Chin G, Weinzweig N, Weinzweig J, Geldner P, Gonzalez M
Division of Plastic Surgery, University of Illinois at Chicago and Cook County Hospital, 60612-7316, USA.
Ann Plast Surg. 1998 Oct;41(4):390-6. doi: 10.1097/00000637-199810000-00007.
A retrospective review of 22 patients who sustained snowblower injuries to the hand was performed. There were 17 men and 5 women, ranging in age from 20 to 68 years (average age, 39.7 years). Fifty percent were manual laborers, 25% were unemployed, 15% were office workers, and 10% were not categorized. The dominant hand was involved in 86% of patients. In all patients, injuries occurred during an attempt to unclog manually the snowblower of wet snow. Patients were evaluated initially in the emergency room, where their wounds were irrigated and debrided, subungual hematomas drained, and nail bed lacerations repaired. Patients with more extensive injuries were taken to the operating room for definitive treatment including open or closed reduction of fractures, fingertip replacement as composite grafts or skin grafts, revision amputations, tenorrhaphies, and digital nerve repairs. All injuries occurred distal to the metacarpophalangeal joints. Only 1 patient sustained an injury to the proximal phalanx. Ten patients injured only 1 finger, 6 patients injured 2 fingers, and 6 patients injured 3 fingers. The middle and ring fingers were most commonly injured (39.6% and 33.3% respectively), followed by the index and little fingers (16.7% and 8.3% respectively), and the thumb (2.1%). Phalangeal fractures were the most common type of injury, occurring in 29.2% of patients, and usually involved the distal phalanx. This was followed in frequency by nail bed injuries (22.9%), amputations (22.9%), tendon lacerations (14.6%), soft-tissue avulsions (6.3%), and digital nerve injuries (4.2%). Snowblower injuries can involve bone, soft tissue, nail bed structures, nerves, and tendons, and may even result in amputation of one or several fingers. These injuries are localized to the distal portions of the fingers. The middle and ring fingers are most commonly involved, with relative sparing of the thumb. Fractures are the most frequent injury, followed by nail bed injuries and amputations. Snowblower injuries are often managed as open fractures with intravenous antibiotics; irrigation and debridement; and repair of bone, soft tissue, and nail bed structures.
对22例手部遭受吹雪机损伤的患者进行了回顾性研究。其中男性17例，女性5例，年龄在20至68岁之间（平均年龄39.7岁）。50%为体力劳动者，25%为无业人员，15%为办公室职员，10%未分类。86%的患者优势手受伤。所有患者均在试图手动清理吹雪机内的湿雪时受伤。患者最初在急诊室接受评估，在那里对伤口进行冲洗和清创，引流甲下血肿，并修复甲床裂伤。伤势较重的患者被送往手术室进行确定性治疗，包括骨折的切开复位或闭合复位、用复合移植物或皮肤移植物进行指尖置换、截肢修复、肌腱缝合和指神经修复。所有损伤均发生在掌指关节远端。只有1例患者近端指骨受伤。10例患者仅1根手指受伤，6例患者2根手指受伤，6例患者3根手指受伤。中指和环指最常受伤（分别为39.6%和33.3%），其次是示指和小指（分别为16.7%和8.3%），拇指最少（2.1%）。指骨骨折是最常见的损伤类型，占患者的29.2%，通常累及远端指骨。其次是甲床损伤（22.9%）、截肢（22.9%）、肌腱裂伤（14.6%）、软组织撕脱伤（6.3%）和指神经损伤（4.2%）。吹雪机损伤可累及骨骼、软组织、甲床结构、神经和肌腱，甚至可能导致一根或多根手指截肢。这些损伤局限于手指远端。中指和环指最常受累，拇指相对较少。骨折是最常见的损伤，其次是甲床损伤和截肢。吹雪机损伤通常作为开放性骨折进行处理，包括静脉使用抗生素、冲洗和清创以及修复骨骼、软组织和甲床结构。
