急诊手外伤的流行病学调查

目的 了解手外伤的发生、构成、分布及影响因素.方法 对2005年4月1日至9月30日在我院就诊的所有手外伤患者进行问卷调查,统计并分析其流行病学特点.结果 共5 233例手外伤患者,占骨科急诊的34.1%,平均年龄为(31.0±12.5)岁,男∶女为4.2∶1,83.0%为开放性损伤,就诊距受伤时间(2.5±4.0)h.职业性损伤占50.8%,家庭生活伤占21.3%,道路交通伤占14.2%,在餐饮及娱乐场受伤占9.9%,运动伤占2.5%,购物场所占1.3%.损伤机制以切割伤(44.4%)和压砸伤(27.7%)最常见.损伤以双侧示指和中指最易受累.结论 手外伤是一种高发损伤,主要发生在青壮年男性中,以职业性损伤多见.职业性损伤和生活性损伤均是预防的重点.

Abstract：

Objective To study the incidence,composition,distribution and influence of acute hand injuries. Methods From April 1st 2005 to September 30th 2005,all patients with acute hand injuries treated at Beijing Jishuitan Hospital were investigated by filling out a questionnaire focusing on all related epidemiological elements. Results A total of 5 233 patients were identified,accounting for 34.1% of all acute orthopedic injuries. Patients were typically (31.0±12.5) years old. They were mostly male,with a male to female hand injures. 21.3% were injured at home,14.2% injured on the road,9.9% injured at leisure places,2.5% injured during sports activities,and 1.3% injured at shopping places.Cutting (44.4%) and crushing (27.7%) were the most common injury mechanisms. Conclusion Acute hand injuries were common injuries,occurring mainly in male adults. Most of these injuries were occupational hand injuries. Prevention should be emphasized.     

工业手外伤调查

目的深入了解我区工业手外伤的发生原因，探索有效的预防措施，降低工业手外伤的发病率。方法我们对本区653例工业手外伤的工人进行了问卷调查。结果男性工人手外伤占80．2％；20～30岁年龄段最多，占31．3％；伤者文化程度较低，初中及初中以下文化程度占82％；单位以个体和集体中小企业为主占71．3％，其中个体企业占31．3％，集体企业占45％；工种以车工、木工、修理工和建筑工为主，占64％；伤前加班和睡眠不足者占33．1％。调查结果对预防工业手外伤有十分重要的参考价值。结论手外伤主要发生在20～50岁男性，手工种以车工、木工、修理工、装配工为主，外伤预防的重点在个体和集体中小企业单位。     

手外伤患者健康教育的调查分析

随着手外科临床治疗技术的不断提高,对护理工作提出了更高要求。在加强临床护理的同时,对患者进行健康教育,不但有助于患者主动参与、积极配合治疗和护理,而且能促进功能康复和心理康复。现就我院从1999年5月～2001年4月,收治的80例手外伤患者的健康教育调查报告分析如下。1资料与方法1.1一般资料本组80例,男63例,女17例;年龄18～52岁。受教育程度:初中以上33例,初中以下45例,文肓2例。1.2方法首先由一名责任护士采用我科自行设计的健康教育需求调查表,以问卷法在详细介绍问卷内容后请患者填表。对其中2名文肓者由其口述后,护士代为填写。将…     

医院急诊手外伤病例的描述性流行病学调查报告

目的 通过对上海华山医院急诊手外伤患者的流行病学调查，了解医院急诊手外病例的构成及其分布特征。方法 对１９９７年４月至１９９８年３月，在上海华山医院就诊的２２７２例急诊手外伤患者进行问卷调查；并对在１９９８年１月来刀诊的１６０例患者进行随该。根据性别、年龄、受伤地点和部位等，分析该群体的流行病学特征。结果 患者平均年龄为３３．８９岁，２０～５０岁的青壮年占８６．１％。男女性别比为２．８６：１。工伤     

