锁骨上窝多处伤的临床分析
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摘要
目的：探讨锁骨上窝多处伤的诊断与治疗方法。方法：10例创伤致锁骨上窝多处伤,9例有臂丛神经损伤,3例伴锁骨下血管损伤；10例均行骨折切复内固定术；9例行臂丛神经探查松解术；1例行锁骨下动静脉结扎,1例行锁骨下动脉取栓术,1例行锁骨下动脉切开取栓、大隐静脉移植术；结果：本组10例,均得随访,随访时间10月～9年,平均2.5年,骨折均已愈合；血管检查结果：9例桡动脉可及,1例锁骨下动脉已结扎；神经功能参照中华医学会手外科学会臂丛功能综合评价试用标准[7],结果：优3良2可3差2。结论：锁骨上窝多处伤早期诊断明确,尽早手术疗效好。
Objective:The injury mechanisms, clinical manifestation, diagnosis, treatment of supraclavicular fosse multiple injuries. Methods:10 acute trauma cases were involved in this series.10 cases had clavicle fracture. Brachial plexus injury was seen in 9 cases. Injuries of the sub clavicle vessels (vessel rupture, artero-venous fistula) were found in 3 cases. Surgical exploration was carried out in 9 cases. Repair of the ruptured vessels was done in 2 cases, while another 1 was managed with vessel ligation. Results: Postoperatively the patients were followed for an average of 30 months. All fractures were healed.9 patients had strong pulsation at the radial artery of the affected side. Assessment of the upper limb function using the standard issued by the Hand Surgery Society of Chinese Medical Association graded 3 cases as excellent 2cases as good 3cases as fair and 2 cases as bad. Conclusion:when you can make a clear diagnosis of supraclavicular fosse multiple injuries, early surgical intervention can lead to satisfactory results.
Objective:The injury mechanisms, clinical manifestation, diagnosis, treatment of supraclavicular fosse multiple injuries. Methods:10 acute trauma cases were involved in this series.10 cases had clavicle fracture. Brachial plexus injury was seen in 9 cases. Injuries of the sub clavicle vessels (vessel rupture, artero-venous fistula) were found in 3 cases. Surgical exploration was carried out in 9 cases. Repair of the ruptured vessels was done in 2 cases, while another 1 was managed with vessel ligation. Results: Postoperatively the patients were followed for an average of 30 months. All fractures were healed.9 patients had strong pulsation at the radial artery of the affected side. Assessment of the upper limb function using the standard issued by the Hand Surgery Society of Chinese Medical Association graded 3 cases as excellent 2cases as good 3cases as fair and 2 cases as bad. Conclusion:when you can make a clear diagnosis of supraclavicular fosse multiple injuries, early surgical intervention can lead to satisfactory results.
引文
1陈维庭,首届全国多发伤学术会议纪要,中华创伤杂[J],1994,10(1)：30-31
2 Association for the Advancement of Automotive Medicine. The abbreviated injury scale 1990 revision. Des Plaines ILL,1990.
3重庆市急救中心.简明损伤定级标准[S].2000.6-11
4美国机动车医学促进会,重庆市急救医疗中心编译.简明损伤定级标准2005.第2版,重庆：重庆出版社,2005.
5潘铁成,刘子雄,汤应雄等.创伤性锁骨下血管损伤的外科治疗.中华创伤杂志,2003,19：693-394.
6向志,时德.锁骨下血管损伤的诊治12例.中华创伤杂志,2003,19：501-502.
7潘达德,顾玉东,侍德等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志,2000,16：130-135.
8顾玉东.臂丛神经损伤的治疗.医师进修杂志.1997,20：225-228.
9肖嵩华,刘芙进,宋守礼等.锁骨下及腋动脉损伤合并臂丛神经损伤的急救与外科治疗(附10例报告).中国矫形外科杂志,2003，11：898-901.
