Diagnosis and treatment of crush syndrome of chest and arm_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CUI Haojie ^# ,  XIONG Ge , ZHANG Chunlin , XIAO Zirun

Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China;

Corresponding author：

XIONG Ge, Email: xiongge@sohu.com

Keywords：

Crush syndrome; upper arm; chest; rhabdomyolysis; compartment syndrome

DOI：

10.7507/1002-1892.201711118

Video：

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ObjectiveTo investigate pathogenesis, diagnosis, and treatment of crush syndrome of chest and arm.MethodsBetween January 2010 and January 2015, 5 cases of crush syndrome of chest and arm caused by pressing oneself in a coma after CO poisoning or alcoholic intoxication were treated. There were 4 males and 1 female with an average age of 36.7 years (range, 28-46 years). Two patients involved left upper limb and chest, while the other three patients involved right upper limb and chest. The crushed time ranged from 4 to 12 hours (mean, 7 hours). All 5 cases received emergency decompression and vacuum sealing drainage (VSD). After surgery, the patients were transferred to Intensive Care Unit to receive continuous renal replacement therapy (CRRT). The wounds were repaired with skin grafts after the patients’ condition were stable.ResultsThe hospitalization time was 26-48 days (mean, 33 days). Necrosis of the skin graft occurred in 1 case, which cured after debridement and skin graft again. The skin graft survived in the other cases and the wounds healed by first intension. Five patients were followed up 12-18 months (mean, 15 months). At last follow-up, the results were excellent in all 5 cases according to the assessment criteria proposed by GU Yudong. The patients got full recovery of their upper limb activities and sensation. All the patients returned to the normal life and work.ConclusionCO poisoning, drunkenness, and pressing oneself together will lead the crush syndrome to severe and rapid progress. The key of the treatment is a comprehensive therapy including a thorough and rapid tension reduction to save the limb function, CRRT, and correction of anemia and electrolyte imbalance.

Citation： CUI Haojie, XIONG Ge, ZHANG Chunlin, XIAO Zirun. Diagnosis and treatment of crush syndrome of chest and arm. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(6): 703-706. doi: 10.7507/1002-1892.201711118 Copy

1.	严政, 於四军, 刘惠亮. 挤压综合征治疗的最新进展. 中华临床医师杂志: 电子版, 2015, 9(15): 2901-2906.
2.	Smith J, Greaves I. Crush injury and crush syndrome: a review. J Trauma, 2003, 54(5 Suppl): S226-S230.
3.	Guner SI, Oncu MR. Evaluation of crush syndrome patients with extremity injuries in the 2011 Van Earthquake in Turkey. J Clin Nurs, 2014, 23(1-2): 243-249.
4.	陈怀祥, 田海平, 刘学军. 51 例挤压伤院前急救分析. 华西医学, 2016, 31(1): 53-56.
5.	顾玉东. 臂丛神经损伤的功能评定标准与治疗方案. 中华手外科杂志, 2011, 27(3): 130.
6.	陈曦, 刘跃洪, 徐巍, 等. 简易大鼠挤压伤-挤压综合征模型建立的实验研究.中国修复重建外科杂志, 2013, 27(1): 77-82.
7.	Bagley WH, Yang H, Shah KH. Rhabdomyolysis. Internal and Emergency Medicine, 2007, 2(3): 210-218.
8.	卢丹萍, 白燕, 张虹丽. 急性一氧化碳中毒致急性肾衰竭 4 例报告. 内科急危重症杂志, 2007, 13(6): 317-318.
9.	王婷, 俞昌赫. 一氧化碳中毒并发横纹肌溶解症 1 例, 广东医学, 2017, 38(z2): 216.
10.	卿胜强, 张静波. 横纹肌溶解致急性肾损伤 1 例并文献复习. 重庆医学, 2018, 47(6): 863-864.
11.	陈碧琳. 大量饮酒致横纹肌溶解. 中国临床实用医学, 2009, 3(4): 85-86.
12.	孙晓辉, 张彧, 李春树. 酒精致横纹肌溶解合并急性肾功能衰竭 1 例报告. 山东医药, 2009, 49(9): 76.
13.	曹玉萍. 急性酒精中毒所致横纹肌溶解综合征的临床护理方法及效果. 中国当代医药, 2016, 23(15): 194-196.
14.	权毅, 潘显明, 邓少林, 等. 汶川大地震挤压伤特点与手术方式选择. 中国修复重建外科杂志, 2009, 23(5): 549-551.
15.	姜正明, 张承铭, 钱伟, 等. 严重挤压伤 5 例救治体会. 中华临床新医学, 2002, 2(7): 645-646.
16.	钟洲, 刘熹, 张晖, 等. 地震挤压综合征迟发性肌肉坏死的临床研究. 中国修复重建外科杂志, 2014, 28(10): 1317-1319.
17.	Fleischmann W, Strecker W, Bombelli M, et al. Vaccum sealing as treatment of soft tissue damage in open fracture. Ufallchirurg, 1993, 96(9): 488-492.
18.	裘华德, 王彦峰. 负压封闭引流技术介绍. 中国实用外科杂志, 1998, 18(4): 233-234.

