| Background China is a large agricultural population and a large agricultural country.Due to the large number of agricultural machinery injuries and disabilities caused each year,it brings huge economic losses and burdens to the society and individuals.Currently,because of the agricultural machinery damage due is serious,it nee ds immediate treatment,and the treatment exist many differences,however,how to find effective treatments to reduce the burden of economic losses is the current urgent task.At present,the research on the damage of agricultural machinery is mainly focused on how to preserve the function of the affected limb to the maximum extent,which requires a reasonable,effective and standardized treatment in the emergency work.How to regulate the use of antibiotics,the time of looking for traumatic skin defect after a period of repair and underwent surgical timing and manner of the second phase of intervention,comparison between different surgical effect,and how to maximize response function of patients,which are the main problems in the current clinical practice.Objective To Preliminaryly summarize the perioperative treatment experience,and standardized antibiotic use;search for the time and method of the first stage repair and second stage intervention of the post-traumatic skin defect;compare the different therapeutic effect between operation method,and find the best way of surgery.Method 238 cases of clinical data of the patients with agricultural machinery damage from the year 2014 to 2017 treated in hand and foot surgical department of Jining city first people’s hospital and Qingdao 401 hospital were retrospectively were collected,the injury situation and sequela caused by agricultural machinery injury of limb function were also recorded.At the same time,the follow-up data of 12 months after operation were collected to record the data of the patients’ postoperative recovery.Results 1.General conditions of patients.Clinical data of 238 agricultural machinery injury patients in this study were collected including 160 men and 78 women,aged 35 ~ 60 years,mean age was 50.3 years,the injured area consists of 38 cases of left hand,right hand,160 cases of 18 cases,left foot,right foot 22 cases.2.Damage level There were 67 cases of class Level I injury,including 47 males and 20 females,75 cases of class Level II injuries including 54 males and 21 females.A total of 68 cases of class Level III injury included 41 males and 27 females.There were 15 cases of class IV injuries including 10 males and 5 femal es.A total of 13 patients,including 8 males and 5 females,were injured.The injury to the patients with surgical treatment for an average of 1.8 h(range from 1 to 3.8 h),skin defect in patients with average size of 29.76 c ㎡(range 9.8 c ㎡ ~ 76.03 c ㎡).3.Surgery and curative effect In 238 patients during anesthesia tourniquets,treated with topical anesthesia debridement surgery,fracture reduction and internal fixation,tendons,soft tissue repair,placed line of vacuum sealing drainage(VSD),includ ing 102 cases of using one line placed the VSD technique in 102 patients,1 line of VSD placed 1 78 cases,lines of VSD placed one in 58 cases.A total of two stage surgery.To repair or take skin flap transposition skin grafting after the primary,seconda ry and tertiary standard respectively in 119 patients,101 cases,18 cases.4.Antibiotic use and hospital stay.Postoperative antibiotics were used to prevent infection,including levofloxacin,ceficidin,cefazolin,ceftriaxone,clindamycin,and imiperinex.The median length of hospital stay was 8.9 days.5.Patients were followed up for 12 months.238 cases of agricultural machinery injury included 45 patients after surgery in hand stiffness of different level,according to the criteria of total active moti on(TAM)there were 32 cases,8 cases,9 cases,6 cases respectively.6.Clinical efficacy of retrograde island flap repair combined with VSD device.238 cases were in the first phase of the operation process of the debridement with the VSD devices,if visible wound granulation tissue of fresh,not the drainage can be removed after 7 days after VSD devices,phase II after debridement,bone between artery retrograde island flap repair,31 cases with skin necrosis and infection,the infection rate was 13%.Conclusion 1.The classification of soft tissue and bone joint injuries according to the.damage of agricultural machinery and equipment can provide some guidance for clinical treatment of this injury.Selecting sensitive antibiotic therapy according to the bacterial culture and drug sensitivity test of the necrotic tissue is helpful to improve the operation,and provide timely and effective repair,which can shorten treatment time,improve prognosis and reduce disability rate.2.High degree of injury in patients with VSD devices using frequency increases,the repair or take skin flap transposition skin grafting combined the VSD device can reduce postoperative infection,improve the survival of skin flap,decrease The Times of change medicine and surgery of utm ost to ensure the basic function of the limb. |
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