颌面部破片+冲击波复合伤致犬颞下颌关节盘损伤的实验研究

Study on the discal injury of temporo-mandibular joint caused by combined injuries of blast waves and high velocity projectiles in maxillofacial regions

目的 研究颌面部破片 +冲击波复合伤对颞下颌关节盘的影响。方法 应用犬颌面部高速破片 +冲击波复合伤动物模型 ,造成犬颌面部损伤。弹着点为左侧下颌骨下缘下颌角前区 ,射距为 6 0m。雷管悬于致伤部位上方 ,距弹着点的距离为 1 0cm ,破片发射同时触爆电雷管 ,对犬颌面部致伤 ,伤后 6h切取伤侧颞下颌关节盘 ,光镜观察关节盘形态变化。结果 所有动物均为左面部开放性伤口 ,部分动物的上、下颌骨及颧骨弓粉碎性骨折 ,创面无活跃性出血 ,关节盘未见明显破裂、出血。组织学结果发现关节盘破裂、出血 ,关节盘胶原纤维水肿。关节滑膜撕裂 ,关节周软组织炎细胞浸润。结论 颌面部破冲复合伤可造成犬伤侧颞下颌关节的损伤。在颌面部爆炸伤患者的治疗中 ,应注意颞下颌关节部损伤情况 ,防止关节强直的发生。

Objective To study the injury of articular disc of temporo- mandibular joint of the wounded side caused by combined injuries of blast waves and high velocity projectiles in maxillofacial regions.Methods The animals were wounded in the same maxillofacial region by the blast waves and high velocity projectiles at the same time.The distance from the explosives to mandible was 10 centimeters,and the distance that the projectiles travelled was 6 meters.The disc was resected and processed after 6 hours. The sample was examined by light microscope.Results All the animals were seriously damaged on the left face.Open wound was seen,and the splintered fracture of maxilla and mandible as well as zygoma in some animals was found.No active bleeding was found.Laceration and bleeding of the articular disc were observed.The synovium of joint was torn apart.The collagen fibers of articular disc were edematous.Acute inflammation along the articular capsule and adjacent soft tissues was evidently found.Conclusions The TMJ could be injured in this animal model of wound.More attention must be paid to patients suffering from this kind of injury.