Burg Alon, Nachum Galit, Salai Moshe, Haviv Barak, Heller Snir, Velkes Steven, Dudkiewicz Israel
Department of Orthopedic Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel.
Isr Med Assoc J. 2009 Sep;11(9):546-51.
Gunshot wounds impose a continuous burden on community and hospital resources. Gunshot injuries to the extremities might involve complex soft tissue, bone, vascular, musculotendinous, and nerve injuries. A precise knowledge of anatomy is needed to evaluate and treat those injuries.
To review our experience with gunshot wounds to the extremities.
We retrospectively reviewed all civilian cases of gunshot wounds to the limbs treated in our institution during 2003-2005. Altogether, we evaluated 60 patients with 77 injuries.
Of the 60 patients 36 had fractures, 75% of them in the lower extremity and 81% in long bones. The most common fixation modality used was external fixation (33%), followed by intramedullary nailing (25%). This relatively high percentage of fracture treated with external fixation may be attributed to the comminuted pattern of the fractures, the general status of the patient, or the local soft tissue problems encountered in gunshot wounds. About one-fifth of the fractures were treated by debridement only without hardware fixation. We treated 10 vascular injuries in 8 patients; 6 of them were injuries to the popliteal vessels. Fractures around the knee comprised the highest risk factor for vascular injuries, since 5 of the 12 fractures around the knee were associated with vascular injury requiring repair or reconstruction. There were 13 nerve injuries (16.8%), most of them of the deep peroneal nerve (38%). Only three patients had concomitant nerve and vascular injuries. The overall direct complication rate in our series was 20%.
To successfully treat complex gunshot injuries a team approach is necessary. This team should be led by an orthopedic surgeon knowledgeable in the functional anatomy of the limbs.
枪伤持续给社区和医院资源带来负担。四肢枪伤可能涉及复杂的软组织、骨骼、血管、肌腱和神经损伤。评估和治疗这些损伤需要精确的解剖学知识。
回顾我们治疗四肢枪伤的经验。
我们回顾性分析了2003年至2005年在我院治疗的所有四肢枪伤的 civilian 病例。总共评估了60例患者的77处损伤。
60例患者中，36例有骨折，其中75%位于下肢，81%位于长骨。最常用的固定方式是外固定（33%），其次是髓内钉固定（25%）。外固定治疗骨折的比例相对较高，可能归因于骨折的粉碎模式、患者的一般状况或枪伤中遇到的局部软组织问题。约五分之一的骨折仅通过清创治疗，未进行内固定。我们治疗了8例患者的10处血管损伤；其中6例是腘血管损伤。膝关节周围骨折是血管损伤的最高危险因素，因为膝关节周围12处骨折中有5处伴有需要修复或重建的血管损伤。有13例神经损伤（16.8%），其中大多数是腓深神经损伤（38%）。只有3例患者同时有神经和血管损伤。我们系列中的总体直接并发症发生率为20%。
要成功治疗复杂的枪伤，团队协作是必要的。该团队应由熟悉四肢功能解剖学的骨科医生领导。
