Rahman Hafizur, Deka Bishal Kumar
Department of Orthopaedics, Tezpur Medical College and Hospital, Bihaguri, Tezpur, Assam, India.
Department of Orthopaedics, Gauhati Medical College and Hospital, Guwahati, Assam, India.
J Orthop. 2022 Sep 26;34:310-315. doi: 10.1016/j.jor.2022.09.013. eCollection 2022 Nov-Dec.
Mangled hand injuries have proved to be a tough challenge for both the patients and surgeons alike. Severe bony and soft tissue injuries necessitate the requirement of a multidisciplinary approach.
In our tertiary care facility, a prospective study was done on the use of the Joshi's external stabilization system (JESS) fixator in the treatment of 31 instances with mangled hand injuries from November 2019 to November 2020. The cases were evaluated for functional outcome at the end of 12 months of follow up.
31 cases of mangled hand injuries with 43 fractures were treated with the said intervention. The mean age of the patients was 33.7 ± 4.2 years and almost 90% patients were males. Machinery injuries were the most frequent type of injury (55%). Cases were intervened at an emergency basis within 24 h of the injury. Functional evaluation was done by Modified Mayo Wrist Score with an average score of 84 ± 10. Good results were seen in about 60% of cases and there were no Poor results.
The application of JESS fixator for the prompt treatment of mangling hand injuries yielded satisfactory results in the working population with an early return to function. The strict adherence to the principles of ligamentotaxis, appropriate wound care and post-operative physiotherapy are other variables in the final outcome of such injuries.
II.
事实证明，手部严重毁损性损伤对患者和外科医生来说都是一项艰巨的挑战。严重的骨骼和软组织损伤需要多学科方法来处理。
在我们的三级医疗中心，于2019年11月至2020年11月对31例手部严重毁损性损伤患者使用乔希外固定系统（JESS）固定器进行了一项前瞻性研究。在随访12个月结束时对病例的功能结果进行评估。
31例手部严重毁损性损伤伴43处骨折接受了上述干预治疗。患者的平均年龄为33.7±4.2岁，近90%为男性。机械损伤是最常见的损伤类型（55%）。患者在受伤后24小时内接受急诊干预。采用改良梅奥腕关节评分进行功能评估，平均评分为84±10。约60%的病例效果良好，无效果差的病例。
应用JESS固定器对手部严重毁损性损伤进行及时治疗，在劳动人群中取得了满意的效果，患者能早期恢复功能。严格遵循韧带整复原则、适当的伤口护理和术后物理治疗是此类损伤最终结果的其他影响因素。
II级。
