争分夺秒ldquo手臂营救战r

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对于每个人来说，手的重要性不言而喻，生活、工作、学习、运动、交流都离不开双手。如果手外伤不能得到及时救治，轻者将会影响生活质量，重者将会落下残疾影响终生。

近日，63岁的裴先生就经历了人生中的巨大劫难——右前手臂被机器严重绞伤，伤势严重，救护车将医院。医院骨科一病区主任曾凡林主任医师及其医疗团队为裴先生进行手术，运用国际最新“骨整形”理念，在历经9个小时的手术后，裴先生的右手保住了，目前恢复情况很好。

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患者术后12天右前臂恢复情况

安全“警世钟”：男子干活时走神，惨遭机器“活吞”

10月13日下午4点左右，裴先生像往常一样在家干活，一时不慎走神，将右手放入搅拌机，瞬间血肉模糊，右前臂大部分皮肤肌肉被严重绞伤····家人迅速拨打，将其送来医院救治。

来院后急诊外科医生立即给予建立静脉通道快速补液、加压包扎止血及夹板外固定治疗，同时请来骨科一病区医生紧急会诊。右前臂尺桡骨、血管、神经裸露，肌腱绞碎，右手苍白、冰凉，毛细血管反应消失，右手手指伸屈活动障碍无知觉···经过骨科医生仔细检查后，初步诊断患者右尺桡骨开放性粉碎性骨折、右尺桡动脉损伤、右前臂掌侧皮肤软组织缺损，属于GustiloⅢC型损伤（开放性骨折分型中最严重的一种）。

患者入院时右手臂伤情

患者入院时拍摄的X光片

受伤程度极为严重！要想保住伤者的手臂和生命，必须立即手术！

立即开通绿色通道

骨科

麻醉科

手术室

各相关科室开始紧张有序的术前准备

团队协作：运用国际最新“骨整形”理念，制定同期修复手术方案

肢体严重开放性损伤的保肢治疗，是骨科医生面对的颇为棘手的问题，其最大的风险在于内固定的感染，一旦处理不好，轻则感染，重则截肢，甚至危及生命。因此以往的治疗多采用分期多次手术治疗：一期行彻底清创，骨折行外固定支架固定，创面采用VSD敷料覆盖；二期行皮瓣覆盖；三期等创面愈合以后，再将外固定架去除，行钢板内固定。如此一来，患者的治疗疗程往往需要一个月或数月才能完成。这种传统的处理方法相对安全，但是治疗周期长，且不利于患者早期的功能锻炼，不仅给患者在心理、生理、经济上带来沉重的负担，同时其整体的功能恢复也相对不佳。

在详细评估了患者的情况后，根据患者家属的需求，骨科一病区医疗团队共同制定了全面、对症的手术方案——“骨整形”。该治疗理念最早由英国骨科学会、重建外科学会、整形外科学会以及美容外科学会共同制订提出，旨在将肢体骨与软组织创伤作为一个整体，由创伤骨科和整形外科医生一起有计划、有次序地高效完成骨与软组织的同期修复，该治疗理念在严重开放性骨折的保肢疗效方面显著优于传统治疗。但是，完成这类手术，需要将严重损伤创面的清创技术、微创骨折内固定技术及皮瓣移植技术整合到一起，不仅是对医生本身技术的考验，更是对医生团队间密切的配合提出了更高的要求。

争分夺秒“手臂营救战”：奋战9小时，帮助患者成功保住患肢

经过充分的讨论与准备后，下午6点半，骨科一病区主任曾凡林主任医师带领医疗团队，迎难而上，正式为患者实施右前臂彻底清创、尺桡骨开放性骨折钢板螺钉内固定、神经、肌腱、血管探查修复术，一场争分夺秒的“手臂营救战”拉开序幕。

首先，对创面进行了彻底的清创，将右前臂坏死挫伤的皮肤、皮下筋膜、肌肉等组织及游离的碎骨块进行了彻底的清创；随后，对尺桡骨骨折予以钢板螺钉内固定术(术中探查尺桡动脉栓塞,为了减少右手缺血时间，术中用自制人工血管临时通血)；同时，取左下肢大隐静脉行血管移植。

术中自制人工血管临时通血

术中取左下肢大隐静脉血管移植

经过9小时奋战，手术顺利完成，直到凌晨3点半，患者的右臂重建血运。看到患者立刻变得红润的右手，全体医护人员卸下疲惫的面容，露出了欣慰的笑容。

术后，经过医护人员半个月的精心治疗和护理，患者的右臂成功保住且恢复良好，一家人对于帮助过他们的医护人员表示深深的感谢。现在，为了恢复其手臂的功能，患者正在积极的进行康复治疗。

患者右臂恢复情况

术后复查X片

“骨整形”是目前国际上最新的骨科手术理念，以往需要多次完成的手术整合在一次完成，不仅从经济上给患者带来了大大的节省，更从生理、心理及肢体功能上给患者带来了显著效果。该项技术对人员、设备、配套技术力量要求很高，以前全国医院能够开展。医院骨科通过不断的自我完善提高，以及“走出去学，请进来教”的专科发展思路，目前已经能够成熟的开展此类手术，医院的前列，为更多县域内的肢体严重开放性损伤的患者带来了福音。

专科特色

医院骨科一病区能常规开展断指（趾、肢）再植；皮肤软组织，骨组织缺损修复，各种局部转移皮瓣，游离穿支皮瓣；骨关节损伤与缺损的修复重建；四肢血管、神经、肌腱损伤及缺损的修复；手部先天性畸形矫正；糖尿病足，褥疮，慢性骨髓炎等，骨不连的显微外科治疗。

骨科一病区地址

医院外科住院楼6楼

骨科一病区电话

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手术医生介绍

曾凡林

主任医师

骨科一病区主任

中共党员，医学研究生，硕士学位，毕业于辽宁医学院，长期从事骨科专业，曾先后医院，北京医院进修学习关节、脊柱技术，医院开展各种创伤骨折的微创髓内钉手术（股骨近端PFNA、Intertan、胫腓骨、股骨髓内钉、小儿弹性髓内钉技术）、膝关节镜、膝关节置换等手术，擅长脊柱骨折、颈、胸腰椎间盘突出、脊椎滑脱、胸腰椎管狭窄手术治疗及脊柱疾病微创治疗（椎间孔镜技术、脊柱骨折PVP、PKP技术），各种关节疾病关节置换，对脊柱、肢体骨盆创伤骨折，关节相关疾病的诊治方面具有丰富的经验，先后在国内核心期刊发表多篇论文。

张强

主治医师

医学硕士研究生，毕业于医院手显微外科专业，毕业后长期从事手足显微外科，医院手外科进修学习，擅长断指（趾、肢）再植；皮肤软组织，骨组织缺损修复（游离穿支皮瓣、各种局部转移皮瓣）；骨关节损伤与缺损的修复重建；四肢血管、神经、肌腱损伤及缺损的修复；手部先天性畸形矫正；糖尿病足，褥疮，慢性骨髓炎等，骨不连的显微外科治疗。

李稳

主治医师

医学硕士研究生，毕业于湖南中医药大学，长期从事骨科临床工作，医院骨科进修学习一年，在脊柱、小儿、骨肿瘤等专业系统学习，拥有丰富的临床经验，擅长脊柱微创手术，小儿骨折闭合复位技术，常见骨肿瘤的鉴别诊断等。

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供稿

骨科一病区张强

编辑

杨婷婷

初审

瞿慧

终审

曾纪爱

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