手外伤术后病人的自我形象调查

为了解手外伤术后病人的自我形象水平 ,对 6 1例手外伤术后住院及门诊病人进行了调查。结果调查对象自评自我形象 (body im age)得分为 9.5 8± 2 .0 4,5 4.0 6 %调查对象的自评得分在平均数以下。病人对手功能的感知得分最低 (2 .5 5± 1.14) ,对手外形的感知得分 3.2 3± 0 .74,对其他人反应的感知得分最高 (3.91± 0 .5 7) ;对手功能的感知可受到病人在家庭中承担的角色的影响。提示手外伤术后病人的自我形象存在一定程度的改变 ,护理上应帮助病人重建健康的自我形象     

医院急诊手外伤流行病学调查及对策

目的调查沙井人民医院急诊手外科患者手外伤发生状况及流行病学特征,探讨预防措施,最大限度降低手外伤的发生率和致残率。方法对1136例手外伤住院病例进行回顾性统计和分析。结果(1)手外伤发生的高危人群是10～40岁的青壮年,男性为主;(2)每年3、4月份及7、8月份为事故高发期,而每天12～18时为事故好发时间;(3)设备条件差,缺少防护装置和违反操作规程是致伤的主因;(4)乡镇和个体私营企业是事故高发单位;(5)切割伤和压砸伤是主要损伤类型,拇、食及中指较易受伤。结论手外伤发生有一定规律可循,针对其发病特征,制定预防措施,可降低发病率和致残率。     

沈阳地区急诊手外伤患者流行病学调查分析

目的调查分析沈阳地区急诊手外伤患者的流行病学特征。方法采用回顾性分析的方法自行设计调查统计表,对2010年1月-2012年12月在我院就诊的急诊手外伤患者进行调查统计并加以分析,主要包括：急诊手外伤患者性别、年龄、文化程度、致伤原因、伤害环境、损伤类型等因素。结果急诊手外伤患者男性明显高于女性,其比值为5．78：1;高发年龄段在16-35岁;文化程度以初中学历所占比例最高。为51％．高中学历占20．69％;引起伤害的原因,以工作中操作不当所受伤害最多,占69．99％,家庭生活中受伤占19．35％：开放性损伤占98．28％,其中挤轧伤、切割伤分别占36．65％,35．06％,闭合性损伤仅占1．72％。结论本地区急诊手外伤患者以青中年居多,且男性比例显著高于女性;工伤、开放性损伤所占比例最高,应重点预防。     

职业性手外伤回归工作状况及影响因素

目的 调查我国职业性手外伤患者一般状况,分析影响职业性手外伤回归工作的因素.方法 对2008年9月至2009年9月在华山医院急诊、门诊就诊及住院的共216名职业性手外伤患者进行前瞻性调查队列分析,了解其基本特征、受伤状况、心理学特征、经济及社会支持情况及回归工作状况,分析回归工作结局与可能的影响因素.结果 约71.7%的患者在离开医院8个月内成功返回工作,缺勤时间中位数为24 d.临床状况、社会支持状况及心理学特征均影响回归工作结局.结论 影响职业性手外伤患者回归工作的因素是多方面的,未来应建立跨学科的干预措施,以促进工人工伤后回归工作.

Abstract：

Objective To study the composition and distribution of occupational hand injuries and to identify the potential determinants of return to work (RTW) after traumatic hand injuries. Methods A prospective cohort study was carried out in 216 patients of occupational hand injuries treated in the department of hand surgury, Huashan Hospital from September 2008 to September 2009. Demographic, clinical, economic and social, psychological features and post-injury information were interviewed and collected. Univariate analysis was used to examine the associations between potential determinants and outcomes of RTW. Results 71.7% of the patients returned to work within 8 month after hospital discharge. The median absence time was 24 days.Factors from socio-demographic, clinical, economic and psychological domains affected RTW in the univariate analyses. Conclusion There were multidimensional factors that affect RTW after occupational hand injury.Future studies should be conducted to develop a multidisciplinary intervention strategy towards promoting RTW.     

