军事飞行人员脑海绵状血管畸形10例及航空医学鉴定

Ten cases of military flying personnel with cerebral cavernous malformation and aeromedical assessment

目的探讨军事飞行人员脑海绵状血管畸形(cerebral cavernous malformations,CCM)的诊疗及航空医学鉴定。方法收集空军特色医学中心2015—2021年收治的诊断为CCM的飞行人员临床资料及航空医学鉴定结论,结合国内外相关鉴定案例及文献进行分析。结果共收集10例飞行人员病例,均为男性,年龄20~41岁,平均年龄28.3岁。其中飞行员8例,空中战技勤人员2例。飞行时间110~4000 h,平均飞行时间1102.0 h。病灶大小3~12 mm,其中<5 mm 2例,5~10 mm 6例,>10 mm 2例。病灶位置包括枕叶(1例)、额叶(4例)、颞叶(2例)、小脑半球(3例),均位于皮层下。10例飞行人员中,仅有1例首发症状为颅内出血(右侧小脑半球),予以手术治疗。3例飞行人员处于地面观察期,航空医学鉴定结论为暂时飞行不合格。其余7例飞行人员随访时间均超过6个月,复查MRI示病变均无改变、脑电图无异常,其中2例空中战技勤人员航空医学鉴定结论为飞行合格;1例直升机飞行员鉴定结论为飞行合格(限副驾驶),2例双座歼击机飞行员鉴定结论分别为飞行合格(限双座机)、飞行合格,2例单座歼击机飞行员鉴定结论为更改原机种后飞行合格(限轰炸机、运输机和直升机)。结论对于CCM军事飞行人员应根据有无症状、病变部位和大小、失能可能性评估、治疗效果、地面观察随访结果以及飞行机种和职别做出航空医学鉴定结论。

Objective To investigate the diagnosis,treatment and aeromedical assessment of military flying personnel with cerebral cavernous malformations(CCM).Methods The clinical data and aeromedical assessment conclusions of military flying personnel with CCM in Air Force Medical Center from 2015 to 2021 were collected and analyzed based on reviewing the relevant aeromedical assessment cases and literatures at home and abroad.Results A total of 10 flying personnel,all male,20-41 years old,with an average age of 28.3 years,including 8 pilots,2 air combat/technical personnel,with the flying hours of 110-4000 h and the average flying hours of 1102.0 h.The sizes of lesions were 3-12 mm,including 2 cases were smaller than 5 mm,6 cases were 5-10 mm and 2 cases were bigger than 10 mm.All lesions were located under the cortex,including a case of occipital lobe,4 cases of frontal lobe,2 cases of temporal lobe and 3 cases of cerebellar hemisphere.Among the 10 flying personnel,only a case presented intracranial haemorrhage(right cerebellar hemisphere)as first symptom and was treated surgically.Three cases were temporarily grounded due to they were under the grounding observation.Other 7 flying personnel had been followed up for more than 6 months.Their reexaminations of MRI showed no change in lesions and EEG examination showed no abnormalities.Two air combat/technical personnel were qualified for flight and 1 helicopter pilot was limited to be a co-pilot,and 2 dual-seat fighter pilots were qualified(limited to dual-seat fighter)and flight-qualified respectively.Two fighter pilots were qualified for lower performance aircraft(limited to bomber,transporter or helicopter).Conclusions For CCM military flying personnel,the aeromedical assessment conclusion should be made according to the symptoms,lesion location and size,inflight incapacitation possibility assessment,treatment effect,ground observation and follow-up results,as well as the aircraft type and occupation.