火器性周围神经间接伤对伤口愈合的影响  

Effect of Indirect Injury to Peripheral Nerve on Wound Healing after Firearm Wounds

作　　者：赖西南 刘荫秋[1] 李开龙[1] 雷安福 练伟坤[1] 安波[1] 陈蕾[1] 

机构地区：[1]第三军医大学野战外科研究所

出　　处：《中华创伤杂志》1995年第3期147-148,共2页Chinese Journal of Trauma

摘　　要：以高、低速投射物致伤犬肢体为实验模型，在观察火器性坐骨神经间接损伤的形态学基础上，对伤道组织内参与伤口愈合的神经递质的第二信使环核苷酸的变化以及胆碱酯酶的活性进行动态观察，探讨上述变化与火器伤伤口愈合的关系。实验发现肢体火器伤时，伤道外坐骨神经结构发生明显损伤，以髓鞘劈裂、轴索裸露、神经微丝减少为特征，高速投射物组明显重于低速投射物伤组。同时伤后６小时至１０天，高速组伤道组织ｃＧＭＰ含量以及胆碱酯酶活性均低于低速组。伤后高速组伤道肉芽组织内标志伤口愈合程度的羟脯氨酸含量低于低速组。实验结果提示肢体火器伤时周围神经间接伤与投射物速度有关，周围神经损伤尤其是神经细胞骨架损伤导致神经递质以及胆硷酯酶活性代谢紊乱是影响火器伤伤口愈合的重要因素。因此肢体火器伤时改善周围神经功能，纠正神经递质代谢紊乱是促进伤口愈合的重要措施。High and low velocity projectile wounds in canine hind extremity were respectively used as an experimental model and the morphologic changes of indirect injuries to sciatic nerves were observed.Meanwhile,the content of cyclic nucleotides (cAMP、cGMP),second messenger of neurotransmitter,and activity of cholinesterase (Ache) at motor end plate of wounded tissue were determined to study the relationship between the above changes and wound healing .It was found that the indirect injuries to scistic nerves beside wound tract were obvious and the morphologic changes were of stripped myelin,naked axon and decrease of neurofilament of neuroskeleton.Those changes of high velocity projectile (HVP) wound were more serious than those of low velocity projectile (LVP) wound.From 6 hours to 10 days after wounding cGMP content and Ache activity of HVP wound were lower than those of LVP wound.The changes of hydroxyprolin content of HVP wound that indicats the degree of wound healing also showed the same tendency.The result suggests that the indirect injuries to sciatic nerves after firearm wound are related to the velocity of projectile.The injured neuroskeleton may cause the disturbance of neurotransmitter and ache that may be contrituted to influence of wound healing.Therefore,the improvement of peripheral nerve function and local metabolism of neurotransmitter after firearm wound of extremity is an important treatment for promoting wound healing.(Original article on page 147)

关 键 词：火器伤 神经纤维 胆碱酯酶类 伤口愈合 

分 类 号：R826.5[医药卫生—临床医学]