基于损伤的颈椎水平对穿透性颈部创伤进行选择性处理。

Selective management of penetrating neck trauma based on cervical level of injury.

作者信息

Biffl W L, Moore E E, Rehse D H, Offner P J, Franciose R J, Burch J M

机构信息

Department of Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, 80204, USA.

出版信息

Am J Surg. 1997 Dec;174(6):678-82. doi: 10.1016/s0002-9610(97)00195-5.

DOI:10.1016/s0002-9610(97)00195-5

PMID:9409596

Abstract

BACKGROUND

Selective surgical exploration of penetrating neck wounds is now the standard of care, but the safety and cost effectiveness of selective diagnostic testing remains controversial. We herein review our 18-year prospective evaluation of a progressively selective approach.

PATIENTS AND METHODS

Since 1979, 312 patients sustained penetrating trauma to the anterior neck; 75% were stabbed and 24% were shot. Zone I was penetrated in 13%, zone II in 67%, and zone III in 20%.

RESULTS

In all, 105 (34%) of the patients had early exploration (16% were nontherapeutic). Of the 207 (66%) observed, 1 (0.5%) required delayed exploration. Length of stay was 8.0 days following exploration, 5.1 days following negative exploration, and 1.5 days following observation. In the last 6 years, 40% have had adjunctive testing: 69% of zone I, 15% of zone II, and 50% of zone III injuries.

CONCLUSION

Selective management of penetrating neck injuries is safe and does not mandate routine diagnostic testing for asymptomatic patients with injuries in zones II and III.

摘要

背景

穿透性颈部创伤的选择性手术探查目前是治疗的标准，但选择性诊断检查的安全性和成本效益仍存在争议。我们在此回顾我们对一种逐步选择性方法进行的18年前瞻性评估。

患者与方法

自1979年以来，312例患者遭受前颈部穿透性创伤；75%为刺伤，24%为枪伤。I区穿透伤占13%，II区占67%，III区占20%。

结果

总共105例（34%）患者进行了早期探查（16%为非治疗性探查）。在观察的207例（66%）患者中，1例（0.5%）需要延迟探查。探查后住院时间为8.0天，阴性探查后为5.1天，观察后为1.5天。在过去6年中，40%的患者进行了辅助检查：I区损伤患者中69%进行了辅助检查，II区为15%，III区为50%。