Rowley D I
University Department of Orthopaedic and Trauma Surgery, Royal Infirmary, Dundee, UK.
J Bone Joint Surg Br. 1996 Sep;78(5):706-9.
Over 200 high-velocity missile injuries treated in a low-technology environment were audited under the aegis of the International Committee of the Red Cross Hospitals in Afghanistan and Northern Kenya. Femoral fractures were treated either by traction or external fixation using a uniaxial frame. The results showed that patients treated by external fixation remained in hospital longer than those treated on traction. The positional outcome was identical in both groups. In tibial fractures the external fixator was only of extra benefit in those of the lower third when compared with simple plaster slabs unless more complex procedures such as flaps or vascular repair were to be performed. In complex humeral fractures, external fixation resulted in long stays in hospital and a large number of interventions when compared with simple treatment in a sling. We conclude therefore that in an environment where facilities are limited and surgeons have only general experience very careful initial wound excision is the most important factor determining outcome. The application of complex holding techniques was generally inappropriate.
在红十字国际委员会的支持下，对阿富汗和肯尼亚北部医院在低技术环境下治疗的200多例高速导弹伤病例进行了审核。股骨骨折采用牵引或使用单轴框架的外固定治疗。结果显示，接受外固定治疗的患者住院时间比接受牵引治疗的患者更长。两组的位置结果相同。在胫骨骨折中，与简单的石膏板相比，外固定器仅对下三分之一骨折的患者有额外益处，除非要进行皮瓣或血管修复等更复杂的手术。在复杂肱骨骨折中，与简单的吊带治疗相比，外固定导致住院时间延长和大量干预。因此，我们得出结论，在设施有限且外科医生只有一般经验的环境中，非常仔细的初始伤口清创是决定结果的最重要因素。应用复杂的固定技术通常不合适。
