most common means of long-bone fracture stabilization. Civilians and detainees seen at Balad received the same high-level care and much, if not all, of their definitive care while at Air Force Theater Hospital. The care rendered to Iraqi citizens and detainees at an Air Force theater hospital is described, with multiple case examples that reflect a high level of definitive care offered in a war zone.
本研究是对在伊拉克巴拉德的空军战区医院接受骨科治疗的伊拉克公民（包括军人和平民）及被拘留者的回顾性分析。确定该患者群体的护理范围，并强调为当地居民提供的护理与迅速空运后送的联军受伤战斗人员所接受护理的差异，是本研究的主要重点。在2005年9月2日至2006年1月18日期间，超过1600例因创伤/与战斗相关损伤而入住伊拉克巴拉德空军战区医院的患者中，约50%为伊拉克公民和被拘留者。给予这一群体的护理与给予迅速空运后送患者的护理不同，因为所有战伤的确定性治疗，包括骨折护理和软组织处理，均由部署的外科医生负责。切开复位内固定、确定性清创、放置伤口负压封闭引流装置（Vacuum-Assisted Closure Device；KCI International，圣安东尼奥，得克萨斯州）以及最后的软组织处理均在空军战区医院进行。所有患者均根据其伤势接受治疗，包括被拘留者，他们获得与其他受伤患者相同水平的护理。本文将描述在战区提供和实施的平民及被拘留者骨科护理的实例，以及该护理与给予迅速后送的美国战斗人员的护理有何不同。受伤的联军战斗人员接受了高级损伤控制骨科护理和初始清创，外固定是长骨骨折稳定的最常见单一手段。在巴拉德见到的平民和被拘留者在空军战区医院接受了相同的高级护理以及大部分（如果不是全部）确定性护理。本文描述了在空军战区医院给予伊拉克公民和被拘留者的护理，并列举了多个案例，这些案例反映了在战区提供的高水平确定性护理。
