Abu-Zidan Fikri M, Jawas Ali, Idris Kamal, Cevik Arif Alper
The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
Turk J Emerg Med. 2024 Apr 4;24(2):67-79. doi: 10.4103/tjem.tjem_11_24. eCollection 2024 Apr-Jun.
Earthquakes are unpredictable natural disasters causing massive injuries. We aim to review the surgical management of earthquake musculoskeletal injuries and the critical care of crush syndrome. We searched the English literature in PubMed without time restriction to select relevant papers. Retrieved articles were critically appraised and summarized. Open wounds should be cleaned, debrided, receive antibiotics, receive tetanus toxoid unless vaccinated in the last 5 years, and re-debrided as needed. The lower limb affected 48.5% (21.9%-81.4%) of body regions/patients. Fractures occurred in 31.1% (11.3%-78%) of body regions/patients. The most common surgery was open reduction and internal fixation done in 21% (0%-76.6%), followed by plaster of Paris in 18.2% (2.3%-48.8%), and external fixation in 6.6% (1%-13%) of operations/patients. Open fractures should be treated with external fixation. Internal fixation should not be done until the wound becomes clean and the fractured bones are properly covered with skin, skin graft, or flap. Fasciotomies were done in 15% (2.8%-27.2%), while amputations were done in 3.7% (0.4%-11.5%) of body regions/patients. Principles of treating crush syndrome include: (1) administering proper intravenous fluids to maintain adequate urine output, (2) monitoring and managing hyperkalemia, and (3) considering renal replacement therapy in case of volume overload, severe hyperkalemia, severe acidemia, or severe uremia. Low-quality studies addressed indications for fasciotomy, amputation, and hyperbaric oxygen therapy. Prospective data collection on future medical management of earthquake injuries should be part of future disaster preparedness. We hope that this review will carry the essential knowledge needed for properly managing earthquake musculoskeletal injuries and crush syndrome in hospitalized patients.
地震是不可预测的自然灾害，会造成大量人员伤亡。我们旨在综述地震所致肌肉骨骼损伤的外科治疗及挤压综合征的重症护理。我们在PubMed上检索了无时间限制的英文文献，以选择相关论文。对检索到的文章进行了严格评估和总结。开放性伤口应进行清洁、清创、使用抗生素、注射破伤风类毒素（除非在过去5年内已接种疫苗），并根据需要再次清创。下肢受影响的身体部位/患者占48.5%（21.9%-81.4%）。骨折发生在31.1%（11.3%-78%）的身体部位/患者中。最常见的手术是切开复位内固定，占21%（0%-76.6%），其次是石膏固定，占18.2%（2.3%-48.8%），外固定占手术/患者的6.6%（1%-13%）。开放性骨折应采用外固定治疗。在伤口清洁且骨折部位被皮肤、皮瓣或皮片妥善覆盖之前，不应进行内固定。筋膜切开术占15%（2.8%-27.2%），截肢占身体部位/患者的3.7%（0.4%-11.5%）。挤压综合征的治疗原则包括：（1）给予适当的静脉输液以维持足够的尿量，（2）监测和处理高钾血症，（3）在出现容量超负荷、严重高钾血症、严重酸血症或严重尿毒症时考虑肾脏替代治疗。低质量研究涉及筋膜切开术、截肢和高压氧治疗的适应证。对地震伤未来医疗管理进行前瞻性数据收集应成为未来灾难准备工作的一部分。我们希望这篇综述能涵盖妥善管理住院患者地震所致肌肉骨骼损伤和挤压综合征所需的基本知识。
