Comparative study on patients with combined burn-blast injuries caused by liquid plastic and liquid metal foreign objects in the body
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摘要:
目的 比较体内液态塑料和液态金属异物烧冲复合伤患者的临床特点、诊断方案、治疗策略等。 方法 该研究为回顾性队列研究。2009年1月—2019年7月,康复大学青岛医院烧伤整形科收治41例符合入选标准的热溶液爆炸导致的烧冲复合伤患者。统计所有患者的性别、年龄、烧伤总面积、伤后入院时间、烧冲复合伤发生部位、体内异物类型。根据体内异物类型将患者分为液态塑料组（30例）和液态金属组（11例）。统计2组患者临床特点（受伤部位肿胀情况、疼痛情况、发热情况、脓肿形成情况、损伤深度、异物活动度、异物剥离难易程度）、影像学检查（超声、计算机X线摄影、CT、磁共振成像检查）情况、治疗情况（修复时期、修复方式）及出院后随访时并发症发生情况。 结果 患者中男33例、女8例,年龄18~65岁,烧伤总面积为1%~78%体表总面积,伤后入院时间为2 h~7 d,烧冲复合伤主要发生在四肢及躯干,体内异物为液态塑料（聚乙烯和丙烯腈丁二烯苯乙烯）和液态金属（液态铁和铝）。液态塑料组患者受伤部位肿胀、损伤深及骨、异物活动度差、异物剥离困难的比例均明显高于液态金属组（P<0.05）。液态金属组患者通过计算机X线摄影、CT检查明确体内异物的比例分别为7/7、8/8,均明显高于液态塑料组的1/5、3/20（P<0.05）；液态金属组患者通过超声检查明确体内异物的比例为11/11,与液态塑料组的24/26相近（P>0.05）；液态金属组患者通过磁共振成像检查明确体内异物的比例为2/2,与液态塑料组的4/4相同。液态塑料组患者行创面Ⅰ期修复、直接缝合的比例均明显低于液态金属组（P<0.05）,行创面延期修复、皮片移植与皮瓣移植的比例均明显高于液态金属组（P<0.05）。2组患者出院后随访时并发症发生情况均无明显差异（P>0.05）。 结论 烧冲复合伤患者因体内异物类型、存在部位不同,受损严重程度也不同。计算机X线摄影和CT检查可用于诊断体内金属类异物,超声和磁共振成像检查可用于诊断体内塑料类异物。多学科协作与综合治疗是救治该类患者的重要手段 。 Abstract:Objective To compare the clinical characteristics, diagnostic plans, and treatment strategies of patients with combined burn-blast injuries caused by liquid plastic and liquid metal foreign objects in the body. Methods This study was a retrospective cohort study. From January 2009 to July 2019, 41 patients with combined burn-blast injuries caused by hot solution explosion who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of Qingdao Hospital of Rehabilitation University. The following indexes of all patients were collected, including gender, age, total burn area, admission time after injury, site of combined burn-blast injuries, and type of foreign objects in the body. According to the type of foreign objects in the body, the patients were divided into liquid plastic group (30 cases) and liquid metal group (11 cases). The following indexes of the two groups of patients were collected, including the clinical characteristics (swelling in the injury site, pain, fever, abscess formation, depth of injury, activity of foreign objects, and difficulty in removing foreign objects), imaging examinations (ultrasound, computed radiography, computed tomography, and magnetic resonance imaging examinations), treatment (repair period and repair method), and incidence of complications during follow-up after discharge. Results There were 33 males and 8 females among the patients, aged 18-65 years. The total burn area was 1% to 78% total body surface area, the admission time after injury was 2 h to 7 d, the combined burn-blast injuries mainly occurred in the limbs and trunk, and the foreign objects in the body were liquid plastics (polyethylene and acrylonitrile butadiene styrene) and liquid metals (liquid iron and aluminum). The proportions with swelling in the injury site, injury with depth to the bone, poor mobility of foreign objects, and difficulty in removing foreign objects in patients in liquid plastic group were significantly higher than those in liquid metal group (P<0.05). The proportions of confirming foreign