高腾飞，许鹏，程红.西安交通大学医学院，陕西西安 7006；.西安市红十字会医院关节坏死与重建外科，陕西西安 70005

手指人咬伤并发指骨坏死65例分析

高腾飞1，许鹏2，程红1
1.西安交通大学医学院，陕西西安 710061；2.西安市红十字会医院关节坏死与重建外科，陕西西安 710005

目的分析手指人咬伤并发指骨坏死的处理方法。方法 整群2014年6月—2015年11月期间收治的65例手指人咬伤并发指骨坏死患者作为研究对象，观察患者受伤部位的临床表现、并发症情况、受伤分期及细菌培养结果。结果65例患者中，33例患者疾病分期为中期，32例患者为晚期，参照Swanson等及TAM系统标准对65例患者的手指功能进行评价，结果显示优31例，良8例，可9例，差4例，截指13例。细菌培养结果显示葡萄菌属、链球菌属及肠道杆菌属为主要感染致病菌。结论手指人咬伤发生后应立即接受治疗，若延误治疗很可能并发感染、指骨坏死等严重并发症，而指骨坏死后往往需咬除指骨或截指处理；应联合应用广谱抗生素预防或抗感染；注意伤指功能的早期锻炼。

人咬伤；指骨坏死；截指；VSD

［Abstract］Objective To analyze the treatment method of human bite injury of fingers combined with phalange necrosis.Methods 65 cases of patients with human bite injury of fingers combined with phalange necrosis admitted and treated in our hospital from June 2014 to November 2015 were selected as the research objects，and the clinical manifestations of injured position，complications，injured staging and bacterial culture results of patients were observed.Results Of the 65 cases，the disease staging of 33 cases was middle stage and of 32 cases was advanced stage，and the finger function of 65 cases was evaluated by Swanson and TAM system standard，and the results revealed that 31 cases were excellent，8 cases were good，9 cases were fair and 4 cases were poor，and the finger amputation occurred to 13 cases，and the bacterial culture results revealed that staphylococcus，streptococcus and enterobacter spp were the main infection pathogens.Conclusion Patients should immediately receive treatment after the occurrence of human bite injury of fingers，the severe complications including infection and phalange necrosis may occur if the treatment is prolonged，but the phalange usually needs to be bitten and removed or given finger amputation treatment after phalange necrosis，and we should apply the wide-spectrum antibiotics for prevention and anti-infection on this basis and pay attention to the early exercise of the injured fingers.

［Key words］Human bite injury；Phalange necrosis；Finger amputation；VSD

人咬伤是指人用牙齿攻击对方所造成的伤害，该 种咬伤与动物咬伤存在一定的差异性，该名词最早被收录于中国医学大辞典中，原文记载人之齿垢最毒，故咬伤之创，亦肿痛异常，失治则臭脓腐烂，日久不敛。人咬伤多发生于多发生于斗殴打架，具有不可预期性，比较常见的咬伤部位为手指、手臂。由于人体的手指关节较多，结构复杂却又不失精细，因此在被咬伤后极易对手指功能造成影响，这也是我国临床在处理手指外伤时以最大程度的恢复患者手指功能为基本原则的主要原因。……