从颌面部火器伤伤情特点谈火器伤的救治

统计、归纳、分析了１０６例颌面颈部火器伤临床资料。总结了枪弹伤的基本特点是：多发伤多，伤情不均一；盲管伤发生率高，伤道曲折；爆炸伤污染严重，感染率高，组织缺损多。根据以上火器伤特点，在临床救治中总结出相应的治疗原则。     

从创伤弹道学角度分析颌面颈火器伤的处理

统计、归纳、分析了１１４例颌面颈部火器伤临床资料，通过对火器伤的伤因，伤道及内折情况分析，总结枪弹伤的特点，重点讨论颌面颈部火器伤的治疗原则，由于枪弹伤时，受伤距离不同，投射物的类型，质量，撞击速度各有差异，以及受伤部位的解剖结构不同，造成的损伤各异，伤情复杂，其基本特点是：１、多发伤多，伤情不均一；２、由于多种因素造成盲管伤发生率高，伤道曲折；３、爆炸伤污染严重，感染率高，组织缺损多，根据以上火     

颌面火器伤伴发颅脑伤临界条件的初步研究

用瑞典模型方法,选用平均射速1294.5m/s和864.4m/s,重1.03g的钢珠分别致伤两组18只狗颌面部,造成颌面部重型火器伤,伤后不同时间观察颌面伤情及颅脑损伤变化,探讨颌面部火器伤伴发颅脑损伤的临界条件。本实验模型方式致伤时,其临界致伤射速是864m/s,临界致伤能量是249J,提示颌面部重型火器伤救治中要注意颅脑的合并损伤。     

548例颌面创伤患者的回顾性分析

目的：通过回顾分析本院颌面创伤住院患者的临床资料，了解西安地区颌面创伤病例的构成、发病特点和临床流行病学现状。方法：对第四军医大学口腔医学院口腔颌面外科2003年7月～2006年6月3年间548例口腔颌面创伤患者的年龄、性别、时间、致伤原因、骨折特点、好发部位、神经损伤以及合并损伤等方面进行流行病学调查分析，采用SPSS10．12软件录入、分析所有数据。结果：颌面创伤患者占本院同期住院患者的22％，男女比例为3．9：1，21～40岁为发病高峰年龄。颌面创伤患者以7月份最多，2月份最少。交通事故在致伤原因中占50．91％，居于首位。颌面损伤以多发性骨折为主，人均骨折部位数为2．3处。在颌面骨骼中，下颌骨骨折最常见，其次是上颌骨和颧弓。在颌面部神经中，眶下神经和面神经损伤最常见。颅脑伤、四肢伤和眼损伤是颌面骨折最常见的合并伤。结论：近年来颌面创伤发病率逐年上升，且伤度加重、伤情复杂，交通事故伤呈上升趋势，创伤患者有年轻化趋势，男女比率有一定下降。     

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。     

颌面部创伤休克28例的救治体会

创伤休克是颌面损伤严重的并发症,是伤员死亡的主要原因之一。因此,防治创伤性休克是抢救伤员生命的重要课题。近20年来,我科成功地救治了颌面部创伤休克28例(不完全统计资料)。现就诊断和救治情况报告如下。临床资料28例中,男22例,女6例。年龄最小者5岁,最大者60岁。其中24例为非火器伤,4例为火器伤。包括颈外动脉和颈内动脉破裂伤各1例,颈内静脉破裂伤     

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。     

颌面创伤3 958例临床回顾

目的 对口腔颌面创伤患者性别、年龄、致伤原因、骨折特点及合并损伤等进行临床流行病学总结。方法对四川大学华西口腔医学院口腔颌面外科1955年至2001年，47年间收治的3958例口腔颌面部创伤患者的病历资料进行统计和分析。结果3958例颌面创伤患者男女比例为4．27：1；21～30岁（33．4％）为发病的高峰年龄段；交通事故（30．6％）在致伤原因中居首位。在颌面部创伤中，下颌骨骨折2299例，占骨折的72．7％，发生率最高。合并损伤以颅脑损伤最为多见，有916例（23．1％）发生。结论颌面创伤住院患者以骨折多见。骨折发生的数量、部位等与致伤原因、受力性质及相应部位的解剖结构有关。颅脑损伤为最严重的并发症，应予以充分重视。     

