颌面部破片复合冲击伤后软组织损伤特点及其临床意义

Characteristics and clinical significance of explosion injury in maxillofacial soft tissue

目的 探讨颌面部破片复合冲击伤 (破 -冲伤 )后软组织损伤特点及其临床意义。方法 15只犬按伤后 0 ,6,2 4 ,72h、7d随机分为 5组 ,每组 3只。采用雷管、滑膛枪以及同步测速及测压系统 ,建立颌面部爆炸伤模型 ,造成犬颌面部破 -冲伤。记录致伤参数 ,观察动物伤情及局部距创缘不同距离的软组织伤后各时相点的病理变化。 结果 15只犬均呈左咬肌区软组织切线伤 ,创面污染严重 ,距伤区创缘 0～ 0 .8cm处肌组织完全坏死 ,0 .9～ 1.6cm处肌组织呈灶性坏死 ,正常组织与坏死组织相嵌存在 ;皮肤坏死范围距创缘 0 .2cm。 结论 颌面部破 -冲伤后软组织损伤范围广 ,污染严重 ,肌组织清创范围应距创缘 0 .9～ 1.6cm ,皮肤切除不小于 0 .2cm。

Objective To study the characteristics and the clinical significance of explosion injury in maxillofacial soft tissue. Methods Explosion injury in maxillofacial soft tissue was made on 15 dogs with detonators and trap guns. Then the dogs were randomly divided into 5 groups (n = 3 in each group) according to the time points designed as 0, 6, 24 and 72 hours and 7 days after injury. The traumatogenic parameters were recorded with a synchronous velometric and manometric system. The traumatic condition and the pathological changes of the soft tissue at different distance from the wound track at different time points were observed after explosion. Results Tangential wounds in the soft tissues in the left masseter area were found in all the 15 dogs. The surfaces of the wounds were contaminative seriously. The muscular tissue on the distance of 0- 0.8 cm to the injured area was completely necrotized. The muscular tissue on the distance of 0.9-1.6 cm to the injured area was focally necrotized, that is, normal tissues coexisted with the necrotized tissues. The necrotized skin ranged for 0.2 cm. Conclusions The explosion injury in the maxillofacial region was characterized by wide range of injury and heavily contamination. Debridement should be made at the area of 0.9-1.6 cm distant to wound track. Skin for no less than 0.2 cm was cut off.