Myerson M S, McGarvey W C, Henderson M R, Hakim J
Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Maryland.
J Orthop Trauma. 1994 Aug;8(4):343-9. doi: 10.1097/00005131-199408000-00012.
By retrospective review of hospital records and by follow-up clinical examinations, we evaluated 58 patients with crush injuries to the foot treated at our institution between 1986 and 1990. All patients had received initial treatment according to a standardized protocol determined by the type and magnitude of the injury. Patients were examined at a mean interval of 3.3 years (range 2-4) after injury, and the functional outcome was determined according to a foot trauma rating scale. Based on this scoring system, 46% of the patients had good functional outcome, 29% had fair results, and 25% had poor results. There was a significant correlation between a good functional outcome and careful adherence to the treatment protocol; however, some patients fared poorly regardless of treatment. Poor results occurred if treatment was not immediately initiated, if soft-tissue coverage was delayed (in those who experienced severe, mangling-type injuries necessitating partial foot amputation), if patients subsequently had neuritis or reflex sympathetic dystrophy, or if patients were involved in ongoing workers' compensation and litigation. We conclude that because crush injuries of the foot may be associated with prolonged morbidity, initial management should be directed toward recognition and treatment of compartment syndromes, early soft-tissue coverage, and rigid skeletal stabilization to enhance soft-tissue healing.
通过回顾医院记录和进行随访临床检查，我们评估了1986年至1990年间在我院接受治疗的58例足部挤压伤患者。所有患者均根据由损伤类型和严重程度确定的标准化方案接受了初始治疗。患者在受伤后平均3.3年（范围2 - 4年）接受检查，并根据足部创伤评分量表确定功能结果。基于该评分系统，46%的患者功能结果良好，29%的结果一般，25%的结果较差。良好的功能结果与严格遵守治疗方案之间存在显著相关性；然而，一些患者无论接受何种治疗，预后都很差。如果没有立即开始治疗、软组织覆盖延迟（对于那些遭受严重毁损型损伤需要部分足部截肢的患者）、患者随后出现神经炎或反射性交感神经营养不良，或者患者卷入正在进行的工伤赔偿和诉讼中，就会出现较差的结果。我们得出结论，由于足部挤压伤可能伴有长期的发病率，初始治疗应针对骨筋膜室综合征的识别和治疗、早期软组织覆盖以及坚固的骨骼固定，以促进软组织愈合。
