火器性颅脑穿透伤的临床研究

A clinical study of penetrating craniocerebral injuries caused byfirearms

火器性颅脑损伤属于头部创伤中的常见类型，在战争及和平时期均较多见．作者回顾性分析西京医院１９７３年至１９９４年期间收治６４８７例的中、重型头部外伤伤员（格拉斯哥昏迷计分３～１２分）中，５６例为火器性颅脑穿透伤．男４９例（８７．５％），女７例（１２．５％），年龄平均２３．８（３月～５１）岁．火器伤类型包括：切线伤３例；盲管伤３９例；贯通伤１４例．损伤的特点是，伤情急、创伤重、病情变化快．经急救和手术处理，６例死亡（１０．７％）．于３个月时随访研究表明，３６例（４６．４％）恢复良好；轻残、重残及植物生存率分别为２８．６％，１４．３％和２％．长期随访研究结果，３５例恢复满意，其中２８例恢复工作能力．文中讨论了对本类损伤的救治原则和手术处理要点．

Penetrating craniocerebral firearm injuries remains one of the most lethal of all head traumas andare common in both war and peace time. Data were reviewed for 6487 moderately, severely head- injuring pa-tients[Glasgow Coma Scale (GCS)scores 3 to 12] treated at Xijing Hospital between 1973 and 1994; Fifty-six of these patients had penetrating craniocerebral injuries caused by firearms. These patients consisted of 49males (87.5%)and 7 females (12.5%)ranging in age from 3 months to 51 years (median 23. 8 years). Thetypes of firearm wound included 3 cases of tangential wound, 39 cases of tubular wound, 14 cases of through-and- through wound. These cases were characterized by acuteness, severity and unstability. After emergencytreatment and operation, 6 cases died(10.7%). The follow- up studies in the third month showed that 26cases(46.4%)had a good recovery, and the rates of moderate disability, severe disability and vegetativestate in this series were 28.6%, 14.3%and 2.0 %respectively. And long- term follow- up studies indicatedthat 35 patients were satisfactorily recuperated and 28 patients were able to resume their occupation. Theprinciples for dealing with penetrating craniocerebral firearm injuries and the hints for operation were dis-cussed in this paper.