颅脑等全身多器官损伤合并颌骨骨折的临床救治

Emergency management of craniomaxillofacial trauma associated with multiple injuries.

目的:探讨颅脑等全身多器官损伤合并颌骨骨折患者的临床救治。方法:对56例颅脑等全身多器官损伤合并颌骨骨折患者的院前急救,入院时Glasgow昏迷评分,入院后的救治以及相关预后进行分析。结果:56例中,颅骨骨折20例,脑震荡伤2例,脑损伤54例,合并全身损伤38例,合并颌骨骨折45例。院前体征昏迷41例,出血20例,恶心呕吐15例,大小便失禁10例。院前急救处理:清创缝合16例,气管切开3例,胸腔闭式引流3例,骨折牵引3例,各种相应处理31例。入院时Glasgow昏迷评分GCS13～15者20例,GCS8～12者10例,GCS5～7者26例。入院后立即施行开颅手术或气管切开术10例,采取保守治疗46例。病情稳定后施行颅脑或全身手术11例,施行颌骨骨折切开复位+钛板内固定术41例。预后情况,本组无死亡病例,所有病例生命体征稳定,失语1例,运动障碍1例,视力丧失1例,听力下降1例,颌骨骨折复位固定术后咬合关系恢复正常及良好者40例。结论:颅脑等全身多器官损伤合并颌面部损伤者的急救应遵循①.影响生命体征时"先全身,后口腔";②.不影响生命体征时应"全身与口腔并举";③.颌面部损伤重,全身损伤轻时应"先口腔,后全身"的原则。

Objective： To study the emergency management of craniomaxillofacial trauma with multiple injuries. Method： 56 cases were observed in constitutional symptoms and emergent treatment before admission bospital,the Glasgow Coma Scale （GCS） of the wounded and management as well as the related restoration conditions during bospital.Result： Of 56 cases, 20 were fracture of skull, two were cerebral concussion, 54 were brain injuries, 38 were multiple injuries, 45 were fracture of jaw. In these wounded,41 appeared coma, 20 happened bleeding, 15 occurred vomit, 10 arised incontinence of feces and urine. At the first-aid program, 16 cases were carried out the debridement, 3 accepted tracheotomy, 3 underwent closed thoracal drainage, 3 were operated by traction of broken bone, and the other 31 were suited medicine before admission hospital. In all wounded,20 were 13-15 GCS, 10 were 8-12 GCS,and 26 were 5-7 GCS. 10 were immediately operated on brain or tracheotomy and 46 were applied conservative treatment after admission hospital.11 were performed the operation as the patient＇s condition turned stable, 41 fracture of jaw were performed the restoration and fixation with titanium plate. No one died in the group, all of the patient＇s life sign were stability and 40 had recoverd the good occlusion,but some of them appeared some disoreder, such as aphasia, motion disable, lose sight and hearing, etc.Conclusion： It would be followed to treat when who suffered from craniocerebral trauma associated with fracture of jaw and multiple injuries.namely 1. it must be ＂the whole body first, the oral cavity second＂ as the wounded＇s life sign is severity damaged.2. it may be ＂the whole body and oral cavity simuhaneoucely＂ in fracture of jaw with multiple trauma that not influence the physiological codition of the patient.and 3. it should be ＂the oral cavity first the whole body second＂ when the trauma is more serious in oral and maxillofacial region than that in other part of the body.