颌面部枪击伤和爆炸伤模型建立及早期救治的初步研究  

A preliminary study of model establishment and early treatment of maxillofacial gunshot wound and blast injury

作　　者：王之发 孙烁辉 马军利 刘聪贺 丁璐 李浪 程洁 李潇 汪维健 WANG Zhifa;SUN Shuohui;MA Junli;LIU Conghe;DING Lu;LI Lang;CHENG Jie;LI Xiao;WANG Weijian(Department of Stomatology,General Hospital of Southern Theater of PLA,Guangzhou 510010,China)

机构地区：[1]中国人民解放军南部战区总医院口腔科

出　　处：《口腔医学》2019年第10期895-901,911,共8页Stomatology

基　　金：军队后勤科研计划重点项目(BGZ15J001);国家自然科学基金资助项目(81700943);广东省自然基金(2017A030310671)

摘　　要：目的①探讨颌面部枪击伤和爆炸伤动物模型的建立;②研究颌面部枪击伤和爆炸伤后的早期救治策略。方法 8只犬(6只中华田园犬和2只比格犬,6月龄,雄性)随机分为两组,枪击伤(A)组和爆炸伤(B)组,致伤前先制作胸腹部和颅脑防护装置,做头颅CT扫描和三维重建。A组:根据有无粉碎性骨折致咬合关系错乱行清创缝合或清创缝合+骨折外固定治疗;B组:爆炸伤致颌面部软组织多发穿通伤并大量异物残留,行清创缝合治疗。枪击伤致伤源为5.8 mm和7.62 mm高精度狙击步枪,致伤距离50 m;爆炸伤致伤源为制式200 g TNT药块,距离分别为3 m和1 m。按照分组情况伤后立即行气管插管和相应的处理,术后给予抗生素预防感染;术后12 h再次行头颅CT扫描和三维重建。结果该模型可稳定地模拟犬颌面部枪击伤和爆炸伤。当枪击伤距离为50 m时,随着致伤源高精度狙击步枪口径的增大(5.8 mm到7.62 mm),颌面部创伤也由咬合关系正常的下颌骨下缘粉碎性骨折变为上下颌骨的粉碎性骨折并伴有咬合关系错乱和严重的软组织撕裂伤。当爆炸伤致伤源固定为含241 g细铁钉的制式200 g TNT药块时,随着致伤距离的缩小,实验动物的颌面部创伤也越来越严重。两组实验动物伤后均采取合适的治疗方法和对症处理,除爆炸伤致伤距离为1 m的犬伤后20 h死亡外,其余均生存状态良好,精神可,行动自如,可少量饮食饮水,存活实验动物均继续饲养四周。结论该实验致伤模型可以实现咬合关系正常和错乱的枪击伤模型和不同程度的爆炸伤模型。伤后立即采取合适的抢救措施,如气管插管、清创缝合、骨折外固定、静脉补液和抗感染后,可维持犬颌面部外形和咀嚼功能的正常;其中早期救治起着至关重要的作用。Objective ①To investigate the animal model establishment of maxillofacial gunshot wound and blast injury;②To study the early treatment strategies of maxillofacial gunshot wound and blast injury. Methods Eight dogs(6 Chinese garden dogs and 2 Beagle dogs, 6 months old, male) were randomly divided into two groups: gunshot wound(A) group and blast injury(B) group. Before the injuries were performed, the protective devices for chest and abdomen and craniocerebral were made. Besides, CT scanning and 3 D reconstruction were also conducted. Group A: Debridement or/and fracture external fixation treatment was performed according to the occlusal relationship changes resulting from gunshot;Group B: Multiple penetrating wounds in the maxillofacial soft tissue and a large amount of foreign body residual resulting from blast injury, and debridement treatment was performed. These wounds caused by gunshot were 5.8 mm and 7.62 mm high-precision sniper rifles, and the injury distance was 50 meters. The source of blast injury was a standard 200 g TNT drug block containing 241 g thin nails, the injury distance was 3 meters and 1 meter, respectively. According to injury conditions, the tracheal intubation and debridement and fracture external fixation treatments were performed immediately after the injury, at the same time, antibiotics were given to prevent infection. CT scanning and 3 D reconstruction were also performed again 12 hours after operation. Results These models could stably simulate canine maxillofacial gunshot wound and blast injury. When the shooting distance was 50 meters, with the increase of the high-precision sniper rifle caliber(5.8 mm to 7.62 mm), the maxillofacial trauma also changed from the comminuted fracture of the lower mandible with normal occlusion to a comminuted fracture of the upper and lower jaw with occlusal dislocation and soft tissue laceration. When the source of blast injury was kept to a 200 g TNT drug block containing 241 g thin nails, the jaw wounds of the experimental animals became more

关 键 词：犬 颌面部 枪击伤 爆炸伤 早期救治 

分 类 号：R782.4[医药卫生—口腔医学]