Stępień Robert, Szczęsny Grzegorz
Department of Orthopedics and Traumatology of the Locomotor System, Medical University of Warsaw, Warsaw, Poland.
Pol Orthop Traumatol. 2014 Jun 18;79:82-7.
Severe, multitissue hand injuries constitute a serious problem of the modern world. Despite investing significant funds in their management these injuries often exclude young people from professional life. It is often due to improper management conducted by untrained personnel lacking appropriate instruments. The goal of this work is to review the literature on the problem and attempt to organize this information.
MATERIAL/METHODS: A review of available literature on mutilating hand trauma, amputations in the hand region, replantation and scales used for assessment of the severity of injury and hand function, both in Poland and internationally.
Hand injuries may be managed through three approaches: concomitant definitive, delayed and secondary. The best results are achieved through the first approach. However sometimes, due to the character of injury or lack of trained personnel, the team is forced to apply temporary dressing and, subsequently, initiate complex further management. HISS scale is a useful tool allowing for precise determination of the severity of injury and, used together with DASH questionnaire, prediction of long-term treatment outcome.
Necessary changes need to be implemented in the healthcare system in order to achieve better results of treatment of severe hand injuries. Proper guidelines for everyday practice should be also introduced. Changes should encompass precise determination of competences of individual centers as well as the mode and indications for patient transport between them. Training of doctors should be modified in such way to ensure that at least one person in each center would be capable of performing proper immediate management of such injuries, making further treatment possible. At the same time, financing, as a strong motivator, should promote appropriate management.
严重的多组织手部损伤是现代社会的一个严重问题。尽管在其治疗上投入了大量资金，但这些损伤往往使年轻人无法从事职业生活。这通常是由于未经培训的人员缺乏合适的器械而进行了不当的处理。这项工作的目的是回顾关于该问题的文献，并试图整理这些信息。
材料/方法：对波兰和国际上有关手部毁损性创伤、手部截肢、再植以及用于评估损伤严重程度和手部功能的量表的现有文献进行综述。
手部损伤可通过三种方法进行处理：即刻确定性处理、延迟处理和二期处理。第一种方法能取得最佳效果。然而，有时由于损伤的性质或缺乏训练有素的人员，团队不得不进行临时包扎，随后启动复杂的进一步治疗。HISS量表是一种有用的工具，可精确确定损伤的严重程度，与DASH问卷一起使用，还可预测长期治疗结果。
医疗保健系统需要进行必要的变革，以取得严重手部损伤更好的治疗效果。还应引入日常实践的适当指南。变革应包括精确确定各个中心的能力，以及患者在各中心之间转运的方式和指征。医生培训应进行调整，以确保每个中心至少有一人能够对手部损伤进行适当的即刻处理，从而使进一步治疗成为可能。同时，作为一种强大激励因素的资金投入应促进适当的治疗。
