火器性牙髓间接损伤的病理特点

实验用初速１５００ｍ／ｓ，重１．０３ｇ钢珠致伤狗颌面部。伤后观察牙髓的病理变化，发现颌面部高速投射物伤时，牙髓存在明显的间接损伤，其损伤的病理特点是造牙本质细胞下层出血，炎细胞浸润和牙髓肿胀；在超微结构水平上表现为牙髓细胞内线粒体肿胀、空化，神经髓鞘变性，部分髓鞘内容物溶解等。本实验结果提示：在颌面火器伤伤员的临床救治时，不能忽视牙髓的间接损伤．     

颌面问高速投射物伤区软组织感染特点的实验观察

用初速１５００ｍ／ｓ，重１．０３ｇ钢珠致伤６只狗颌面部，伤后６，１２，２４ｈ取距伤道壁不同距离的肌肉组织做需氧及厌氧菌培养，实验发现，颌面高速投射物伤区，距伤道壁０．５ｃｍ以内的软组织，伤后６ｈ开始出现细菌感染，随致伤时间延长。     

犬颌面致伤瞬间内压力变化研究

实验采用瑞典创伤模型方法建立动物模型，用重１．０３ｇ，射速８００－８５０ｍ／ｓ和１３５０－１４００ｍ／ｓ的钢珠致伤犬和离体犬头，造成重型颌面伤，记录致伤瞬间脑内压力变化，通过致伤射速和致伤点距颅脑的距离与脑内压力变化的关系研究颌面部高速投射伤伴发颅脑损伤的机理。实验结果证实，颌面部高速投射伤时瞬时空腔效应用、冲击波效应造成的脑内压力变化是伴发颅脑损伤的重要原因。文中还对相关的临床意义进行了讨论。     

颌面部重型火器伤后脑脊液CK—BB变化研究

用高速投射物致伤犬颌面部，建立重型颌面伤动物模型。于伤前、伤后不同时间测定脑脑挫伤脊液中脑型肌酸激酶同功酶（ＣＫ—ＢＢ）变化，用光、电镜观察脑组织损伤病理特点．实验发现动物伤后发生颅底出血、脑挫伤等损伤改变，脑脊液中ＣＫ—ＢＢ值明显升高，说明颌面部重型火器伤后存在颅脑损伤，ＣＫ—ＢＢ的测定有助于对颌面部火器伤患者整体伤情及预后综合判断。     

犬颌面部致伤瞬间脑内压力变化研究

实验采用瑞典创伤模型方法建立动物模型。用重1.03g,射速800～850m/s和1350～1400m/s的钢珠致伤犬和离体犬头。造成重型颌面伤,记录致伤瞬间脑内压力变化,通过致伤射速和致伤点距颅脑的距离与脑内压力变化的关系研究颤面部高速投射伤伴发颅脑损伤的机理。实验结果证实,颌面部高速投射伤时瞬时空腔效应、冲击波效应造成的脑内压力变化是伴发颅脑损伤的重要原因。文中还对相关的临床意义进行了讨论。     

多功能生物撞击机的应用与评估

目的 :应用新型多功能生物撞击机进行颌面部撞击伤与高速投射物伤的动物试验 ,评估该致伤系统 ,为颌面部创伤提供研究手段。方法 :使用生物撞击机的一、二级撞击系统对犬进行颌面部撞击伤与高速投射物伤的动物试验 ,应用信号测试记录系统通过微机对致伤过程中多路力学信号进行精确记录分析 ,实时测试致伤参数。结果 :一级撞击系统可造成犬颌面部软组织挫裂伤 ,颌骨骨折 ;二级撞击系统可造成犬颌面部软组织洞穿性缺损 ,颌面骨折、骨缺损。结论 :多功能生物撞击系统经过动物测试实验 ,性能稳定 ,可满足模拟颌面部撞击伤和投射物损伤的研究 ,具有良好的操作性和可重复性     

