Jovanovic S, Wertheimer B, Zelic Z, Getos Z
Department of Orthopedic Surgery, Osijek University Hospital, Croatia.
Mil Med. 1999 Jan;164(1):44-7.
This paper outlines the causative factors, incidence, and localization of extremity amputations of wounded persons treated at the Osijek University Hospital (Eastern Slavonia) during 1991 and 1992. The medical documentation of 5,024 patients was analyzed. Of these, 1,560 patients were treated in the hospital (31.0%). A total of 1,916 extremity injuries were found in hospitalized wounded patients. Injuries of the lower extremities were found in 1,226 patients and injuries of the upper extremities in 690 patients. Gunshot-explosive fractures of the extremity bones were diagnosed in 1,122 patients (71.9%): 735 (47.1%) in the lower extremities and 387 (25.8%) in the upper extremities. In 90 cases (4.6%), amputation of the extremities (including the fingers) using an open circular or flap technique was performed. Large amputations (above the wrist and ankle joints) were performed on 40 patients (2.6%). Amputation of the upper extremities was performed on 53 patients (58.9%), and amputation of the lower extremities was performed on 37 patients (41.1%). Injuries of the major blood vessels were treated with primary reconstruction in the upper extremities in 44 patients and in the lower extremities in 96 patients. Unstable gunshot-explosive fractures of the long bones were stabilized with external fixation, and fractures of the short bones were stabilized by means of minimal osteosynthesis or external fixation. Secondary amputations (on the lower extremities) were performed on 2 patients because of vascular insufficiency. Not a single secondary amputation procedure was performed because of infection, secondary uncontrolled hemorrhage, or gas gangrene. Amputation is a radical and irreversible intervention, and indications for amputation must be determined by those with great surgical experience and good knowledge of military-surgical doctrine.
本文概述了1991年和1992年在奥西耶克大学医院（东斯拉沃尼亚）接受治疗的伤员肢体截肢的致病因素、发生率和部位。分析了5024例患者的医疗记录。其中，1560例患者在该医院接受治疗（占31.0%）。在住院伤员中总共发现1916例肢体损伤。下肢损伤患者1226例，上肢损伤患者690例。1122例患者（占71.9%）被诊断为肢体骨骼枪爆性骨折：下肢735例（占47.1%），上肢387例（占25.8%）。90例（占4.6%）采用开放环形或皮瓣技术进行了包括手指在内的肢体截肢。40例患者（占2.6%）进行了大截肢（腕关节和踝关节以上）。上肢截肢53例（占58.9%），下肢截肢37例（占41.1%）。44例上肢主要血管损伤患者和96例下肢主要血管损伤患者接受了一期重建治疗。长骨不稳定枪爆性骨折采用外固定稳定，短骨骨折采用微创接骨术或外固定稳定。2例患者因血管功能不全进行了二期截肢（下肢）。没有因感染、继发性无法控制的出血或气性坏疽而进行二期截肢手术。截肢是一种根治性且不可逆转的干预措施，截肢指征必须由具有丰富手术经验且精通军事外科学说的人员来确定。