10董玉珍,洪光祥,王发斌.锁骨下血管合并臂丛损伤的手术治疗.中国误诊学杂志,2004,4：1082-1083.
11李良,吴明有,田书锋等.胸外伤迟发性血气胸的外科治疗.中国实用期刊,2008,35：79.
12曾凡,赵灵等.外伤性右锁骨下动静脉断裂大出血救治一例.中华急诊医学杂志,2006,15：22.
13装连魁,梁炳生,尹芸生等.臂丛神经损伤的治疗.实用骨科杂志.1995,1：7-10.
1陈维庭,首届全国多发伤学术会议纪要,中华创伤杂[J],1994,10(1)：30-31
2 Association for the Advancement of Automotive Medicine. The abbreviated injury scale 1990 revision. Des Plaines ILL,1990.
3重庆市急救中心.简明损伤定级标准[S].2000.6-11
4美国机动车医学促进会,重庆市急救医疗中心编译.简明损伤定级标准2005.第2版,重庆：重庆出版社,2005.
5潘铁成,刘子雄,汤应雄等.创伤性锁骨下血管损伤的外科治疗.中华创伤杂志,2003,19：693-394.
6向志,时德.锁骨下血管损伤的诊治12例.中华创伤杂志,2003,19：501-502.
7装连魁,梁炳生,尹芸生等.臂丛神经损伤的治疗.实用骨科杂志.1995,1：7-10.
8顾玉东.臂丛神经损伤的治疗.医师进修杂志.1997,20：225-228.
9肖嵩华,刘芙进,宋守礼等.锁骨下及腋动脉损伤合并臂丛神经损伤的急救与外科治疗(附10例报告).中国矫形外科杂志,2003,11：898-901.
10董玉珍,洪光祥,王发斌.锁骨下血管合并臂丛损伤的手术治疗.中国误诊学杂志,2004,4：1082-1083.
11李良,吴明有,田书锋等.胸外伤迟发性血气胸的外科治疗.中国实用期刊,2008,35：79.
12曾凡,赵灵等.外伤性右锁骨下动静脉断裂大出血救治一例.中华急诊医学杂志,2006,15：22.
13曹扬,陈中,林平等.锁骨下血管损伤继发臂丛神经受压征的治疗.中华手外科杂志,2001,17：40-42.
14 Pfammatter T, Kunzli A, Hilfiker PR, et al. Relief of subclavian venous and brachial plexus compression syndrome caused by traumatic subclavian artery aneurysm by means of transluminal stent2grafting. J Trauma,1998,45:9722974.
15 Karkos CD, Thomson GJ. Combined subclavian artery and brachial plexus injury following blunt trauma to the shoulder. Injury,1998,29:3952396.
16潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志,2000,16：1302135.
17徐达传,主编.手功能修复重建外科解剖学.第1版.北京：人民卫生出版社,1996.3362339.
18 Hansky B, Murray E, Minami K, et al. Delayed brachial plexus paralysis due to subclavian pseudoaneurysm after clavicular fracture. Eur J Cardiothorac Surg,1993,7:4972498.
19 Johnson SF,Johnson SB,Strodel WE,et al. Brachial plexuss injury:association with subclavian and axillery vascular trauma[J]. J Trauma,1991,31:1546～1550.
20 Shaw AD, Milne AA,Christie J, et al. Vascular trauma of the upper limb and associated nerve injuries [J]. Injury,1995,26:515-518.
2 Association for the Advancement of Automotive Medicine. The abbreviated injury scale 1990 revision. Des Plaines ILL,1990.
3重庆市急救中心.简明损伤定级标准[S].2000.6-11
4美国机动车医学促进会,重庆市急救医疗中心编译.简明损伤定级标准2005.第2版,重庆：重庆出版社,2005.
5潘铁成,刘子雄,汤应雄等.创伤性锁骨下血管损伤的外科治疗.中华创伤杂志,2003,19：693-394.
