Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County + University of Southern California Medical Center, University of Southern California, Los Angeles, CA 90033, USA.
Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County + University of Southern California Medical Center, University of Southern California, Los Angeles, CA 90033, USA.
Am J Emerg Med. 2021 Jul;45:11-16. doi: 10.1016/j.ajem.2021.02.034. Epub 2021 Feb 21.
Field amputation can be life-saving for entrapped patients requiring surgical extrication. Under these austere conditions, the procedure must be performed as rapidly as possible with limited equipment, often in a confined space, while minimizing provider risk. The aim of this study was to determine the ideal saw, and optimal approach, through bone or joint, for a field amputation.
This was a prospective cadaver-based study. Four saws (Gigli, manual pruning, electric oscillating and electric reciprocating) were tested in human cadavers. Each saw was used to transect four separate long bones (humerus, ulna/radius, femur and tibia/fibula), previously exposed at a standardized location. The time required for each saw to cut through the bone, the number of attempts required to seat the saw when transecting the bone, slippage, quality of proximal bone cut and extent of body fluid splatter as well as the physical space required by each device during the amputation were recorded. Additionally, the most effective saw in the through bone assessment was compared to limb amputation using scalpel and scissors for a through joint amputation at the elbow, wrist, knee and ankle. Univariate analysis was used to compare the outcomes between the different saws.
The fastest saw for the through bone amputation was the reciprocating followed by oscillating (2.1 [1.4-3.7] seconds vs 3.0 [1.6-4.9] seconds). The manual pruning (58.8 [25-121] seconds) was the slowest (p = 0.007). Overall, the oscillating saw was superior or equivalent to the other devices in number of attempts (1), slippage (0), quality of bone cut (100% good) and physical space requirements (4500 cm), and was the second fastest. In comparison, a through joint amputation (125.0 [50-147] seconds for scalpel and scissor; 125.5 [86-217] seconds for the oscillating saw) was significantly slower than through bone with the Gigli (p = 0.029), the oscillating (p = 0.029) and the reciprocal saw (p = 0.029).
The speed, precision, safety, space required, as well as the adjustable blade of the oscillating saw make it ideal for a field amputation. A Gigli saw is an excellent backup for when electrical tools cannot be used. Through bone amputation is faster than a through joint amputation.
对于需要手术解救的被困患者，野外截肢术可能是救命的。在这种严峻的情况下，必须尽快使用有限的设备在狭小的空间内进行手术，同时将医护人员的风险降到最低。本研究旨在确定野外截肢术的理想锯以及通过骨或关节进行截肢的最佳方法。
这是一项前瞻性的尸体研究。在人体尸体上测试了四种锯(Gigli 锯、手动修剪锯、电动摆动锯和电动往复锯)。每种锯都用于切割四个预先在标准化位置暴露的不同长骨(肱骨、尺骨/桡骨、股骨和胫骨/腓骨)。记录每个锯切割骨头所需的时间、切割骨头时放置锯所需的尝试次数、滑动、近端骨切割质量以及每个设备在截肢过程中所需的体液飞溅范围以及物理空间。此外，通过关节切割的肘部、腕部、膝部和踝部比较了在通过骨评估中最有效的锯与手术刀和剪刀的肢体截肢。使用单变量分析比较不同锯之间的结果。
通过骨截肢最快的锯是往复锯，其次是摆动锯(2.1[1.4-3.7]秒对 3.0[1.6-4.9]秒)。手动修剪锯(58.8[25-121]秒)是最慢的(p=0.007)。总的来说，摆动锯在尝试次数(1)、滑动(0)、骨切割质量(100%良好)和物理空间要求(4500cm)方面优于或等同于其他设备，并且是第二快的。相比之下，通过关节的截肢(手术刀和剪刀 125.0[50-147]秒;摆动锯 125.5[86-217]秒)明显慢于通过骨切割的 Gigli 锯(p=0.029)、摆动锯(p=0.029)和往复锯(p=0.029)。
摆动锯的速度、精度、安全性、所需空间以及可调节刀片使其成为野外截肢术的理想选择。Gigli 锯是电动工具无法使用时的绝佳备用选择。通过骨截肢比通过关节截肢更快。
