Analysis of Risk Factors of Wound Infection in Gunshot Injuries with Retained Bullets

殘留子彈之槍傷併發傷口感染的危險因子分析

彭亞蘋(Ya-Ping Pong) ； 蔡慧虹(Hui-Hong Tsai) ； 鄭勝峰(Seng-Feng Jeng) ； 林燦勳(Tsan-Shiun Lin) ； 安伯忠(Po-Chung An) ； 謝青華(Ching-Hua Hsieh)

《中華民國整形外科醫學會雜誌》 13卷3期 (2004/09) Pp. 137-146

https://doi.org/10.7096/JPSA.200409.0137

摘要

本文對於從民國八十三年一月至九十一年六月期間在高雄長庚紀念醫院共二十六個病人之三十一個不同殘留子彈之槍傷傷口進行回溯性分析，來找出併發傷口感染的危險因子。病人平均年齡爲二十九歲而其中二十個爲男性。休克、周邊血管損傷、子彈大小、子彈碎裂與否、以及從到急診室至手術取出子彈之時間和傷口感染之機會並未被發現的明顯之相關。槍傷傷口如伴隨粉碎性骨折則被發現會增加傷口感染之機會；在五個此類之傷口中，有四個併發傷口感染，而且在後績清創手術中都發現有周邊肌肉組織壞死之現象。高速度子彈撞擊像骨頭等高密度障礙物而被阻擋後將高能量轉移到周邊組織造成周邊組織傷害之加劇可能是此類傷口增加感染機會之原因。爲避免殘留子彈之槍傷口併發傷口感染，應該對於此類之槍傷傷口特別注意。

並列摘要

To establish the pattern and potential of would infection in gunshot injuries with retained bullets, a retrospective survey was undertaken at Chang Gung Memorial Hospital in Kaohsiung. Twenty-six cases, with a combined total of thirty-one gunshot wounds with retained bullets distributed in different sites, were seen between January 1994 and June 2002. The average age was 29 years and 24 patients were male. Shock, peripheral vessel injury, bullet size, bullet fragmentation, and a linger time lag between arrival at the emergency room and surgery to remove the bullet was not associated with an increased of wound infection. Associated extremity comminuted bone fractures in five cases were recognized as a risk factor for wound infection, as four of these cases sustained wound infection; in addition, muscle necrosis inside all of the infected wounds was found in subsequent debridement surgery. High kinetic energy during the impact of high velocity missiles that are stopped by the obstacle of high-density bones is suggested to contribute to tissue special attention in such situations to prevent further wound infection.

並列關鍵字

Gunshot injury ； Retained bullet ； Wound infection ； Comminuted bone fracture