现代战争条件下肢体作战外科创伤的治疗

I. Trutyak, D. Los, V. Medzyn, Vasyl Trunkvalter, Volodymyr Zukovsky
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引用次数: 2

摘要

2022年2月至9月西部军医临床中心收治伤员总数中,肢体战斗损伤占63.3%。子弹伤造成的肢体战斗损伤占10.4%,弹片和地雷炸伤占68.1%,炸伤占21.5%。医疗护理的第二个作用是对伤员进行紧急手术干预,用外固定架固定骨折和抗休克治疗。第三和第四种作用- -伤员的治疗是采用多学科方法,由不同专业的医生参与,首先是普通外科医生、创伤科医生、血管外科医生、整形外科医生和麻醉师。最常见的手术干预是枪伤的重复和二次清创术,93%的伤者需要进行手术。创面主要病原菌为鲍曼不动杆菌、铜绿假单胞菌、产气肠杆菌、普通变形杆菌、粪肠球菌等,组织微生物污染水平较高,为104 ~ 108/g。根据重建阶梯的规则,使用各种类型的塑料来闭合软组织缺损。软组织创面愈合后确定采用内固定替代固定方法的时机,分析临床和实验室参数,并评估并发症的风险。肢体截肢的主要原因是软组织和骨骼的常见缺陷,这些缺陷不受重建的影响,骨融合和感染坏死过程的进展没有预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
TREATMENT OF COMBAT SURGICAL TRAUMA OF THE LIMBS IN THE CONDITIONS OF MODERN WAR
Among the total number of wounded who entered the Military Medical Clinical Center of the Western Region from February to September 2022, combat injury to the limbs was in 63.3%. Bullet wounds caused combat injury to the limbs in 10.4%, shrapnel and mine-explosive – in 68.1%, explosive injury – in 21.5%. At the second role of medical care, emergency surgical interventions were performed on the wounded, immobilization of bone fractures with an external fixation and anti-shock therapy. At the third and fourth roles – the treatment of the wounded consisted in the use of a multidisciplinary approach with the involvement of doctors of various specialties, first of all, general surgeons, traumatologists, vascular, plastic surgeons and anesthesiologists. The most frequent surgical intervention was repeatened and secondary debridment of gunshot wounds, which was required by 93% of the wounded. The main pathogens that vegetated in wounds were Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter aerogenes, Proteus vulgaris, Enterococcus faecalis with high levels of microbial contamination – 104-108/g in tissues., Various types of plastics were used to close soft tissue defects, according to the rule of the reconstruction ladder. After healing a soft tissue wound to determine the timing of replacing the method of fixing fractures with internal osteosynthesis, were analyzed clinical and laboratory parameters and assessed the risks of complications. The main causes of amputations of the limbs were common defects in soft tissue and bones, which were not subject to reconstruction with no prognosis for bone fusion and progression of the infectious-necrotic process.
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