Grassi R, Pinto A, Rotondo A, Gigliotti S, Corrado E M, De Durante C, Fanucci A
II Servizio Radiologico, Ospedale A. Cardarelli, Napoli.
Radiol Med. 1996 Jan-Feb;91(1-2):6-12.
Two different series of patients with burst injuries of the hand were retrospectively reviewed: one series included 23 men, 15-55 years old, referred to the emergency department for the first-instance assessment of injuries of the right hand (13 patients) and left hand (10 patients). The other series included 44 patients (42 men and 2 women, aged 7-61 years) referred to our department for second-instance examinations: the latter patients had burst injuries involving only the hands in 43 cases and both the hand and the foot in one case. We report the radiologic patterns of traumatic bone injuries (fractures and amputations) and of musculotendinous and cutaneous injuries and discuss their mechanisms and pathogenesis. The two series were compared and the results follow: in both series the right hand was more frequently involved, metacarpal bones were most often fractured and phalanges most often amputated. In the first series, in the right hand the carpal bones were involved in one patient only, the 2nd and 3rd metacarpal bones were most frequently fractured and the 2nd finger was most frequently involved. In the left hand, the carpal bones were never affected, the 1st metacarpal bone was most often amputated and the 5th metacarpal bone most often fractured; the 2nd finger was most frequently involved. In the second series, in the right hand, the 1st metacarpal bone was most frequently fractured and the 2nd metacarpal bone most often amputated; the 2nd finger was most frequently involved. In the left hand, the 4th metacarpal bone was most frequently fractured and the 5th metacarpal bone most often amputated. The severity of the above injuries and the extent of tissue damage depend on several factors, including firecracker speed, shape, size, weight and characteristics. Radiologic exams are very useful for the accurate study of these traumatic injuries, providing indirect information about musculotendinous and cutaneous involvement. Prompted by the relative lack of information on the management of these injuries, we suggest that radiologic exams be quickly performed to help choose the most appropriate surgical approach for best cosmetic and functional results.
第一组包括23名年龄在15至55岁之间的男性，他们因右手（13例）和左手（10例）损伤首次到急诊科就诊。另一组包括44例患者（42名男性和2名女性，年龄在7至61岁之间），他们因二次检查转诊至我科：后一组患者中，43例仅手部有爆震伤，1例手部和足部均有爆震伤。我们报告了创伤性骨损伤（骨折和截肢）以及肌肉肌腱和皮肤损伤的放射学表现，并讨论了其机制和发病原理。比较了这两组患者的情况，结果如下：两组中右手受累更为常见，掌骨骨折最为常见，指骨截肢最为常见。在第一组中，右手仅有1例腕骨受累，第2和第3掌骨骨折最为常见，第2指受累最为常见。左手腕骨从未受累，第1掌骨截肢最为常见，第5掌骨骨折最为常见；第2指受累最为常见。在第二组中，右手第1掌骨骨折最为常见，第2掌骨截肢最为常见；第2指受累最为常见。左手第4掌骨骨折最为常见，第5掌骨截肢最为常见。上述损伤的严重程度和组织损伤范围取决于多个因素，包括鞭炮速度、形状、大小、重量和特性。放射学检查对于准确研究这些创伤性损伤非常有用，可提供有关肌肉肌腱和皮肤受累的间接信息。鉴于关于这些损伤治疗的信息相对较少，我们建议尽快进行放射学检查，以帮助选择最合适的手术方法，从而获得最佳的美容和功能效果。
