Vigouroux F, Choufani C, Grosset A, Barbier O, Rigal S, Mathieu L
Department of orthopedic surgery and traumatology, Desgenettes military hospital, 108, boulevard Pinel, 69275 Lyon 3, France.
Department of orthopedic surgery and traumatology, Begin military hospital, 69, avenue de Paris, 94160 Saint-Mandé, France.
Hand Surg Rehabil. 2018 Dec;37(6):342-348. doi: 10.1016/j.hansur.2018.09.002. Epub 2018 Oct 15.
The purpose of this report was to analyze sequential management of patients with combat-related hand injuries in the Kabul International Airport Combat Support Hospital and to identify principles of hand damage control orthopedics (DCO). A retrospective study was conducted using the French Opex data system that included all the patients who received sequential treatment for combat-related hand injuries from 2009 to 2013. Demographics, mechanism, injury pattern, reasons for DCO application and surgical procedures performed during initial and definitive treatment were described. Forty-one patients were included: 14 French soldiers and 27 Afghan patients. Explosive devices were the most common injury mechanism. There were multiple reasons for DCO application in 20 cases. Debridement, skeletal fixation by pinning or splinting, and delayed primary closure were the main emergent procedures. Primary and secondary treatment data did not differ between French and Afghan patients. Although Afghan patients were fully treated on site, the time to secondary procedures was three time higher in this group because of intense operational activity during the period study. The functional outcome was only evaluated in French soldiers who were treated definitely in France. Hand DCO may be required in various situations encountered in both military and civilian settings: polytrauma; delayed transfer to hand specialist; complex high-energy injuries due to firearms or explosive devices. The basic elements of this specific surgical tactic are meticulous debridement, detailed wound assessment and temporary skin coverage.
本报告旨在分析喀布尔国际机场战斗支援医院中与战斗相关手部损伤患者的序贯管理，并确定手部损伤控制骨科（DCO）的原则。使用法国Opex数据系统进行了一项回顾性研究，该系统纳入了2009年至2013年期间接受与战斗相关手部损伤序贯治疗的所有患者。描述了人口统计学、损伤机制、损伤模式、应用DCO的原因以及初始和确定性治疗期间所进行的外科手术。纳入了41例患者：14名法国士兵和27名阿富汗患者。爆炸装置是最常见的损伤机制。20例患者应用DCO有多种原因。清创、用钢针或夹板进行骨骼固定以及延迟一期缝合是主要的急诊手术。法国和阿富汗患者的一期和二期治疗数据没有差异。尽管阿富汗患者在当地得到了充分治疗，但由于研究期间行动密集，该组患者进行二期手术的时间比法国士兵高三倍。仅对在法国接受确定性治疗的法国士兵评估了功能结局。在军事和民用环境中遇到的各种情况下都可能需要手部DCO：多发伤；延迟转诊至手部专科医生；火器或爆炸装置导致的复杂高能损伤。这种特定手术策略的基本要素是细致的清创、详细的伤口评估和临时皮肤覆盖。
