早期皮瓣修复创面对面神经爆炸性损伤恢复过程的影响

Influence of early repair of the explosive wound on the recovery of the facial nerves

目的 通过伤后早期用皮瓣修复创面 ,研究促进面神经爆炸伤恢复的方法。方法 麻醉下在离犬面部 1 0cm处放置雷管模拟爆轰波致伤效应 ,并在雷管爆炸同时 ,用滑膛枪发射钢珠弹致犬同侧咬肌切线伤以模拟破片致伤。实验组伤后 3天 ,用吻合血管的股薄肌游离皮瓣修复创面 ;对照组不做早期修复 ,伤后 2周延期局部拉拢缝合。伤后不同时间取材面神经及面神经核进行HE和Nissel’s染色 ,观察面神经轴突和胞体的病理改变及神经传导速度变化。结果 实验组面神经炎症消退较快 ,神经传导速度快 ;而对照组炎症持续时间长 ,恢复缓慢。结论 颌面部爆炸伤后早期皮瓣修复创面有利于面神经创伤的恢复。

Objective To promote the recovery of the injured facial nerves by early repair of the wounds with flaps. ?Methods The detonator was placed 10 cm away from the face of the dogs to imitate the explosive effect.At the time of explosion of detonator, a steel ball was sent out by a rifle producing the masseter tangent injury to imitate the effect of parcels. The experimental group were repaired by the free flap of the musculus gracilis with anastomosis of blood vessel 3 days later. In contrast, the control group was not repaired until 2 weeks after the trauma. At different time after injury, the dog's facial nerves were taken and stained by HE staining, and the nucleus of facial nerves were stained by Nissle's staining to observe the pathological changes of the axons and neurons of the facial nerves. The velocity of facial nerve action potential was also recorded and compared between two groups.?Results The inflammation of the experimental group subsidized rapidly and the velocity of facial nerve action potential recovered more quickly than that of the control group, in which the inflammation lasted longer.?Conclusion Repair of the facial blast wounds at early stage after injury could promote the recovery of the facial nerves.