颌面部高速投射物伤损伤特点与早期救治关系的实验研究

在颌面部高速投射物伤的动物模型上，观察局部组织损伤特点和脑、心、肺损伤情况．发现：（１）颌面部高速投射物伤时，局部组织器官损伤严重而广泛，若不及时妥善处理，可因阻塞呼吸道或大量失血而危及生命；（２）伤区肌肉组织挫伤区范围在０．５ｃｍ以内；（３）颌面部高速投射伤时，脑、心、肺损伤的发生率较高．提示：在颌面火器伤伤员的早期救治时，最重要的是保持呼吸道通畅和彻底止血；早期清创时，肌肉组织的切除范围一般不超过０５ｃｍ；在救治过程中还应严密监测脑、心肺损伤后的变化，并采取相应的救治措施。     

颌面部爆炸伤动物模型的建立和损伤特点的观察

实验选用８号雷管距犬面部不同距离引爆致伤，建立并选择颌面爆炸伤动物模型。于伤后０．５ｈ，６ｈ，２４ｈ观察伤情，切取咬肌组织标本行光镜，透射电镜观察。实验发现，伤后初期救治的首要问题是保持呼吸道通畅。初期清创中肌组织的切除范围在０．５－１．０ｃｍ。     

颌面部火器伤致颅脑损伤与LPO,SOD变化关系

犬颌面部高速投射物致伤后不同时间观察脑损伤病理特点，同时测定脑匀浆中ＬＰＯ、ＳＯＤ含量并与正常值对照。实验发现实验动物有程度不同的脑挫伤表现，脑匀浆中ＬＰＯ值显示高于伤前。ＳＯＤ值伤后１ｈ下降，６ｈ开始上升．实验结果说明，颌面部高速投射伤时，自由基因素参与伴发脑损伤的进一步发展，影响整体伤情的转归和愈合．     

颌面部高速投射物伤致下牙槽神经间接损伤的超微结构研究

目的：研究颌面部高速投射物伤导致的下牙槽神经间接损伤的特点。方法：18只实验犬随机均分为6组,以直径6．0mm、质量0．88g的高速投射物（不锈钢珠）致伤犬右下颌骨体部,但不直接伤及下牙槽神经;分别于伤后6h、24h、3d、7d、2w及4w处死实验犬,用透射电镜观察伤侧下牙槽神经距离弹着点0．5cm处、2．0cm处及对侧下牙槽神经的超微结构变化。结果：伤侧下牙槽神经距弹着点0．5cm处损伤较重,且超微结构变化出现较早;2．0cm处损伤相对较轻,且超微结构变化出现较迟;对侧下牙槽神经仅有轻度一过性损伤。结论：颌面部高速投射物伤导致的下牙槽神经间接损伤均有损伤范围较广,损伤程度随着距离的增加而迅速递减,损伤具有不均匀性等特点。     

颌面部火器伤伴发颅脑损伤病理特点及临床意义

狗12只(正常对照2只),用重1.03g、射速1300m/s钢珠致伤颌面部、造成重型颌面部火器伤,伤后即时、6小时分别开颅,检查颅脑损伤情况,切取脑组织标本行光、电镜观察。实验发现颌面部重型火器伤时伴有颅脑损伤,病理特点为颅脑区域性出血及脑挫伤,组织学观察神经组织主要为细胞、髓鞘的变性改变,提示临床处理中应注意颅脑并发症。     

颌面部高速投射物伤区软组织感染特点的实验观察

用初速 15 0 0 m/ s,重 1.0 3g钢珠致伤 6只狗颌面部 ,伤后 6 ,12 ,2 4h取距伤道壁不同距离的肌肉组织做需氧及厌氧菌培养。实验发现 :颌面部高速投射物伤区 ,距伤道壁 0 .5 cm以内的软组织 ,伤后 6 h开始出现细菌感染 ,随致伤时间延长 ,感染细菌的数量明显增多 ,距伤道壁 0 .5 cm以外的组织 ,在伤后 2 4h,细菌的污染数量远远低于感染细菌的临界数量 ;感染或污染细菌的种类以需氧及兼性厌氧菌为主。研究提示 :颌面部高速投射物伤区组织存在明显的细菌感染 ,但其严重感染的区域在距伤道壁 0 .5 cm以内 ,从控制感染的角度清创时切除距伤道壁 0 .5 cm以内的软组织即可 ,扩大清创范围并不能起到控制感染的效果 ;而清创后应用有效抗生素是防治伤口感染 ,保证早期救治成功的重要措施。     

