颌面部爆炸伤病理特点及早期修复研究  

Pathological characteristics of maxillofacial explosive injury and the early reconstruction of soft tissue defects

作　　者：雷德林[1] 王昭领[1] 白振西[1] 周树夏[1] 李兵仓[2] 张良潮[3] 吴国萍[2] 

机构地区：[1]中国人民解放军第四军医大学口腔医学院颌面外科,西安710032 [2]中国人民解放军第三军医大学野战外科研究所六室 [3]中国人民解放军第三军医大学野战外科研究所六室

出　　处：《中国急救医学》2003年第1期5-6,共2页Chinese Journal of Critical Care Medicine

基　　金：全军"十五"医药卫生指令性课题资助项目 ( 0 1L0 75)

摘　　要：目的　探讨颌面部爆炸伤的病理特点及早期修复软组织缺损的方法。方法　 30只犬随机分成 6组 ,利用高速破片复合冲击波模拟爆炸对犬颌面部致伤。记录致伤参数 ,并通过大体观察及组织观察方法研究伤后不同时间点动物伤情及伤道周围软组织的病理变化。取一组动物于伤后 72h二次清创 ,股薄肌肌皮瓣游离移植对局部组织缺损进行修复。结果　颌面部创面污染严重 ,伤后肌组织近伤道 0 8cm范围内坏死严重 ,振荡区波及到 1 6cm外组织 ,伤后 2 4h周围组织炎性反应明显 ,同时可见小血管损伤明显。组织坏死呈进行性加重至伤后 72h ,伤后 1 68h开始有明显肉芽组织生成。吻合血管皮瓣组织愈合良好。结论　颌面部爆炸伤伤情重 ,污染明显 ,组织坏死范围大 ,愈合延迟 。Objective To study the pathological characteristics of maxillofacial explosive injury and explore an effective method for the early reconstruction of tissue defects.Methods The explosive injury was induced by smooth bore barrels combined with detonators.In this study,maxillofacial regions of 30 dogs were used as the targets.The animals were randomly divided into 6 groups for pathological observation and reconstruction.At different time points (0,6,24,72,168 h)after injury,the specimens of soft tissues at different distance from wound track were harvested for pathological observation.5 dogs in one group were re-debrided and reconstructed with vascularized gracilis flaps 72 h following injury.Results The wound was seriously contaminated.Muscles at 0～0 8 cm distance from the wound track were completely necrotic and the areas of necrosis extended beyond 1 6 cm, together with the injuries of micro-vessels.All the flaps healed well.Conclusions With wide range of necrosis and serious contamination,vascularized flaps should be effective of the early reconstruction of the tissue defects caused by explosive injury in maxillofacial region.

关 键 词：病理特点 早期修复 颌面部 爆炸伤 组织缺损 游离皮瓣 外科修复 

分 类 号：R782.4[医药卫生—口腔医学]