Donnally Chester J, Hannay William, Rapp Derek A, Lekic Nikola, Dodds Seth D
Department of Orthopedics, Jackson Memorial Hospital, 1611 N.W. 12th Avenue, Miami, FL, 33136-1096, USA.
Arch Orthop Trauma Surg. 2017 Dec;137(12):1615-1621. doi: 10.1007/s00402-017-2783-y. Epub 2017 Aug 31.
We intend to describe and analyze the spectrum of upper extremity injuries that arises from both accidental and intentional machete injuries with a focus on associated complications and comorbidities. This review is the first from a United States institution, and the only from a designated level 1 trauma center.
A retrospective review of machete related upper extremity injuries admitted to a level 1 trauma center from 2008 to 2016. The following data was collected on admitted patients: demographics, mechanism of injury, surgical management, and complications. We assessed the data with Pearson Chi square analysis.
This cohort consisted of 48 patients (mean = 42 ± 13 years old); the majority were men (96%) involved in an assault (81%). These patients had a high rate of documented psychiatric history, substance and tobacco abuse, and being underinsured. Patient follow-up was extremely variable: 75% of patients presented for follow-up care (mean = 149 ± 344 days; range 8-1846 days). 44% had complications (i.e., infection, tendon rupture, nerve palsy). We identified no associations when examining follow-up rates or complication rates regarding patient comorbidities, insurance status, mechanism of injury, or the need for a nerve, artery, or tendon repair. Patients with current tobacco use did have an increased risk for infection. The majority (52%) of injuries occurred on the ulnar side of the forearm and to the non-dominant extremity (66%). Patients assaulted by machetes are significantly more likely to have a history of psychiatric illness, substance abuse, tobacco use, and are more likely to be underinsured compared to those with accidental machete injuries.
While machete injuries may be uncommon in most areas of the United States, physicians should give special attention to the patient comorbidities as many of these patients have complex medical and social issues which could complicate attempts of appropriate treatment.
IV; Prognostic Study.
我们旨在描述和分析因意外和故意砍伤导致的上肢损伤谱，重点关注相关并发症和合并症。本综述是美国一家机构的首次研究，也是唯一来自指定一级创伤中心的研究。
对2008年至2016年入住一级创伤中心的与砍伤相关的上肢损伤进行回顾性研究。收集入院患者的以下数据：人口统计学资料、损伤机制、手术治疗及并发症。我们采用Pearson卡方分析对数据进行评估。
该队列包括48例患者（平均年龄42±13岁）；大多数为男性（96%），涉及袭击事件（81%）。这些患者有精神病史、药物和烟草滥用以及保险不足的记录比例较高。患者随访情况差异极大：75%的患者前来接受随访（平均149±344天；范围8 - 1846天）。44%的患者出现并发症（如感染、肌腱断裂、神经麻痹）。在检查患者合并症、保险状况、损伤机制或神经、动脉或肌腱修复需求的随访率或并发症率时，我们未发现相关性。当前吸烟的患者感染风险确实增加。大多数损伤（52%）发生在前臂尺侧和非优势肢体（66%）。与意外砍伤患者相比，被砍刀袭击的患者患精神疾病、药物滥用、吸烟的病史显著更多，且保险不足的可能性更大。
虽然在美国大多数地区砍伤可能并不常见，但医生应特别关注患者的合并症，因为这些患者中有许多存在复杂的医疗和社会问题，可能会使适当治疗的尝试变得复杂。
IV；预后研究。