手外伤康复病人情绪状况调查分析

手外伤患者临床治愈后，手功能的恢复仍是一个艰苦而漫长的过程，是继手外伤后对患者身心的又一较持续的负性刺激。为了解手外伤康复病人的心理健康状况，作者对部分手外科康复病人的情绪状况进行调查，从而有针对性地对患者进行心理疏导，以达到理想的康复效果。     

Alcohol-related hand injuries

The study was based on 1199 patients consecutively treated for hand injuries in the Second Department of Surgery of the Jagiellonian University in Krakow between the years 1987 and 2000. Three hundred and twenty of these patients (26.6%) had consumed alcohol several hours before an accident. Data collected from an interview with the patient and a doctor on duty were used in the study. Routine tests for blood alcohol concentration were not carried out. Young men (89.3%), mostly manual workers (74.3%) (p<0.001), constituted the majority of patients in the alcohol group. They were younger on average (p<0.001) than sober patients. In most cases, the accident had happened at home (65.9%) (p<0.001) and the main cause of injury was a cut with glass (p<0.001). Despite only minor injuries they were treated in hospital due to their state of intoxication. The degree of hand disability was higher (p<0.05) than with sober patients. The average cost of treatment in a state of intoxication was more than twice as high as the cost of treatment in sober patients. Alcohol-related hand injuries present a major medical and socioeconomic problem.     

Causes and consequences of hand injuries

BACKGROUND: Hand injuries are considered to be the most frequent body injuries, the treatment of which is of long duration and great community expense. The aim of this study was to define the most frequent causes of hand injury in the investigated materials; the severity of hand injuries and outcome of treatment performed in the typical trauma surgery ward; and overall costs of hand-injury treatment. METHODS: Between 1987 and 2000, 1199 patients (average age 37.0 years (+/- 15) were treated for complex hand injuries in II Surgery Clinic in Cracow. Causes, places, and mechanisms of hand injuries were evaluated as were types and duration of treatment. We also estimated also total (direct and indirect) treatment costs. RESULTS: Of all hand injuries, 45.3% occurred at home and 19.7% at work. Hand injuries caused by mechanical equipment predominated (34.9%) and were the most severe. Up to 26.7% of injuries occurred after alcohol consumption. Average total treatment time was 76.9 days (+/- 67). Hand impairment of variable severity was found in 58.5% of patients. Indirect costs constituted a dominant part of overall costs (96%). CONCLUSIONS: The complex treatment of the injured hand at specialist centers allows for shorter treatment duration, improved treatment results, and decreased indirect expenses.     

Mutilated hand injuries

The authors provide a review of treatment of the mutilated hand, discussing the effect of injury on soft tissue loss, intrinsic and extrinsic musculature, paravascular structures, tendons, and the bony skeleton. The authors review functional loss and restoration.     

烟台市手外伤流行病学特征及预防对策

目的调查烟台市手外伤发生状况及流行特征,探讨预防措施,最大限度降低手外伤的发生和致残率.方法对4088例手外伤住院病历进行回顾性统计和分析.结果 (1)手外伤发生的高危人群是15～45岁的青壮年,男性为主;(2)每年3、4月份及7、8月份为事故高发期,而每天11～12时、13～15时为事故好发时间;(3)设备条件差,缺少防护装置和违反操作规程是致伤的主因;(4)乡镇和个体私营企业是事故高发单位;(5)切割伤和压砸伤是主要损伤类型,示、拇及中指较易受伤;(6)伤员经过转诊后就诊时间明显长于直接就诊者(P＜0.01).结论手外伤发生有一定规律可循,针对其发病特征,制定预防措施,可降低发病率.     

手部高压注射伤的治疗特点

[目的]探讨手部高压注射伤（high-pressure injection injuries of the hand，HPIIH）的发病机制，分析切开引流对其病程发展的影响。[方法]2001年11月～2005年11月，对5例手部高压注射伤作了切开引流、清创。[结果]3例伤口愈合良好，1例指腹和甲床部分坏死，作了邻指皮瓣修复，1例手指末节坏死于远侧指间关节以远截指。[结论]手部高压注射伤因注入物不同，造成结果差异较大。首次切开引流的时间常决定病程发展与疗效。切开引流充分是治疗的及时措施，必要时需多次清创引流。     

Cost,profile, and postoperative resource use for surgically managed acute hand and wrist injuries with emergency department presentation