Indirect testimony of stress conduction from mandible to skull in maxillofacial trauma: morphological changes of temporomandibular joint disc]

There were cerebral injuries accompanied in maxillofacial high velocity projectile wound.Owing to the special anatomic relationship between skull and facial bones,the stress conduction of bone was an important factor of cerebral injury in maxillofacial wound.In this experiment,the canine mandibular regions were wounded by steel spheres,which weight 1.03g,impacting velocity at 1400m/s,to produce severely maxillofacial firearm wounds.The morphological and pathological changes of temporomandibular joint disc of wounded side were observed with light and electron microscopes.The microscopic injuries of disc,including arrangement disorder of figre,spotty edema and some fibrous dissolution,etc,were found.These results have provided an indirect evidence of injurous mechanism of the cerebral injury accompaning maxillofacial high enery misslle wound.     

Small-vessel pathology and anastomosis following maxillofacial firearm wounds: an experimental study

This experiment was designed to provide a biological basis for early reconstruction of maxillofacial defects caused by firearms using free vascularized flap transfer. The pathologic changes of small-vessel injury, injury mechanism, and the feasibility for early anastomosis of these vessels in the maxillofacial region following high-velocity missile wounds were studied. Dogs' faces were wounded by a steel sphere, weighing 0.7 g and 1.03 g, with an initial velocity of 1,300 m/s or 1,500 m/s. Angiography and high-speed x-ray photography were used to record the effect of injury to blood vessels and other tissues. The pathologic changes in the small blood vessels in the wounds were studied by light microscopy (LM) and electron microscopy (EM). Anastomosis of small vessels in the wound was performed at different times after injury. There were temporary cavity effects and small vascular injury in the wounds. The pathologic changes of the small vessels included microthrombus formation, endothelial loss, breaks in the internal elastic layer, and necrosis. Degeneration of cells was found to end 3 cm from the wound edge. Anastomosis of the vessels performed 3 days after injury provided good short-term patency. These results suggest that the operation for repairing facial defects should be performed 3 days after injury.     

平时颌面火器伤301例特点及救治体会

目的：探讨平时颌面火器伤的特点和救治经验，以期提高临床救治水平。方法：回顾分析301例颌面火器伤的伤因、伤情和救治，分析总结伤情特点及救治原则。结果：伤员中男女比例为5．1：1。301例火器伤中，枪弹伤占57％。伤情以多发伤为主，占66％。合并伤以颅脑伤最常见（16％）。所有伤员中，共有伤道900余处，多为盲管伤（72％），发生异物存留者占67％。复合伤主要为烧伤和冲击伤，多见于爆炸伤。救治措施主要为维持生命、早期清创和抗感染。结论：颌面部火器伤因致伤物、致伤方式和解剖因素而多变，救治时应综合考虑，对症治疗。     

Bullet injuries in the maxillary-facial range. Report on experiences of treatment of 60 patients at the Gondar College of Medical Sciences in Ethiopia

A report on the management of 60 patients with missile injuries to the soft and bony tissues of the maxillofacial region is given. The period between the injury and the beginning of the treatment was on the average 2.2 days. There were 15 penetrating, 36 perforating and 9 avulsive wounds. A primary wound closure was carried out after gentle debridement of the soft and bony tissues and the using of the bone suturing as the only method of fixation. In 4 cases the secundary wound closure was performed following an open wound management. There was a primary wound healing in 31 patients. The 22 cases of disturbed wound healing partly associated with osteomyelitis occurred frequently in patients suffering from perforating wounds who came to the the hospital more than 4 days following the injury.     

