背景:在阿富汗和伊拉克战争期间,对服役人员的大多数伤害涉及肌肉骨骼系统。这些伤口通常发生在关节周围,在某些情况下,会导致创伤性关节切开术-这种诊断并不总是明确的,特别是当没有伴随的关节骨折。本研究的目的是评估无骨折的关节周围爆炸伤的诊断和治疗。
方法:研究队列包括12名连续患者(12名四肢受累),这些患者在四肢周围的关节爆炸伤没有骨折。穿透性关节损伤的诊断依据为临床检查,射线照相结果,或吸气。关节周围伤口被定义为任何伤口,或者不透射线的爆炸碎片,在关节的5厘米内。计算每位患者的新损伤严重程度评分(NISS)。四个病人有上,8例下肢损伤。12例患者中有9例进行了关节囊穿透,并进行了关节冲洗和清创。
结果:两名患者保留了关节内金属碎片。一名患者在关节5cm范围内有软组织破裂伤口,但没有关节囊穿透。上肢和下肢的伤口分布之间没有显着差异(p=0.23)。然而,与其他爆炸机制相比,简易爆炸装置(IED)引起的爆炸伤害明显更多(p=0.01)。
结论:仅涉及软组织的关节附近的肢体爆炸伤在外科治疗中提出了独特的挑战。应保持对关节囊穿透的高度怀疑,以便可以适当治疗关节内损伤。
BACKGROUND: During the wars in Afghanistan and Iraq most injuries to service members involved the musculoskeletal system. These wounds often occurred around joints, and in some cases result in traumatic arthrotomy-a diagnosis that is not always clear, especially when there is no concomitant articular fracture. The aim of the present study is to evaluate the diagnosis and treatment of peri-articular blast injuries without fracture.
METHODS: The study cohort included 12 consecutive patients (12 involved extremities) who sustained peri-articular blast wounds of the extremities without fractures. The diagnosis of penetrating articular injury was based on clinical examination, radiographic findings, or aspiration. A peri-articular wound was defined as any wound, or radio-opaque blast fragment, within 5 cm of a joint. The New Injury Severity Score (NISS) was calculated for each patient. Four patients had upper, and 8 patients had lower extremity injuries. Nine of 12 patients had joint capsular penetration and underwent joint irrigation and debridement.
RESULTS: Two patients had retained intra-articular metal fragments. One patient had soft tissue blast wounds within 5 cm of a joint but did not have joint capsule penetration. There were no significant differences (p = 0.23) between the distribution of wounds to upper versus lower extremities. However, there were a significantly greater number of blast injuries attributed to Improvised Explosive Devices (IEDs) than from other blast mechanisms (p = 0.01).
CONCLUSIONS: Extremity blast injuries in the vicinity of joints involving only soft tissues present a unique challenge in surgical management. A high index of suspicion should be maintained for joint capsular penetration so that intra-articular injuries may be appropriately treated.