170四肢异物显微镜下取出术叶震海陆志方’刘建文△黄显军▲熊敏黄清雨张咸中(上海娄葑手外科医院，上海市)【摘要】目的探讨四肢异物伤的特点并介绍显微镜下异物取出术。方法对四肢异物伤122例，通过x线摄片检查、采集病史和查体等明确诊断，分别采用直接取出术、切开取出术和显微镜下异物取出术三种方法治疗。结果122例153个异物均顺利取出，用时5—220 rain，平均用时58 rain。3例同时行断指再植术，再植指均成活。显微镜下异物弹道及周围组织分为弹道13、弹道区和异物区，由中心向外周弹道区可见组织断裂带、出血区、充血区和正常组织；异物区可见异物、出血区、充血区和正常组织。结论四肢异物伤经诊断明确均应考虑取出；非陈旧性和未探查过的四肢异物适用显微镜下异物取出术。【关键词】异物伤；显微镜；异物取出术；弹道【中图分类号】R568【文献标识码】A【文章编号】1673-6575(2007)03-0170-02Removal of the foreign bodies in the extremities under microscopeYEZhen—hai，LUZhi-fang，LIUJian一棚en，HUANGXianqun，XIONGMin，HUANGQing—yu，ZHANGXian·zhong(Lo咖ng胁蒯SurgeryHospital ofShanghai，Shanghai，China)【Abstract】0bJectiveTo explore the feature of the foreign body injury of the extremity and introduce the method of removal of the foreign body under microscope．MethodsOne hundred and twenty two cases of foreign body injury of the extremity，fromJune2000 toAugust2005，were diagnosed byX—ray，disease history and physical examination．The foreign bodies were taken out directly，incised or under microscope，respectively．ResultsOne hundred and fifty three foreign bodies of122 eases were taken out successfully，the duration of operation ranged from5 rain to220 min。mean58 rain．Fingers of3Cases were replanted at the salne time and all survived．Under microscope，the删ectory of the foreign bodies consisted of a ballistic door，a ballistic area and a foreign body area．From center to side，the ballistic al'ea included a splitting band，a bleeding area，a hyperaemie area and normal tis- sue，while the foreign body area included the foreign body，a bleeding area，a hyperaemie al'ea and normal tissue．ConclusionThe foreign body in the extremity should be taken out88 soon鹋the diagnosis is conformed．Micro— scope is suitable for the removal of foreign body in extremity whieh has not been wounded or incised before．【Key words】Foreign body injury；Microscope；Surgery；Trajectory对于人体来说，任何物质出现在生理上不应该出现的地方，都可以称为异物。异物主要可以分为来自人体本身的异物和来自外界环境的异物。我们将金属、玻璃及木刺等异物因非医源原因进入肢体引起的损伤称为异物伤。由于进入肢体的机制不同、物质不同、部位不同，临床表现不尽一致，也应灵活地采用不同的治疗方法。2000年6月至2005年8月，我们治疗异物伤122例，现将四肢异物伤的特点及显微镜下异物取出术报道如下。1资料与方法△苏州工业园区娄葑医院上肢外科▲浙江省荣军医院手外科‘通讯作者：陆志方，上海市闵行区永平路6l号(上海)上海娄葑手外科医院(暨上海交通大学医学院附属第三人民医院手外科分院)，E—mail：sstone2001@263．net作者简介：叶震海(1968～)．男，硕士，主治医师，研究方向：创伤骨科。·论著·1．1临床资料本组病例122例，153个异物；男46例，女76例；年龄5～76岁，平均26．3岁。受伤时间小于8 h患者98例，大于8 h17例，其中7例超过24 h。按异物伤部位分类见表1；按不同异物伤的损伤机制及病例特点分类，见表2。表1按异物伤部位分类表

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