1. 严政, 於四军, 刘惠亮. 挤压综合征治疗的最新进展. 中华临床医师杂志: 电子版, 2015, 9(15): 2901-2906.
2. Smith J, Greaves I. Crush injury and crush syndrome: a review. J Trauma, 2003, 54(5 Suppl): S226-S230.
3. Guner SI, Oncu MR. Evaluation of crush syndrome patients with extremity injuries in the 2011 Van Earthquake in Turkey. J Clin Nurs, 2014, 23(1-2): 243-249.
4. 陈怀祥, 田海平, 刘学军. 51 例挤压伤院前急救分析. 华西医学, 2016, 31(1): 53-56.
5. 顾玉东. 臂丛神经损伤的功能评定标准与治疗方案. 中华手外科杂志, 2011, 27(3): 130.
6. 陈曦, 刘跃洪, 徐巍, 等. 简易大鼠挤压伤-挤压综合征模型建立的实验研究.中国修复重建外科杂志, 2013, 27(1): 77-82.
7. Bagley WH, Yang H, Shah KH. Rhabdomyolysis. Internal and Emergency Medicine, 2007, 2(3): 210-218.
8. 卢丹萍, 白燕, 张虹丽. 急性一氧化碳中毒致急性肾衰竭 4 例报告. 内科急危重症杂志, 2007, 13(6): 317-318.
9. 王婷, 俞昌赫. 一氧化碳中毒并发横纹肌溶解症 1 例, 广东医学, 2017, 38(z2): 216.
10. 卿胜强, 张静波. 横纹肌溶解致急性肾损伤 1 例并文献复习. 重庆医学, 2018, 47(6): 863-864.
11. 陈碧琳. 大量饮酒致横纹肌溶解. 中国临床实用医学, 2009, 3(4): 85-86.
12. 孙晓辉, 张彧, 李春树. 酒精致横纹肌溶解合并急性肾功能衰竭 1 例报告. 山东医药, 2009, 49(9): 76.
13. 曹玉萍. 急性酒精中毒所致横纹肌溶解综合征的临床护理方法及效果. 中国当代医药, 2016, 23(15): 194-196.
14. 权毅, 潘显明, 邓少林, 等. 汶川大地震挤压伤特点与手术方式选择. 中国修复重建外科杂志, 2009, 23(5): 549-551.
15. 姜正明, 张承铭, 钱伟, 等. 严重挤压伤 5 例救治体会. 中华临床新医学, 2002, 2(7): 645-646.
16. 钟洲, 刘熹, 张晖, 等. 地震挤压综合征迟发性肌肉坏死的临床研究. 中国修复重建外科杂志, 2014, 28(10): 1317-1319.
17. Fleischmann W, Strecker W, Bombelli M, et al. Vaccum sealing as treatment of soft tissue damage in open fracture. Ufallchirurg, 1993, 96(9): 488-492.
18. 裘华德, 王彦峰. 负压封闭引流技术介绍. 中国实用外科杂志, 1998, 18(4): 233-234.

Chinese Journal of Reparative and Reconstructive Surgery

Diagnosis and treatment of crush syndrome of chest and arm

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