Objective: To investigate the characteristics of patients with crush injury in Wenchuan earthquake and the corresponding operational methods.
Methods: From May 12th 2008 to June 18th 2008, 202 patients with crush injury of soft tissue were treated, including 110 males and 92 females. Twenty-five patients aged 19 months to 16 years, 129 patients aged 17-60 years and 48 patients aged above 61 years. The crushed time was 30 minutes to 154 hours. Sixty cases of open injuries were treated by debridement and dressing or suture; 16 cases of damaged extremities (18 limbs) and 6 cases of acute renal failure due to crush syndrome (8 limbs) received amputation; 32 cases of interfascial space syndrome crisis (42 limbs) were treated by fascia cavity decompression; 15 cases received the resection of necrotic muscle for 31 times; and 9 cases received continuous renal replacement therapy (CRRT).
Results: All the wounds healed except 2 cases which died from intestinal bleeding and intracranial hemorrhage during the treatment of CRRT. Two cases were discharged 8 months after treatment, while the other 198 cases recovered and were discharged 15-120 days after treatment. The average hospitalization time was 53 days. Twenty-two cases (26 limbs) were fixed with artificial limbs 3-6 months after amputation and achieved good functional outcome.
Conclusion: The treatment principle of crush injury is "be active to decompress and be prudent to amputate", the hardening muscle and the increasing level of creatine kinase and blood potassium are the golden indicators of fascia cavity decompression. Decompression at an earlier period is preferred when there is a dilemma to choose, and open amputation should be performed when the necrotic muscle is hard to clear or the necrosis boundary is not distinct.