颌面颈部火器伤救治的研究

Medical Aid for Firearm Wounds in Neck and Maxillofacial Regions

目的：为了提高颌面颈部战（创）伤救治水平和伤员生存质量．方法：从１９７９年４月到１９９１年１０月，应用基础研究，对火器伤下颌骨不同部位、不同条件的骨缺损，采用三种不同的方法进行Ⅰ期植骨５１例；对颌面部复合软组织缺损的伤例，采用带血管神经及肌蒂的组织瓣转位，或游离组织瓣移植，进行功能性修复８８例；对颈部大血管火器伤，采用旁路血管（改道）移植重建其血流；对火器性迷走神经损伤，用吻合血管的腓肠神经移植重建其功能．结果：伤后Ⅰ期植骨骨成活率为９２％（４７／５１）；游离组织瓣移植功能重建率为９１％（８０／８８）；颈部大血管及迷走神经损伤，重建其功能取得了好的疗效．结论：应用解剖学研究，是新的手术方法设计的基础，各种新术式能提高临床救治的水平．

Aim: This research aims at improving medical aid and quality of life for firearm wounds in neck and maxillofacial regions. Methods: Three kinds of methods were adopted to repair jaw bone defects. Transposition or transplantation of the muscle flap with vascular and nervous pedicle was used for those patients suffered from soft tissue defects of the maxillofacial regions. Carotid artery bypass was employed for those who had a firearm wound of great vessels in the neck. Vascularized sural nerve transplantation was perfomed to repair vagus nerve injury. Results: Successful rate for primary bone transplantation was 92% (47/51). The care rate for functional reconstruction of tissue or organ defects in maxillofacial regions was 91%(80/88). Conclusion: It is a breakthrough over conventional concepts in the reconstruction of large mandibular defects following serious firearm wound by using iliac flap with dual blood supplies.