6向志,时德.锁骨下血管损伤的诊治12例.中华创伤杂志,2003,19：501-502.
7潘达德,顾玉东,侍德等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志,2000,16：130-135.
8顾玉东.臂丛神经损伤的治疗.医师进修杂志.1997,20：225-228.
9肖嵩华,刘芙进,宋守礼等.锁骨下及腋动脉损伤合并臂丛神经损伤的急救与外科治疗(附10例报告).中国矫形外科杂志,2003，11：898-901.
10董玉珍,洪光祥,王发斌.锁骨下血管合并臂丛损伤的手术治疗.中国误诊学杂志,2004,4：1082-1083.
11李良,吴明有,田书锋等.胸外伤迟发性血气胸的外科治疗.中国实用期刊,2008,35：79.
12曾凡,赵灵等.外伤性右锁骨下动静脉断裂大出血救治一例.中华急诊医学杂志,2006,15：22.
13装连魁,梁炳生,尹芸生等.臂丛神经损伤的治疗.实用骨科杂志.1995,1：7-10.
1陈维庭,首届全国多发伤学术会议纪要,中华创伤杂[J],1994,10(1)：30-31
2 Association for the Advancement of Automotive Medicine. The abbreviated injury scale 1990 revision. Des Plaines ILL,1990.
3重庆市急救中心.简明损伤定级标准[S].2000.6-11
4美国机动车医学促进会,重庆市急救医疗中心编译.简明损伤定级标准2005.第2版,重庆：重庆出版社,2005.
5潘铁成,刘子雄,汤应雄等.创伤性锁骨下血管损伤的外科治疗.中华创伤杂志,2003,19：693-394.
6向志,时德.锁骨下血管损伤的诊治12例.中华创伤杂志,2003,19：501-502.
7装连魁,梁炳生,尹芸生等.臂丛神经损伤的治疗.实用骨科杂志.1995,1：7-10.
8顾玉东.臂丛神经损伤的治疗.医师进修杂志.1997,20：225-228.
9肖嵩华,刘芙进,宋守礼等.锁骨下及腋动脉损伤合并臂丛神经损伤的急救与外科治疗(附10例报告).中国矫形外科杂志,2003,11：898-901.
10董玉珍,洪光祥,王发斌.锁骨下血管合并臂丛损伤的手术治疗.中国误诊学杂志,2004,4：1082-1083.
11李良,吴明有,田书锋等.胸外伤迟发性血气胸的外科治疗.中国实用期刊,2008,35：79.
12曾凡,赵灵等.外伤性右锁骨下动静脉断裂大出血救治一例.中华急诊医学杂志,2006,15：22.
13曹扬,陈中,林平等.锁骨下血管损伤继发臂丛神经受压征的治疗.中华手外科杂志,2001,17：40-42.
14 Pfammatter T, Kunzli A, Hilfiker PR, et al. Relief of subclavian venous and brachial plexus compression syndrome caused by traumatic subclavian artery aneurysm by means of transluminal stent2grafting. J Trauma,1998,45:9722974.
15 Karkos CD, Thomson GJ. Combined subclavian artery and brachial plexus injury following blunt trauma to the shoulder. Injury,1998,29:3952396.
16潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志,2000,16：1302135.
17徐达传,主编.手功能修复重建外科解剖学.第1版.北京：人民卫生出版社,1996.3362339.
18 Hansky B, Murray E, Minami K, et al. Delayed brachial plexus paralysis due to subclavian pseudoaneurysm after clavicular fracture. Eur J Cardiothorac Surg,1993,7:4972498.
19 Johnson SF,Johnson SB,Strodel WE,et al. Brachial plexuss injury:association with subclavian and axillery vascular trauma[J]. J Trauma,1991,31:1546～1550.
20 Shaw AD, Milne AA,Christie J, et al. Vascular trauma of the upper limb and associated nerve injuries [J]. Injury,1995,26:515-518.
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