Goodman Avi D, Got Christopher J, Weiss Arnold-Peter C
Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
J Hand Surg Am. 2017 Jun;42(6):456-463. doi: 10.1016/j.jhsa.2017.03.028. Epub 2017 Apr 25.
Crush injuries of the hand are a rare but devastating phenomenon, with historically poor outcomes. A compressive force, usually caused by a high-energy mechanism such as a motor vehicle or industrial accident, crushes and transiently increases the pressures within the hand. This force acts on the incompressible blood in the vasculature and leads to a dramatic rise in tissue pressures and damage to multiple tissue types, including bones, blood vessels, nerves, and soft tissues. A wide zone of injury results from a delayed inflammatory reaction involving the zone bordering the crushed cells, which may initially belie the severity of the injury. As such, these injuries go on to produce tremendous inflammation and swelling, potentially followed by compartment syndrome or other vascular damage, infection, neurological injury, and tissue necrosis. Crush injuries with minimal skin disruptions can be particularly challenging to accurately diagnose and manage. This paper provides a review of the initial evaluation of hand crush injuries as well as short- and long-term management strategies.
手部挤压伤虽罕见但极具破坏性，历来预后不佳。挤压伤通常由机动车或工业事故等高能量机制导致，这种压缩力会对手部造成挤压并使手部内压力瞬间升高。该力量作用于脉管系统中不可压缩的血液，导致组织压力急剧上升，并对包括骨骼、血管、神经和软组织在内的多种组织类型造成损伤。损伤区域周边会出现延迟性炎症反应，进而导致广泛的损伤区域，这可能最初会掩盖损伤的严重程度。因此，这些损伤会引发严重的炎症和肿胀，随后可能出现骨筋膜室综合征或其他血管损伤、感染、神经损伤以及组织坏死。皮肤破损极小的挤压伤在准确诊断和处理方面可能极具挑战性。本文综述了手部挤压伤的初始评估以及短期和长期管理策略。
