MRI与病理学评价封闭式负压引流技术早期治疗肢体枪弹伤疗效  

MAGNETIC RESONANCE IMAGING AND PATHOLOGICAL EVALUATION OF VACUUM SEALING DRAINAGE EFFICACY OF EARLY TREATED LIMB GUNSHOT

作　　者：李荣刚[1] 刘兴炎[2] 陈克明[2] 叶建军[2] 高明轩[2] 葛宝丰[2] 王勇[2] 熊发明[1] 梁建平[1] 

机构地区：[1]兰州大学第二临床医学院,兰州730030 [2]兰州军区兰州总医院骨科中心

出　　处：《中国修复重建外科杂志》2010年第3期335-339,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：全军“十一五”重点课题资助项目(06G033)~~

摘　　要：目的枪弹伤对周围组织器官波及范围较大,不易清创,极易感染。传统治疗是彻底清创,充分开放引流,但可引起正常组织的损伤与并发症。通过MRI、病理学方法评价封闭式负压引流技术(vacuum sealing drainage,VSD)对猪肢体枪弹软组织贯通伤早期处理效果,为临床枪弹伤早期救治提供实验依据。方法取健康成年长白猪8只,体重(45±5)kg,采用国产95式步枪于25m距离射击致双后肢贯通伤,共8对16个,取左侧为实验组(n=8),右侧为对照组(n=8)。于伤后6h行弹道出、入口清创消毒后,实验组行VSD治疗,敷料贯穿整个弹道;对照组采用单层油纱覆盖弹道出口创面,入口直接拉拢缝合后无菌纱布覆盖。大体观察两组弹道及周围皮肤情况。伤后5、24、48、72h行MRI检查及取材行组织学观察,0、12、24、48、72h行细菌学计数。结果伤后即刻两组弹道入口口径为(0.30±0.15)cm,出口为(5.00±2.50)cm。伤后72h实验组弹道表面清洁、红润,未见渗出及肿胀;对照组弹道周围肿胀明显,弹道内见脓液、坏死肌肉及组织脱落,出口处可见弹道缺损空腔。MRI检查:实验组伤后5h原发弹道外缘见一线性T1WI结合T2WI双低信号,随时间延长碎裂区及组织变形区T1WI信号逐渐增强;对照组伤后5hT1WI呈低信号,之后碎裂区、组织变形区T2WI信号逐渐增高,T1WI增强不明显。组织学观察实验组伤后5h以渗出为主,24～72h肉芽组织逐渐增多,肌纤维溶解,炎性细胞浸润不明显;对照组伤后5～48h肌纤维逐渐溶解,炎性细胞浸润,至72h肌组织肿胀溶解变性,大量炎性细胞浸润聚集成菌团。伤后0h实验组及对照组细菌数差异无统计学意义(P>0.05);12、24、48、72h对照组细菌数较实验组明显升高,差异均有统计学意义(P<0.05)。结论MRI结合病理学对VSD早期处理肢体枪弹伤具有指导意义。MRI在伤后72h内能准确反映枪弹伤组织损伤范围,VSD可推迟感染时间,缩短创面�Abstract： Objective Gunshot wound spreads to the surrounding tissues and organs, it is difficult to debride and easy to infect. The conventional treatment is thorough, extensive debridement, fully open drainage, which often causes normal tissue damage and compl ications. To evaluate the effectiveness of vacuum seal ing drainage （VSD） treating the penetrating wound in porcine extremity by MRI and pathological methods so as to provide theoretical basis for future cl inical use. Methods Eight healthy adult pigs, weighing （45 ± 5） kg, were selected. Eight pairs of hind l imb penetrating wounds （16 wounds） were made by using Chinese-made 95-type rifle at 25 meters distance, which were randomly divided into experimental group （left side, n=8） and the control group （right side, n=8）. After debriding and disinfecting the penetrating wounds at 6 hours after injury, wounds were treated with VSD in experimental group. The ball istics exports of the wounds were covered with single-layer gauze and imports were directly sutured and covered with sterile gauze in control group. The trajectory and the general condition of the adjacent skin were observed. MRI and histological observation were taken at 5, 24, 48, and 72 hours after injury, bacterial counting analysis was done at 0, 12, 24, 48, and 72 hours after injury. Results The aperture of the trajectory exit and entry were （5.00 ± 2.50） cm and （0.30 ± 0.15） cm immediately after injury. The wound surface was clean, rosy without leakage and swell ing after 72 hours in experimental group; wound and adjacent tissue were swell ing obviously, pus, muscle necrosis and exfol iative tissue was observed, and deep defect cavity at the trajectory exit could be seen in control group. MRI showed that pairs of l inear low signal in T1WI and T2WI was seen in trajector of experimental group at 5 hours after injury, and signal in T1WI gradually increased at disrupted area and tissue deformation area at 24, 48, and 72 hours; in control group, low signal in T1WI

关 键 词：枪弹伤 封闭式负压引流技术 MRI 病理学检查 猪 

分 类 号：R826.68[医药卫生—临床医学] R445.2