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成人患者的严重肢体损伤

Authors
Jeremy W Cannon, MD, FACS
Todd E Rasmussen, MD, FACS, COL, USAF, MC
Section Editors
Heidi L Frankel, MD, FACS
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
张东, 副主任医师

引言

肢体创伤是急诊医学和外科学中最常见的一种损伤类型。在评估肢体损伤时，4个功能组成(神经、血管、骨和软组织)中的每一个都必须既单独考虑又联合考虑。如果这4个功能组成中有3个受损，则患者有“肢体毁损”[1]。严重肢体损伤患者要获得最佳结局需要多学科处理，需要由普外科医生或创伤外科医生仔细监管以及其他专科医生的协助，包括骨科医生、血管外科医生、整形外科医生及康复科医生。在大多数情况下，即使是肢体毁损的患者，仍可以尝试保肢。然而，有时肢体损伤太严重，需在初始手术时行一期截肢术以挽救患者的生命。

本专题将总结严重肢体损伤的初始处理。轻度肢体损伤的处理，包括孤立性骨折的处理，将在别处讨论。 (参见“骨折处理的一般原则：骨折愈合和骨折描述”和“骨折治疗的一般原则：早期和晚期并发症”和“急性骨折的一般处理原则”和“骨折确定性处理的一般原则”)

病因

肢体损伤的病因范围很广，从跌倒和机动车辆碰撞到爆炸和爆炸伤。肢体损伤的性质和严重程度在军事活动和平民生活中不同。军事性肢体损伤主要是穿入伤和复合伤，伴有较高的开放性骨折和血管损伤发生率[2]。相反，平民生活中严重肢体损伤大多数为钝挫伤，但仍有12%左右的平民肢体损伤为穿入伤或复合伤。

平民 — 平民肢体损伤最常见的原因是跌倒(占下肢损伤的50%-60%和上肢损伤的30%)、工业或工作相关事故(高达20%的上肢损伤)和机动车碰撞[3]。大多数上肢损伤的发生是由于使用机械或工具。

在有非致命性创伤的平民中，上肢和下肢损伤是最常见的住院原因，超过1/3的住院患者有严重的或危及肢体的损伤[3-5]。

                              

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-16.
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