枪弹和爆炸所致犬面神经损伤特点的对比研究  

Comparative study between the characteristics of facial nerve jnjury resulted from gun-shot and that from blast

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

机构地区：[1]西安第四军医大学口腔医学院颌面外科,710032 [2]第三军医大学大坪医院野战外科研究所第六研究室

出　　处：《实用口腔医学杂志》2003年第4期321-324,共4页Journal of Practical Stomatology

基　　金：军队"九五"规划指令性课题"颌面战伤救治"资助 (96L0 4 7)

摘　　要：目的 :比较面神经枪弹伤和爆炸伤的损伤及恢复情况间的差异 ,为临床上分类处理不同致伤因素导致的外周神经战伤提供理论依据。方法 :选用成年犬 40只 ,随机分为枪伤组和爆炸伤组 ,每组各 2 0只。麻醉下爆炸伤组在距犬面部 10cm处放置雷管模拟爆轰波致伤效应 ,并在雷管爆炸同时 ,用滑膛枪发射钢珠弹致伤犬面下部以模拟破片伤。枪伤组不放置雷管 ,分别于伤后即刻、6h、1d、3d、7d取两组面神经进行HE和免疫组化染色 ,并检测伤后 6h、3d、7d面神经动作电位传导速度 ,观察面神经的病理改变和功能恢复情况。结果 :伤后即刻大体观察两组动物面神经干水肿 ,枪伤组神经外膜下有散在出血和小血肿 ;爆炸伤组外膜下弥散出血 ,血肿范围也较大。镜下观察爆炸伤组面神经全颅外段轴突均发生广泛断裂 ,神经干内高度水肿 ,断裂的轴突呈小片段或碎片样 ,大量炎细胞浸润 ,免疫组化染色只有少量轴突神经纤维细丝蛋白阳性 ;而枪伤组在距伤道 2cm以内神经可见散在结构破坏 ,距伤道 2～ 3cm结构改变很轻。结论 :枪弹所致面神经伤随距伤道的距离增加而减轻 ,爆炸所致损伤与距伤道的距离没有明显关系 ,损伤程度更重 ,范围更广。Objective: To study the difference between the facial nerve injury by gun-shot and that by blast. Methods: 40 adult dogs were divided into 2 groups, with 20 dogs in each. In the blast group, the impact wave was simulated by detonator blast in the distance of 10 cm over the dog's masseter. At the same time,a steel ball was projected to the dog's face by a rifle to imitate segments in blast. In the gun-shot group, only the steel ball was used. Then the facial nerve was taken at the time of immediateness, 6 hours, 1 day, 3 days and 7 days following the injury for HE or immunocytochemical staining. And the facial nerve conduction velocity was examined 6 hours, 3 days and 7 days after injury.Results: The facial nerve edema was found in both groups just after injury. There was scattering hemorrhage and little hematoma below the spineurium in the gun-shot wound, as well as the diffusing bleeding and larger hematoma in blast wound. In the blast group, the severe edema could be found by light microscope in the whole extracranial facial nerve. Axonal fragments, infiltrating imflammatory cells and few neurofilament protein NF positive axons were observed. In the gun-shot group, only scattering damage was found within 2 cm from the wound track.Conclusion: The facial nerve injury by gun-shot bacomes less severe with the increase of distance from the wound track, but the blast injury is wider and more severe.

关 键 词：枪弹伤 爆炸伤 面神经损伤 犬 神经传导速度 神经纤维细丝蛋白 

分 类 号：R826.62[医药卫生—临床医学] R651.3