Current Trends in the Management of Open Fractures over the Lower Extremities

隨著台灣目前交通事故的高發生率，不論是急診處的醫師、骨科醫師或整形外科醫師，每天所面對的下肢閉放性骨折病例亦與日俱增。而另一方面，因醫療科技的進步，包括急救措施、傷口處理、骨折固定及顯微手術重建的最近發展，均使得這一類嚴重骨折的病息有了更多保留肢體，並能恢復良好的功能的機會。本文係針對有關治療下肢閉放性骨折的現代趨勢；包括：受傷機轉、急救要領、清創術、骨骼因定法、適當因定器的使用、保留肢體或裁肢的抉擇，以及臨床上客觀的裁肢標準予以逐項討論。結論則弦調以下四點，（一）病息在急診處急救至生命徵象穩定後，應儘速送入開刀房內處理骨折。尤其是合併血管受損的骨折，更應在6小時之內予以手術接合。（二）徹底的清創術是手術成功的不二法門。骨折的分類應在清創術後才決定，內固定或外因定器的選擇乃依臨床狀況而異。複雜閉放性骨折的傷口勿作初期的密閉縫合，以免感染。（三）開放性的傷口應在每24到48小時作反覆清創術，並在受傷後5到7天內行顯微軟組織覆蓋手術。（四）對於保留肢體或裁肢的選擇，應由外傷科成員作團隊的諮商決定。病人與家屬在術前需被詳細告知肢體重建手術的日後種種可能併發症及功能缺失。

關鍵字

下肢開放性骨性；骨骼固定術；挽救患肢

並列摘要

With the current advance in resuscitation, wound management, bony fixation, and microsurgical reconstruction, the possibility of limb-salvage for mangled lower extremities is increasing. The purposes of this review are to emphasize the following aspects in treating open fractures: (1) the mechanism of injury, initial assessment, and resuscitation; (2) the principles of debridement and fixation; (3) the controversies in the choice of adequate fixators for lower extremities; (4) the mangled extremity and limb salvage; and (5) criteria for decision making. It is of principal consequence that all the emergency physicians, orthopedists, and plastic surgeons update their knowledge and understand the implications of soft tissue damage severity to achieve the best outcome after these devastating injuries.

並列關鍵字

open fractures ； lower extremity ； skeletal stabilization ； limb salvage

國際替代計量

Current Trends in the Management of Open Fractures over the Lower Extremities

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