负压封闭引流技术在口腔颌面头颈部火器伤救治中的相关研究进展

口腔颌面头颈部火器伤是现代战争中的高发伤、常见伤,它具有着感染风险大,致死率高的特点。负压封闭引流技术(vacuum sealing drainage, VSD)在临床中有着较为成熟的应用且疗效显著。近年来研究发现,VSD技术在火器伤救治中可以有效地促进引流预防伤口感染,VSD有望成为口腔颌面头颈部火器伤救治中的优选方法。本文就VSD技术在口腔颌面头颈部火器伤救治的优势和研究进展做一综述。     

颌面部骨折142例临床报告

目的:总结分析颌面部骨折的病因、临床特点及治疗方法。方法:对中国医科大学附属口腔医院2004年10月-2005年9月收治的142例颌面骨骨折患者,分别从其年龄、性别、病因、骨折类型、全身损伤、治疗及手术并发症等各方面,进行综合分析研究。结果:颌面部骨折好发于男性,20～50岁为好发年龄段;交通事故损伤最常见(59.15%);多见下颌骨骨折(50.00%)及颧骨复合体骨折(29.58%);常伴发全身损伤(35.21%);治疗中复位后坚固内固定术是最佳方法(81.65%);手术切口以口内为主(58.72%);术后神经损伤及感染极少见。结论:颌面部骨折以青壮年居多,最主要病因是交通事故,除复位颌间牵引保守治疗外,复位后坚固内固定是现今临床最常用的治疗方法。     

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。     

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.     

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.     

Injury patterns and outcomes in bicycle-related maxillofacial traumata: A retrospective analysis of 162 cases

The objective of the current study is to retrospectively evaluate cycling related dental and maxillofacial injuries and to gain insight into the epidemiology and results of these accidents. Data of patients who were admitted due to the maxillofacial injuries between April 2018 and September 2020 were retrospectively evaluated regarding the patients’ characteristics, helmet wearing, type of radiological assessment required for diagnosis and therapy, injury patterns, duration of hospitalization and concomitant injuries. Data of 162 patients were included. 86 (53.08%) patients presented with at least one maxillofacial fracture. A total of 186 maxillofacial bones were fractured. Zygomatico-maxillary complex was the most commonly affected region (n:103, 55,36%). Analysis of the dental traumata revealed that crown fracture without pulp exposure was the most commonly observed entity (n:37, 32.46%) and upper central incisors (n:61, 53.50%) were the most commonly affected teeth. The overall ratio of the number of the fracture line/fracture case was 2.80. However, this ratio was statistically higher in e-bike cases (4.25) compared to non-e-bike riders (2.34) (p:0.014). Bicycle related maxillofacial injuries could correlate with specific morbidity rates and result in severe injuries of the maxillofacial region.     

Analysis of 126 hospitalized elder maxillofacial trauma victims in central China

Background

The aim of this study was to analyzed the characteristics and treatment of maxillofacial injuries in the elder patients with maxillofacial injuries in central China.

Material and Methods

We retrospectively analyzed the characteristics and treatment of maxillofacial injuries in the patients over the age of 60 to analyze the trends and clinical characteristics of maxillofacial trauma in elder patients from the First Affiliated Hospital of Zhengzhou University (from 2010 to 2013) in central China and to present recommendations on prevention and management.