Study DesignRetrospective cost-of-illness study.IntroductionInjuries to the hand and wrist are common. Most uncomplicated and stable upper extremity injuries recover with conservative management; however, some require surgical intervention. The economic burden on the health care system from such injuries can be considerable.Purpose of the StudyTo estimate the economic implications of surgically managed acute hand and wrist injuries at one urban health care network.MethodsUsing 33 primary diagnosis ICD-10 codes involving the hand and wrist, 453 consecutive patients from 2014 to 2015 electronic billing records who attended the study setting emergency department and received consequent surgical intervention and outpatient follow-up were identified. Electronic medical records were reviewed to extract demographic data. Costs were calculated from resource use in the emergency department, inpatient, and outpatient settings. Results are presented by demographics, injury type, mechanism of injury, and patient pathway.ResultsTwo hundred and twenty-six individuals (n 1?4 264 surgeries) were included. The total cost of all injuries was $1,204,606. The median cost per injury for non-compensable cases (n = 191) was $4508 [IQR $3993-$6172] and $5057 [IQR $3957-$6730] for compensable cases (n = 35). The median number of postoperative appointments with a surgeon was 2.00 (IQR 1.00-3.00) for both compensable and non-compensable cases. The number of hand therapy appointments for non-compensable cases and compensable cases was 4 [IQR 2-6] and 2 [IQR 1-3], respectively.DiscussionFindings of this investigation highlight opportunities for health promotion strategies for reducing avoidable injuries and present considerations for reducing cost burden by addressing high fail to attend (FTA) appointment rates.ConclusionSurgically managed hand and wrist injuries contribute to a significant financial burden on the health care system. Further research using stringent data collection methods are required to establish epidemiological data and national estimates of cost burden.     

手外伤流行病学描述性研究

目的 通过对本院就诊的手外伤患的流行病学调查了解本行政区手外伤病例的构成、发病特点和社会影响及意义。方法 对2001年7月～2002年6月，在本院就诊的2664例急诊和住院手外伤患进行问卷调查，作描述性研究分析。结果 于外伤患占本院同期就诊患的3.56‰，以男性20～40岁青年居多，工伤占76.0％，开放性损伤占95.3％，手指损伤占74.2％，工伤患中私营企业员工占68.O％。结论本组手外伤患以男性青年为主，主要是私营企业的员工，与机器设备差、无安全保护措施、无熟练专业技能、劳动强度大等因素有关，手外伤对个人和社会造成很大损失，应加强对私营企业的安全生产监管，积极预防手外伤的发生。     

A characterization of home maintenance equipment-related hand and lower arm injuries

BackgroundThousands of Americans sustain injuries from various household appliances each year, though injury patterns have not been well characterized. We thus sought to determine the incidence, characteristics, and trends of household appliance-related hand injuries over the past decade.MethodsThe National Electronic Injury Surveillance System database (NEISS) was queried from 2010 through 2019. Our analysis grouped patients into 10-year age groups. We defined types of appliances and injuries Chi-square tests were used to compare the most common injury mechanisms by age group.ResultsBetween 2010 and 2019, 30,336 total cases of home workshop equipment-related upper extremity injuries were recorded; 2,574 (8.48%) of these affected females, compared to 27,762 (91.52%) of the cases affecting males. Across all age groups, males were between 6 and 13 more times likely to be injured than females (p < 0.001). Between 2010 and 2019, we recorded a decline in total injuries from 168,795 to 147,584, with a Pearson correlation coefficient of -0.68 (p = 0.031). The appliances most likely to injure those in their 10s through 40s were mechanical tools such as screwdrivers. Meanwhile, those in their 50s through 70s were most likely to be injured by saws. Both amputations and avulsions were found to significantly increase with age (p = 0.038, p = 0.027, respectively). Most injuries result from manual tools and saws.DiscussionMales are significantly more likely to incur injuries than females from maintenance equipment, and risk of avulsions and amputations increase significantly with age. This aligns with previous research which also suggested that older saws were most likely to injure older individuals; namely, following new regulations on saws, older adults were more likely to be affected. This is especially worrisome in light of recent research showing that older adults with amputations are less likely to be offered replantations. Overall, these results can continue to guide and optimize community interventions on an epidemiological basis.