Belmont Philip J, Thomas Dimitri, Goodman Gens P, Schoenfeld Andrew J, Zacchilli Michael, Burks Rob, Owens Brett D
Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
J Trauma. 2011 Jul;71(1):E1-7. doi: 10.1097/TA.0b013e3181edebed.
A prospective, longitudinal analysis of musculoskeletal combat injuries sustained by a large combat-deployed maneuver unit has not previously been performed.
A detailed description of the musculoskeletal combat casualty care statistics, distribution of wounds, and mechanisms of injury incurred by a US Army Brigade Combat Team during "The Surge" phase of Operation Iraqi Freedom was performed using a centralized casualty database and an electronic medical record system.
Among the 4,122 soldiers deployed, there were 242 musculoskeletal combat wounds in 176 combat casualties. The musculoskeletal combat casualty rate for the Brigade Combat Team was 34.2 per 1,000 soldier combat-years. Spine, pelvis, and long bone fractures comprised 55.9% (33 of 59) of the total fractures sustained in combat. Explosions accounted for 80.7% (142 of 176) of all musculoskeletal combat casualties. Musculoskeletal combat casualty wound incidence rates per 1,000 combat-years were as follows: major amputation, 2.1; minor amputation, 0.6; open fracture, 5.0; closed fracture, 6.4; and soft-tissue/neurovascular injury, 32.8. Among musculoskeletal combat casualties, the likelihood of a gunshot wound causing an open fracture was significantly greater (45.8% [11 of 24]) when compared with explosions (10.6% [15 of 142]) (p = 0.0006). Long bone amputations were more often caused by explosive mechanisms than gunshot wounds.
A large burden of complex orthopedic injuries has resulted from the combat experience in Operation Iraqi Freedom. This is because of increased enemy reliance on explosive devices, the use of individual and vehicular body armor, and improved survivability of combat-injured soldiers.
此前尚未对大规模作战部署机动部队所遭受的肌肉骨骼战伤进行前瞻性纵向分析。
利用集中伤亡数据库和电子病历系统，对美国陆军旅战斗队在伊拉克自由行动“增兵”阶段所发生的肌肉骨骼战伤护理统计数据、伤口分布及受伤机制进行了详细描述。
在4122名部署士兵中，176名战斗伤员有242处肌肉骨骼战伤。该旅战斗队的肌肉骨骼战伤发生率为每1000士兵战斗年34.2例。脊柱、骨盆和长骨骨折占战斗中总骨折数的55.9%（59例中的33例）。爆炸导致了所有肌肉骨骼战伤的80.7%（176例中的142例）。每1000战斗年的肌肉骨骼战伤伤口发生率如下：大截肢，2.1；小截肢，0.6；开放性骨折，5.0；闭合性骨折，6.4；软组织/神经血管损伤，32.8。在肌肉骨骼战伤伤员中，枪伤导致开放性骨折的可能性（45.8%[24例中的11例]）显著高于爆炸伤（10.6%[142例中的15例]）（p = 0.0006）。长骨截肢更多是由爆炸机制而非枪伤导致。
伊拉克自由行动中的战斗经历导致了大量复杂骨科损伤。这是由于敌人对爆炸装置的依赖增加、个人和车辆防弹衣的使用以及战斗受伤士兵生存能力的提高。
