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.	嚴政, 於四軍, 劉惠亮. 擠壓綜合征治療的最新進展. 中華臨床醫師雜志: 電子版, 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.	陳懷祥, 田海平, 劉學軍. 51 例擠壓傷院前急救分析. 華西醫學, 2016, 31(1): 53-56.
5.	顧玉東. 臂叢神經損傷的功能評定標準與治療方案. 中華手外科雜志, 2011, 27(3): 130.
6.	陳曦, 劉躍洪, 徐巍, 等. 簡易大鼠擠壓傷-擠壓綜合征模型建立的實驗研究.中國修復重建外科雜志, 2013, 27(1): 77-82.
7.	Bagley WH, Yang H, Shah KH. Rhabdomyolysis. Internal and Emergency Medicine, 2007, 2(3): 210-218.
8.	盧丹萍, 白燕, 張虹麗. 急性一氧化碳中毒致急性腎衰竭 4 例報告. 內科急危重癥雜志, 2007, 13(6): 317-318.
9.	王婷, 俞昌赫. 一氧化碳中毒并發橫紋肌溶解癥 1 例, 廣東醫學, 2017, 38(z2): 216.
10.	卿勝強, 張靜波. 橫紋肌溶解致急性腎損傷 1 例并文獻復習. 重慶醫學, 2018, 47(6): 863-864.
11.	陳碧琳. 大量飲酒致橫紋肌溶解. 中國臨床實用醫學, 2009, 3(4): 85-86.
12.	孫曉輝, 張彧, 李春樹. 酒精致橫紋肌溶解合并急性腎功能衰竭 1 例報告. 山東醫藥, 2009, 49(9): 76.
13.	曹玉萍. 急性酒精中毒所致橫紋肌溶解綜合征的臨床護理方法及效果. 中國當代醫藥, 2016, 23(15): 194-196.
14.	權毅, 潘顯明, 鄧少林, 等. 汶川大地震擠壓傷特點與手術方式選擇. 中國修復重建外科雜志, 2009, 23(5): 549-551.
15.	姜正明, 張承銘, 錢偉, 等. 嚴重擠壓傷 5 例救治體會. 中華臨床新醫學, 2002, 2(7): 645-646.
16.	鐘洲, 劉熹, 張暉, 等. 地震擠壓綜合征遲發性肌肉壞死的臨床研究. 中國修復重建外科雜志, 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.	裘華德, 王彥峰. 負壓封閉引流技術介紹. 中國實用外科雜志, 1998, 18(4): 233-234.

1. 嚴政, 於四軍, 劉惠亮. 擠壓綜合征治療的最新進展. 中華臨床醫師雜志: 電子版, 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. 陳懷祥, 田海平, 劉學軍. 51 例擠壓傷院前急救分析. 華西醫學, 2016, 31(1): 53-56.
5. 顧玉東. 臂叢神經損傷的功能評定標準與治療方案. 中華手外科雜志, 2011, 27(3): 130.
6. 陳曦, 劉躍洪, 徐巍, 等. 簡易大鼠擠壓傷-擠壓綜合征模型建立的實驗研究.中國修復重建外科雜志, 2013, 27(1): 77-82.
7. Bagley WH, Yang H, Shah KH. Rhabdomyolysis. Internal and Emergency Medicine, 2007, 2(3): 210-218.
8. 盧丹萍, 白燕, 張虹麗. 急性一氧化碳中毒致急性腎衰竭 4 例報告. 內科急危重癥雜志, 2007, 13(6): 317-318.
9. 王婷, 俞昌赫. 一氧化碳中毒并發橫紋肌溶解癥 1 例, 廣東醫學, 2017, 38(z2): 216.
10. 卿勝強, 張靜波. 橫紋肌溶解致急性腎損傷 1 例并文獻復習. 重慶醫學, 2018, 47(6): 863-864.
11. 陳碧琳. 大量飲酒致橫紋肌溶解. 中國臨床實用醫學, 2009, 3(4): 85-86.
12. 孫曉輝, 張彧, 李春樹. 酒精致橫紋肌溶解合并急性腎功能衰竭 1 例報告. 山東醫藥, 2009, 49(9): 76.
13. 曹玉萍. 急性酒精中毒所致橫紋肌溶解綜合征的臨床護理方法及效果. 中國當代醫藥, 2016, 23(15): 194-196.
14. 權毅, 潘顯明, 鄧少林, 等. 汶川大地震擠壓傷特點與手術方式選擇. 中國修復重建外科雜志, 2009, 23(5): 549-551.
15. 姜正明, 張承銘, 錢偉, 等. 嚴重擠壓傷 5 例救治體會. 中華臨床新醫學, 2002, 2(7): 645-646.
16. 鐘洲, 劉熹, 張暉, 等. 地震擠壓綜合征遲發性肌肉壞死的臨床研究. 中國修復重建外科雜志, 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. 裘華德, 王彥峰. 負壓封閉引流技術介紹. 中國實用外科雜志, 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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