Bertani A, Mathieu L, Dahan J-L, Launay F, Rongiéras F, Rigal S
Service de chirurgie orthopédique, HIA Desgenettes, Lyon, France.
Service de chirurgie orthopédique, HIA Percy, Clamart, France.
Orthop Traumatol Surg Res. 2015 May;101(3):365-8. doi: 10.1016/j.otsr.2015.02.003. Epub 2015 Mar 29.
Meeting paediatric needs is among the priorities of western healthcare providers working in Afghanistan.
Insufficient information is available on paediatric wartime injuries to the extremities. Our objective here was to describe these injuries and their management on the field.
We retrospectively reviewed consecutive cases of injuries to the extremities in children (< 16 years of age) due to weapons and managed at the Kabul International Airport (KaIA) Combat Support Hospital between June 2009 and April 2013. We identified 89 patients with a mean age of 10.2 ± 3.5 years and a total of 137 elemental lesions.
Explosive devices accounted for most injuries (78.6%) and carried a significantly higher risk of multiple lesions. There were 54 bone lesions (traumatic amputations and fractures) and 83 soft-tissue lesions. The amputation rate was 18%. Presence of bone lesions was associated with a higher risk of injury to blood vessels and nerves. Of the 89 patients, four (4.5%) died and eight (9%) were transferred elsewhere. Of the 77 remaining patients, at last follow-up (median, one month; range, 0.1-16 months), 73 (95%) had achieved a full recovery (healed wound and/or fracture) or were recovering with no expectation that further surgery would be needed.
Despite the absence of paediatric surgeons, the combat support hospital provided appropriate care at the limb salvage and reconstruction phases. The highly specialised treatments needed to manage sequelae were very rarely provided. These treatments probably deserve to be developed in combat support hospitals.
满足儿科需求是在阿富汗工作的西方医疗保健提供者的优先事项之一。
关于战时小儿四肢损伤的信息不足。我们在此的目的是描述这些损伤及其现场处理情况。
我们回顾性分析了2009年6月至2013年4月间在喀布尔国际机场战斗支援医院接受治疗的16岁以下儿童因武器导致的四肢损伤连续病例。我们确定了89例患者，平均年龄为10.2±3.5岁，共有137处原发性损伤。
爆炸装置造成的损伤最多（78.6%），且多处损伤的风险显著更高。有54处骨损伤（创伤性截肢和骨折）和83处软组织损伤。截肢率为18%。骨损伤的存在与血管和神经损伤的风险较高相关。89例患者中，4例（4.5%）死亡，8例（9%）被转至其他地方。在其余77例患者中，在最后随访时（中位时间为1个月；范围为0.1 - 16个月），73例（95%）已完全康复（伤口愈合和/或骨折愈合）或正在恢复，预计无需进一步手术。
尽管没有小儿外科医生，但战斗支援医院在肢体挽救和重建阶段提供了适当的护理。处理后遗症所需的高度专业化治疗很少提供。这些治疗可能值得在战斗支援医院开展。
