Wolf Jennifer Moriatis, Bucknell Allan
Department of Orthopaedic Surgery, University of Colorado-Denver, 12631 E. 17th Avenue, Room 4602, Aurora, Colorado 80045, USA.
Mil Med. 2010 Oct;175(10):742-4. doi: 10.7205/milmed-d-10-00025.
We present a case in which arthroscopy was used to remove foreign body debris secondary to an improvised explosive device (IED) from the wrist. The patient had noted pain for 6 months after sustaining multiple injuries after an IED detonation near the armored car in which he was traveling. He had pain on examination at the ulnar fovea with palpation and palpable clunking with forced ulnar deviation. Radiographs showed multiple small metallic objects scattered throughout the soft tissues, with one larger intra-articular object in the wrist. Metallic objects in joints can cause lead toxicity, chondral injury, and inflammatory reaction or abscess. Minimally invasive surgical treatment was proposed with the goals of further joint evaluation and excision of the metallic debris. Arthroscopic removal of the foreign body and repair of the triangular fibrocartilage complex resolved the patient's symptoms, and he had improved function at final follow-up at 22 months.
我们报告一例使用关节镜从腕部清除简易爆炸装置（IED）所致异物碎片的病例。患者在乘坐装甲车时遭遇IED爆炸，多处受伤后持续疼痛6个月。检查时，其尺骨凹处触诊疼痛，强迫尺侧偏斜时可触及弹响。X线片显示多个小金属物体散在分布于整个软组织中，腕关节内有一个较大的物体。关节内的金属物体可导致铅中毒、软骨损伤、炎症反应或脓肿。我们提出采用微创外科治疗，目的是进一步评估关节并切除金属碎片。关节镜下清除异物并修复三角纤维软骨复合体解决了患者的症状，在22个月的最终随访时其功能得到改善。