Results

Of the 932 patients with maxillofacial injuries, 126 aged over 60 years old accounting for 13.52% of all the patients (male:female, 1.74:1; mean age, 67.08 years old). Approximately 52% of the patients were injured by falls. The most frequently observed type of injuries was soft tissue injuries (100%), followed by facial fractures (83.05%). Of the patients with soft tissue injuries, the abrasions accounted the most, followed by lacerations. The numbers of patients of midface fracture (60 patients) were almost similar to the number of lower face fractures (66 patients). Eighty two patients (65.08%%) demonstrated associated injuries, of which craniocerebral injuries were the most prevalent. One hundred and four patients (82.54%) had other systemic medical conditions, with cardiovascular diseases the most and followed by metabolic diseases and musculoskeletal conditions. Furthermore, the study indicated a relationship between maxillofacial fractures and musculoskeletal conditions. Only 13 patients (10.32%) sustained local infections, of whom had other medical conditions. Most of the facial injuries (85.71%) in older people were operated including debridement, fixing loose teeth, reduction, intermaxillary fixation and open reduction and internal fixation (ORIF).

Conclusions

Our analysis of the characteristics of maxillofacial injuries in the elder patents may help to promote clinical research to develop more effective treatment and possibly prevent such injuries. Key words: Maxillofacial, trauma, elderly, characteristics, treatment.     

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。     

Self-inflicted craniomaxillofacial gunshot wounds: management,reconstruction, and outcomes

Suicide by firearm remains one of the leading causes of violence-related injury death in the United States each year. The mortality rate from these injuries is high, resulting in a paucity of outcome data in the literature regarding injuries to the maxillofacial region. This has largely been attributed to a lack of funding for research in this area compared to other leading causes of mortality in the United States. The aim of this study was to detail the authors’ experience and approach to complex maxillofacial reconstruction using both local reconstructive methods and microvascular free tissue transfer. A retrospective cohort study was designed, including patients who sustained self-inflicted gunshot wounds to the maxillofacial region between January 1, 2012 and May 1, 2020. Forty-one patients met the inclusion criteria. The majority of the patients were male (87.8%). Mean patient age was 44.2 ± 16.6 years. Alcohol or drugs, and a psychiatric history were present in a majority of the cases. The most involved anatomical region was the midface (75.6% of cases). Seven patients required free tissue transfer for reconstruction, with many needing multiple flaps. Self-inflicted gunshot wounds represent challenging reconstruction scenarios, often in the setting of severe psychological trauma, and require a multidisciplinary team to ensure the optimal outcome.     

伴全身多系统创伤颌面伤患者的综合救治

目的:研究伴发身体其他部位创伤的颌面伤患者综合救治中专科确定性手术时机和适应证。方法:回顾性统计4所大型综合医院口腔科病房近20年收治的4 869例口腔颌面部创伤患者的临床资料,分析伴发身体其他部位创伤状况和专科手术时机。结果:4 869例患者中,面骨骨折3 364例,软组织伤1 505例。伴发其他部位创伤1 524例(占31.3%),其中颅脑伤570例(37.4%),肢体伤545例(35.8%),胸部伤170例(11.2%),眼创伤151例(9.9%),脊柱伤54例(3.3%),腹部伤34例(2.2%)。74%的颅脑伴发伤患者伤后4周内、76.2%的眼伴发伤患者伤后7d内进行了面骨骨折手术治疗。而肢体、脊柱、胸腹部伴发伤患者,面骨骨折手术均有不同程度延误。结论:伴发多系统创伤的颌面伤患者的救治需要多学科间的合作,在患者呼吸系统、循环系统等全身状况稳定的情况下,大部分颌面多发伤患者可以同期或早期进行专科处理。     

眼眶骨折138例CT影像分析

目的:对眼眶骨折进行CT检查分析,以提高临床诊断水平。方法:对颌面部外伤伴眼眶骨折的138例患者的145只眼CT检查结果进行研究分析。结果:眼眶骨折以眶内壁、眶外壁骨折最多见,且以多壁骨折为主。145只眼中发生单壁骨折51例(35.17%),双壁骨折48例(33.10%),三壁骨折31例(21.38%),四壁骨折15例(10.35%)。结论:颌面部外伤大多存在复杂的眼眶骨折,应将CT列为常规检查方法。