Evaluation of maxillofacial weapon injuries: 15-year experience in Belgrade

The aim of this research was to evaluate maxillofacial weapon-related injuries from the epidemiological, clinical, and forensic points of view. Analysis of medical records of 183 patients treated for weapon-related injuries in Belgrade maxillofacial surgery clinics in the period 1988 through 2002 has been carried out. Most treated patients were male, 21 to 50 years of age, and injured during the war in the territory of the former Yugoslavia. Injuries involving the mandible were the most frequent (40%); firearm (85%) and perforating (70%) wounds occurred more frequently than explosive (25%) and penetrating (30%) wounds; in certain cases, medical records were incomplete and thus useless for forensic court expertise and evidence. A rapid increase in maxillofacial weapon-related injuries was recorded in the period from 1991 to 1995 as a result of war injuries; high-velocity projectiles caused most of the injuries. It is necessary to keep adequate medical records for successful forensic and court expertise and evidence.     

螺旋CT三维重建在复杂颌面骨折的应用

目的:探讨螺旋CT三维重建对复杂颌面骨折的临床应用价值。方法:对26例复杂颌面骨折患者行螺旋CT 扫描,层厚3 mm或5 mm,应用表面阴影显示法进行三维图像重建,用不同的旋转轴观察不同角度骨折的三维病变图像。若怀疑下颌骨骨折时,应用勾画删除技术对图像进行切割删除处理,以便单独显示下颌骨的三维图像。结果:螺旋CT三维重建能清楚显示复杂颌面骨折的立体解剖图像及与周围结构关系;应用勾画删除技术可清楚显示下颌骨骨折部位与移位,尤其是髁突骨折移位的方向和程度。结论:螺旋CT三维重建有利于确定复杂颌面骨折的程度与骨折的移位情况,有利于手术方案的设计与实施。     

颌面部爆炸伤软组织缺损动物模型的建立

目的　本实验旨在建立一种颌面部爆炸伤软组织缺损的动物模型 ,以供对口腔颌面部爆炸伤的病理、病理生理学以及修复治疗进行深入的研究。方法　采用滑膛枪发射的钢珠模拟爆炸性武器的爆炸破片 ,同步控制系统触发 RDX电雷管爆炸模拟爆炸性武器的爆炸冲击波 ,致伤犬咬肌区软组织 ,建立颌面部爆炸伤软组织缺损动物模型。检测致伤参数 ,观察动物伤情。结果　破片伤平均能量吸收为 ( 3 4 4.1± 75 .9) J,平均能量传递率为 ( 4 4.4±10 .4 ) %。局部组织冲击波平均压力峰值 60 6.6k Pa。 15只实验犬均造成左咬肌区皮肤肌肉切线伤 ,软组织创面范围( 4 .8± 1.4 ) cm× ( 3 .5± 0 .7) cm。结论　该颌面部破冲复合伤软组织缺损动物模型能较真实地模拟爆炸伤的致伤效果 ,伤情与实际爆炸伤接近 ,重复性和稳定性好 ,可用于颌面部爆炸伤基础理论及临床救治的实验研究。     

颌面部中、小手术后负压引流的应用

目的 探讨颌面部中、小手术后合理有效的创腔引流方式.方法 将80例颌面部中、小手术患者随机平均分为橡皮条引流组(A组)和负压引流组(B组),每组40例,观察术后创腔积液、血肿、感染等并发症发生情况,记录B组术后引流量,分析比较两种引流方式对患者术后外观和护理影响.结果 B组术后第1天引流量占总引流量的83.57％,第2～3天占16.43％.A组患者术后创面敷料渗透,甚至渗透患者衣物,而B组术后创面清洁,便于术后护理.两组患者术后创面渗出量及并发症发生情况经统计学分析无明显差异.结论 颌面部中、小手术术后应用负压引流比橡皮条引流具有保持创面清洁、操作简便等优点.