objects in the body through computed radiography and computed tomography examinations in patients in liquid metal group were 7/7 and 8/8, respectively, which were significantly higher than 1/5 and 3/20 in liquid plastic group (P<0.05); the proportion of confirming foreign objects in the body through ultrasound examination in patients in liquid metal group was 11/11, which was similar to 24/26 (P>0.05); the proportion of confirming foreign objects in the body through magnetic resonance imaging examination in patients in liquid metal group was 2/2, which was the same as 4/4 in liquid plastic group. The proportions of patients in liquid plastic group who underwent stage Ⅰ wound repair and direct suture were significantly lower than those in liquid metal group (P<0.05), while the proportions of patients who underwent delayed wound repair, skin grafting, and flap grafting were significantly higher than those in liquid metal group (P<0.05). There was no statistically significant difference in the incidence of complications between the two groups of patients during follow-up after discharge (P>0.05). Conclusions Combined burn-blast injuries could result in damages of different severity in patients due to different types and locations of foreign objects in the body. Computed radiography and computed tomography examinations can be used to diagnose metal foreign objects in the body, while ultrasound and magnetic resonance imaging examinations can be used to diagnose plastic foreign objects in the body. Multidisciplinary collaboration and comprehensive treatment are important means of treating this type of patients. -
Key words:
- Burns /
- Foreign bodies /
- Combined burn-blast injuries /
- Liquid plastics /
- Liquid metals /
- Clinical features /
- Wound repair
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参考文献
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图 1 例1面部塑料异物烧冲复合伤患者的检查及治疗情况。1A.入院2 h,右下颌可见长约0.8 cm的异物外露；1B.入院2 h,颅脑CT平扫示右面部气泡征,异物不显影；1C.入院3 d,行面部清创、异物取出术；1D.术中见右面部腮腺导管损伤,面神经颧支、颊支、下颌缘支损伤,笑肌、提上群肌、提口角肌、口轮匝肌、颊肌和咀嚼肌损伤；1E.取出的塑料异物大小为14.0 cm×8.0 cm×1.5 cm；1F.随访3个月,面部有色素沉着及轻微瘢痕形成
图 2 例2眼内金属异物和消化道金属异物烧冲复合伤患者的检查及治疗情况。2A.入院8 h,颅脑CT检查示左眶下异物(白色箭头)；2B.入院8 h,计算机X线摄影检查示食道下段异物(白色箭头)；2C.入院8 h,胸部CT检查示右下肺不张、液气胸、右胸廓塌陷；2D.入院4 d,钡餐全消化道造影检查示食道下段、胃底、贲门黏膜纹粗乱、扭曲,食道右侧胸腔瘘形成；2E.入院5 d,行消化道异物取出,结肠食道吻合手术后的钡餐全消化道造影检查；2F.入院12 d,CT示右肺复张及条索影
Table 1. 2组体内异物烧冲复合伤患者临床表现比较（例）
组别 例数 受伤部位肿胀 疼痛 发热 损伤深及骨 异物活动度差 异物剥离困难 脓肿形成 液态塑料组 30 25 27 20 24 25 25 7 液态金属组 11 5 8 6 5 5 2 3 P值 0.041 0.316 0.491 0.041 0.041 <0.001 >0.999 注：2组组名均对应造成烧冲复合伤的体内异物类型 
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Table 2. 2组体内异物烧冲复合伤患者的修复时期和修复方式比较（例）
组别 例数 修复时期 修复方式 Ⅰ期 延期 直接缝合 皮片移植 皮瓣移植 液态塑料组 30 18 12 18 9 3 液态金属组 11 9 2 9 2 0 P值 <0.001 <0.001 <0.001 <0.001 <0.001 注：2组组名均对应造成烧冲复合伤的体内异物类型
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Table 3. 2组体内异物烧冲复合伤患者出院后随访时并发症发生情况比较（例）
组别 例数 出血 感染 窦道形成 瘢痕形成 慢性创面 感觉异常 功能障碍 液态塑料组 30 5 28 2 30 3 17 9 液态金属组 11 2 10 1 11 1 6 4 P值 >0.999 >0.999 >0.999 — >0.999 >0.999 0.719 注：2组组名均对应造成烧冲复合伤的体内异物类型；“—”表示无此项
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