ﻓﺎﺷﻴﻮﺗﻮﻣﻲ در ﻟﻪ ﺷﺪﮔﻲ در ﺣﺎدﺛﻪ زﻟﺰﻟﻪ ﺑﻢ و ﭘﻴﮕﻴﺮي دو ﺳﺎﻟﺔ ﺑﻴﻤﺎران

Fasciatomy for Crush Injury; the Results of Two Years Fallow up in Bam Earthquake

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺩﺭ ﺳﺎﻋﺖ 5:30 ﺻﺒﺢ ﺭﻭﺯ ﭘﻨﺠﻢ ﺩﻱ ﻣﺎﻩ ﺳﺎﻝ 1382 )26 ﺩﺳﺎﻣﺒﺮ 2003 ﺯﻟﺰﻟﻪ ﺍﯼ ﻫﻮﻟﻨﺎﻙ ﺑﺎ ﻗﺪﺭﺕ 5/7 ﺩﺭ ﻣﻘﻴﺎﺱ ﺭﻳﺸﺘﺮ ﺩﺭ ﺟﻨﻮﺏ ﻛﺮﻣﺎﻥ، ﺩﺭ ﺷﻬﺮﺳﺘﺎﻥ ﺑـﻢ ﺭﻭﯼ ﺩﺍﺩ ﻛﻪ ﺣﺪﻭﺩ 80 ﻫﺰﺍﺭ ﻛﺸﺘﻪ ﻭ ﺯﺧﻤﻲ ﺑﺮﺟﺎﻱ ﮔﺬﺍﺷﺖ. ﺑﻴﻤﺎﺭﺳﺘـﺎﻥ ﺍﻟﺰﻫﺮﺍ )ﺱ( ﺷﻬﺮ ﺍﺻﻔﻬـﺎﻥ ﺑﻪ ﻋﻨﻮﺍﻥ ﻳﮑﯽ ﺍﺯ ﻣﺮﺍﻛﺰ ﺍﺭﺟﺎﻉ ﻣﺼﺪﻭﻣﺎﻥ ﺍﻳﻦ ﺣﺎﺩﺛﻪ ﭘﺬﻳﺮﺍﻱ ﺣﺪﻭﺩ 255 ﺑﻴﻤﺎﺭ ﺑﻮﺩ ﻛﻪ ﺍﺯ ﺍﻳﻦ ﺗﻌـﺪﺍﺩ 20 ﻧﻔـﺮ ﺑـﻪ ﻋﻠـﺖ ﺻﺪﻣﺎﺕ ﻧﺴﺞ ﻧﺮﻡ ﺩﺭ ﺍﻧﺪﺍﻡ ﻫﺎﻱ ﺗﺤﺘﺎﻧﻲ ﻭ ﻓﻮﻗﺎﻧﻲ ﺗﺤﺖ ﻋﻤﻞ ﻓﺎﺷﻴﻮﺗﻮﻣﯽ ﺍﻧﺪﺍﻡ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺯ ﻧﻈﺮ ﻭﺿﻌﻴﺖ ﻋﻤـﻮﻣﻲ ﻭ ﺷﺮﺍﻳﻂ ﺑﺎﻟﻴﻨﻲ، ﻭﺿﻌﻴﺖ ﻣﺪﻳﻜﺎﻝ ﺑﺮﺭﺳﻲ ﺷﺪﻧﺪ. ﻫﺪﻑ ﺍﺯ ﺍﻧﺠﺎﻡ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮﺭﺳﻲ ﻋﻮﺍﺭﺽ ﻭ ﺳﺮﺍﻧﺠﺎﻡ ﺍﻧﺪﺍﻡ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ ﻓﺎﺷﻴﻮﺗـﻮﻣﻲ ﺷﺪﻩ ﻣﻲ ﺑﺎﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺍﺯ 255 ﺑﻴﻤـﺎﺭ ﺯﻟـﺰﻟﻪ ﺯﺩﻩ ﺍﯼ ﻛـﻪ ﺑـﻪ ﺑﻴﻤﺎﺭﺳﺘـﺎﻥ ﺍﻟﺰﻫـﺮﺍ )ﺱ( ﺍﺭﺟـﺎﻉ ﺩﺍﺩﻩ ﺷـﺪﻧﺪ، ﺩﺭ 20 ﺑﻴﻤـﺎﺭ ﻣﺒﺘـﻼ ﺑﻪ Crush Syndrome ﺩﺭ 26 ﺍﻧﺪﺍﻡ ﻓﺎﺷﻴﻮﺗـﻮﻣﻲ ﺍﻧﺠﺎﻡ ﺷﺪ ﻭ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺭ ﻃﻲ ﻣـﺪﺕ 24 ﻣﺎﻩ ﺗﺤﺖ ﭘﻴﮕﻴﺮﻱ ﻣﻨﺎﺳﺐ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﺩﺭ ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﺍﻧﺪﺍﻡ ﻫﺎ ﺩﺭ ﺩﺭﺍﺯ ﻣﺪﺕ ﺍﺯ ﻧﻈﺮ ﻋﻤﻠﻜـﺮﺩ ﺣﺴﻲ ﻭ ﺣﺮﻛﺘﻲ ﻭ ﺩﺍﻣﻨﺔ ﺣﺮﻛﺎﺕ ﻣﻔﺼﻠﯽ ﺑﺮﺭﺳﻲ ﺷﺪﻧﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻛﻠﻴﺔ ﺑﻴﻤﺎﺭﺍﻥ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺑﻌﺪ ﺍﺯ 24 ﻣﺎﻩ ﺍﺯ ﺣﺎﺩﺛﻪ ﻗﺎﺩﺭ ﺑﻪ ﺭﺍﻩ ﺭﻓﺘﻦ ﺩﺭ ﺍﻧﺪﺍﻡ ﮔﺮﻓﺘﺎﺭ ﺩﺭ ﺣـﺪ ﻗﺎﺑﻞ ﻗﺒـﻮﻝ ﺑﻮﺩﻧﺪ. ﺩﺭ 7 ﺑﻴﻤﺎﺭ 11 ﺍﻧﺪﺍﻡ( ﺣﺲ ﺍﻧﺪﺍﻡ ﻫﺎ ﺑﻪ ﺻﻮﺭﺕ ﻫﻴﭙﻮﺳﺘـﺰﻱ ﻳﺎ ﻫﻴﭙـﺮﺳﺘﺰﻱ ﺑﺎﺯﮔﺸﺖ ﻛﺎﻣﻞ ﺩﺍﺷﺘﻪ ﺍﺳﺖ ﻭ ﺑﻘﻴﻪ ﺑﻴﻤـﺎﺭﺍﻥ ﺣﺲ ﺍﻧﺪﺍﻡ ﺩﺭ ﺣﺪ ﻗﺎﺑﻞ ﻗﺒﻮﻝ ﻭ ﻧﺴﺒﻲ ﺑﺮﮔﺸﺖ ﺩﺍﺷﺖ ﻭ ﺗﻨﻬﺎ ﺩﺭ ﻳﻚ ﺑﻴﻤﺎﺭ ﺑﻪ ﻋﻠﺖ ﺩﺑﺮﻳﺪﻣﺎﻥ ﺭﺍﺩﻳﻜﺎﻝ ﺗﻨﻬﺎ ﺣﺲ ﻋﺼﺐ ﺻﺎﻓﻦ ﻭﺟﻮﺩ ﺩﺍﺷﺖ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺍﻧﺠﺎﻡ ﻓﺎﺷﻴﻮﺗﻮﻣﻲ ﺩﺭ ﺍﻧﺪﺍﻡ ﻫﺎﻱ ﺩﭼﺎﺭ Crush Syndrome ﻧﻪ ﺗﻨﻬﺎ ﻋـﻮﺍﺭﺽ ﺧﻄﺮﻧﺎﮐﯽ ﺑﺮﺍﻱ ﺑﻴﻤﺎﺭ ﻧﺪﺍﺭﺩ ﺑﻠﻜﻪ ﺩﺭ ﻧﮕﻬﺪﺍﺭﻱ ﻋﻀﻮ ﻭ ﺣﺘﻲ ﺍﻳﺠﺎﺩ ﻋﻤﻠﮑـﺮﺩ ﺍﻧﺪﺍﻡ ﺩﺭ ﺣﺪ ﻗﺎﺑﻞ ﻗﺒﻮﻝ ﻛﻤﻚ ﻛﻨﻨﺪﻩ ﻣﻲ ﺑﺎﺷﺪ. ﺍﻳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﻧﻴﺎﺯ ﺑﻪ ﺗﻮﺟﻪ ﻭ ﭘﻴﮕﻴـﺮﻱ ﻭ ﺣﻤﺎﻳﺖ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﻭ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺗﺮﻣﻴﻤﻲ ﻭ ﺍﺻﻼﺣﻲ ﺍﻧﺪﺍﻡ ﻭ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺍﺭﺗﻮﺯﻫﺎﻱ ﻣﻨﺎﺳﺐ ﺟﻬﺖ ﺑﻬﺒﻮﺩ ﻋﻤﻠﻜـﺮﺩ ﻋﻀﻮ ﺩﺍﺭﻧﺪ. ﺩﺭ ﻧﻬﺎﻳﺖ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﺤﻮﺓ ﺗﻔﻜـﺮ ﺩﺭ ﻛﺸﻮﺭ ﻣﺎ ﻛﻪ ﺍﺯ ﻧﻈﺮ ﺑﻬـﺪﺍﺷﺖ ﺭﻭﺍﻧﻲ ﻓـﺮﺩ ﻭ ﺟﺎﻣﻌﻪ، ﻗﻄـﻊ ﻋﻀﻮ ﺑﺎﻋﺚ ﻋﻮﺍﻗﺐ ﺟﺒـﺮﺍﻥ ﻧﺎﭘﺬﻳﺮ ﻣﻲ ﺷﻮﺩ، ﻧﺠﺎﺕ ﺍﻧﺪﺍﻡ ﺭﺍ ﺑﺎﻳﺪ ﺑﻪ ﻋﻨﻮﺍﻥ ﻳﻚ ﺍﻗـﺪﺍﻡ ﻣﻬـﻢ ﺩﺭﻣﺎﻧﻲ ـ ﺣﻤﺎﻳﺘﻲ ﺑﺮﺍﻱ ﺑﻴﻤﺎﺭﺍﻥ Crush Injury ﺩﺭ ﻧﻈﺮ ﺩﺍﺷﺖ.

Introduction & Objective: At 5:30 AM of 25th December 2003 a strong earthquake was occurred in Bam that led to 80 thousands death and traumatic patients. St Zahra hospital as a referral center admitted 255 patients in twenty patients because of soft tissue injury in upper and lower extremity fasciatomy were done. The main aim of this study is evaluation of complication and outcome of these patients. Material & Methods: In 20 cases of fasciatomy of 26 extremities were undergone fasciatomy. In 24 months of follow-up, sensation and motor function of limbs and ROM of joints were evaluated. Results: All of patient after 24 months could walk without help and ROM of joints were within normal ranges. In 7 patients (11 extremities) the sensation were as hyposthesia or hyperesthesia. The others had good or normal sensation in extremities. Only in one patient because of radical debridment, sensation was present only in safenous dermatome. The rest patients had good sensation in palmar region. Conclusions: Fasciatomy is not only a safe procedure but also necessary for limb salvages. Fasciatomy also can preserve normal function of limbs. For best results, physical therapy and prosthesis usage is necessary for patients. Even if fasciatomy can not preserve limb function it must do, because of limb salvage.