Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, The Netherlands.
Scand J Trauma Resusc Emerg Med. 2013 Jan 14;21:2. doi: 10.1186/1757-7241-21-2.
A selective non-operative management (SNOM) has found to be an adequate and safe strategy to assess and treat patients suffering from penetrating trauma of the extremities (PTE). With this SNOM comes a strategy in which adjuvant investigations or interventions are not routinely performed, but based on physical examination only.
All subsequent patients presented with PTE at a Dutch level I trauma center from October 2000 to June 2011 were included in this study. In-hospital and long-term outcome was analysed in the light of assessment of these patients according to the SNOM protocol.
A total of 668 patients (88.2% male; 33.8% gunshot wounds) with PTE presented at the Emergency Department of a level 1 traumacenter, of whom 156 were admitted for surgical treatment or observation. Overall, 22 (14%) patients that were admitted underwent exploration of the extremity for vascular injury. After conservative observation, two (1.5%) patients needed an intervention to treat (late onset) vascular complications. Other long-term extremity related complications were loss of function or other deformity (n = 9) due to missed nerve injury, including 2 patients with peroneal nerve injury caused by delayed compartment syndrome treatment.
A SNOM protocol for initial assessment and treatment of PTE is feasible and safe. Clinical examination of the injured extremity is a reliable diagnostic 'tool' for excluding vascular injury. Repeated assessments for nerve injuries are important as these are the ones that are frequently missed and result in long-term disability.
II / III, retrospective prognostic observational cohort study Key words Penetrating trauma, extremity, vascular injury, complications.
选择性非手术治疗（SNOM）已被证明是一种评估和治疗四肢穿透性创伤（PTE）患者的充分且安全的策略。采用这种 SNOM 策略时，不会常规进行辅助检查或干预，而仅根据体格检查结果进行决策。
本研究纳入了 2000 年 10 月至 2011 年 6 月期间在荷兰一级创伤中心就诊的所有 PTE 患者。根据 SNOM 方案对这些患者进行评估，并分析其住院期间和长期结局。
共有 668 例（88.2%为男性；33.8%为枪伤）PTE 患者就诊于一家一级创伤中心的急诊部，其中 156 例因需要手术治疗或观察而住院。总体而言，22 例（14%）接受过肢体探查以确定是否存在血管损伤。在保守观察后，2 例（1.5%）患者因（迟发性）血管并发症需要进行干预治疗。由于漏诊神经损伤，导致其他肢体相关并发症（功能丧失或其他畸形），共 9 例，包括 2 例因延迟治疗骨筋膜室综合征而导致腓总神经损伤的患者。
用于初始评估和治疗 PTE 的 SNOM 方案是可行且安全的。受伤肢体的临床检查是排除血管损伤的可靠诊断“工具”。对神经损伤进行重复评估非常重要，因为这些损伤通常会被漏诊，导致长期残疾。
II/III，回顾性预后观察队列研究。
穿透性创伤，四肢，血管损伤，并发症。
