高海拔地区战士血管迷走性晕厥导致面部外伤临床分析

Clinical analysis of maxillofacial injury due to vasovagal syncope in soldiers at high altitude

目的通过回顾分析高原地区晕厥导致颌面部外伤患者病例资料,了解这类面部外伤伤情和治疗特点。方法选择1997～2007年收治的以晕厥而导致的面部外伤病例36例,患者均为部队战士,由于长时间站立发生晕厥,导致面部外伤。回顾分析这类伤情的临床特征和治疗特点。结果所有患者均有颏部线形软组织挫裂伤,清创缝合后伤口Ⅰ期愈合;32例(88.9%)共116颗牙齿有不同程度牙折,其中12.9%的牙齿需要拔除,其余牙齿进行相应的牙体牙髓治疗,并义齿修复牙体牙列缺损;9例(25%)发生颞下颌关节挫伤,对症处理;其中5例由岗台跌落者中4例发生下颌骨骨折,通过牙弓夹板和坚固内固定治疗恢复原有的咬合关系。结论高海拔地区战士长时间站立发生晕厥导致面部外伤的原因和伤情特殊,在处理软组织伤的同时要避免漏诊牙齿、颞下颌关节和下颌骨损伤;牙齿和下颌骨损伤是治疗的重点,恢复患者咀嚼功能是治愈的标准。

Objective To characterize the wound and treatment of maxillofacial injuries due to vasovagal syncope in patients at high altitude. Methods A retrospective review of 36 patients with maxillofacial injury resulting from vasovagal syncope from 1997 to 2007 was performed. All the cases were soldiers,who were injured in face due to syncope after long-time standing. The wound characteristics and treatments of the patients were reviewed. Results All the patients had soft tissue lacerations with linear margin at region of chins, and got primary wound healing after debridment and suturing. Among 32 patients （88.9%） , 116 teeth suffered crown or crown-root fractures, 12.9% of which were extracted endodontie treatment and denture restoration were performed in other teeth. At last,the defect of teeth and dentition of the 32 cases was restored. Nine patients （25%） with contusion of temporomandibular joint got symptomatic treatment. Among the 9 cases,4 patients suffered mandibular fracture resulting from falling during sentry duty,whose occlusal relation was restored by fixing with an arch bar. Conclusion Maxillofacial injury as a result of syncope in soldiers at high ahitude has special etiological factors and clinical characteristics. It is important to avoid missing diagnosis. Treatment of teeth and mandibular fracture should be emphasized, and the curative criterion is recovering patients masticatory function.