From the Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN.
J Am Acad Orthop Surg. 2019 Jan 1;27(1):e1-e8. doi: 10.5435/JAAOS-D-17-00833.
High-voltage electrical injuries are relatively rare injuries that pose unique challenges to the treating physician, yet the initial management follows well-established life-saving, trauma- and burn-related principles. The upper extremities are involved in most electrical injuries because they are typically the contact points to the voltage source. The amount of current that passes through a specific tissue is inversely proportional to the tissue's intrinsic resistance with electricity predominantly affecting the skeletal muscle secondary to its large volume in the upper extremity. Therefore, cutaneous burns often underestimate the true extent of the injury because most current is through the deep tissues. Emergent surgical exploration is reserved for patients with compartment syndrome; otherwise, initial débridement can be delayed for 24 to 48 hours to allow tissue demarcation. Early rehabilitation, wound coverage, and delayed deformity reconstruction are important concepts in treating electrical injuries.
高压电损伤相对少见，但对治疗医生提出了独特的挑战，然而其初始处理遵循明确的、与生命相关的、创伤和烧伤的治疗原则。上肢是最常发生电损伤的部位，因为上肢通常是接触电压源的部位。电流通过特定组织的量与组织的固有电阻成反比，电流主要影响上肢的大块骨骼肌，因为它的体积较大。因此，皮肤烧伤往往低估了损伤的真实范围，因为大部分电流都通过深部组织。只有在发生筋膜间室综合征的患者中才需要紧急进行外科探查；否则，最初的清创术可以延迟 24 到 48 小时，以允许组织分界。早期康复、创面覆盖和延迟的畸形重建是治疗电损伤的重要概念。
