面颅伤救治的临床研究

Study on clinical treatment of faciocranial injuries

目的 研究面颅伤临床特征、救治方法和疗效。方法 对 2 5 0例面颅伤患者采用放射影像学诊断、常规面颅X线照片和CT、MRI脑扫描。个别进行脑部正电子发射计算机断层扫描 (PET) ,同时常规血气分析 ,部分呼吸监护 ,了解和纠正伤后低氧血症。对 30例患者行颅脑彩色多普勒超声血流显像检测 ,了解伤后脑血流改变。结果 本组 2 5 0例经救治后痊愈 2 2 5例 (90 % ) ,中残 2 4例(9 .6 % ) ,死亡 1例 (0 .4 % )。生存者均无明显的颌面部畸形和功能障碍。结论 颌面部软组织开放伤 ,早期彻底清创 ,一期愈合 ,防止疤痕挛缩 ;错位骨折及时复位固定 ,防止骨性畸形。低氧血症是面颅伤患者死亡的主要原因 。

Objective To discuss the clinical features, treatment methods and currative efficiency of faciocranial injuries. Methods X ray of faciocranial region, CT and MRI scans of brain were performed in 250 patients with faciocranial injuries for radiological diagnosis, and Position Emission Tomography ( PET) scans of brain were also used in some patients . Blood gas analysis and respiratory monitoring were given to find and improve the hypoxemia. Colorful ultrasonic Doppler examination for blood flow of cranium and brain were given in 30 patients to observe the changes of blood flow in brain after injuries.Results Among 250 patients, 225 were cured (90%), 24 middle mutilated (9.6%), and 1 died (0.4%). No significant deformity and dysfunction appeared in the survivals.Conclusion Debridement should be applied completely and early in opening soft tissues injuries of maxillofacial region for primary healing and preventing scar contracture. Dystopy bone fracture should be replaced and fixed in time to prevent bony deformity. Hypoxemia is the main reason of the death of patients , and also an important factor of deformity.