枪伤病理分区与枪伤治疗

20世纪80年代初我国学者首先提出,枪伤伤道及其周围组织可分为原发伤道区、挫伤区和振荡区3区,其中挫伤区为紧靠原发伤道的组织坏死区,挫伤区之外为振荡区.笔者课题组于近年来采用磁共振成像(MRI)扫描和常规病理学观察相结合的方法研究发现,枪伤组织应分为原发伤道区、凝固性坏死区、组织碎裂区和组织变性区4区.其中凝固性坏死区和组织碎裂区相当于挫伤区,但凝固性坏死区为不可逆坏死,需清创切除;而组织碎裂区仍具有修复能力,应予保留,故将两者分开命名.4区分区法明确了枪伤清创范围,对解决枪伤保守疗法和彻底清创疗法的争端有一定指导意义,但各区形成机制还有待进一步研究.

Pathological zonation of gunshot wounds and its guidance on the treatment methods

The Chinese investigators separated bullet wounds into three zones in the beginning of 1980s:a primary wound tract,a contusion zone adjacent to prinary wound tract,and a concussion zone neighboring the contusion zone. Basing on the research results by MRI scan and pathological observation,the author and his coworkers recently proposed that the gunshot wounds should be divided into four consecutive zones:a primary wound tract,a zone of coagulative necrosis,a zone of muscle disruption,and a zone of muscle distortion. A zone of coagulative necrosis plus a zone of muscle disruption equals to a contusion zone,they are separately named because the former is irreversibly devitalized and the latter still has the ability to recover. The sectionalized method shows the range of debridement and provide reference for the conservative treatment or thoroughly debridement. However,the mechanism of each zone need to be further studied.