颅脑火器伤的判断与救治

目的分析总结颅脑火器伤的临床特点。方法对31年内共收治的201例颅脑火器伤病例进行分析。结果男179例，女22例；盲管伤119例，贯通伤70例，浅切线伤7例，颅面联合伤5例；早期合并症主要有脑挫裂伤88.6％，颅内血肿19.4％，感染21.0％。晚期合并症主要有异物存留、癫痫等。死亡26例，死亡率12.94％。结论火器性投射物具有强大的压力波，能产生较大的瞬时伤道，可对颅脑造成严重而广泛的损伤，不能用一般颅脑外伤的致伤原理和经验来诊治火器性颅脑伤。早期准确判断、彻底清创、注意手术方法的选择和手术要点的掌握、尽量减少脑组织的继发损伤、防止各种并发症是降低死亡及残废率的关键。

THE JUDGEMENT AND MANAGEMENT OF MISSILE HEAD INJURY

Objective:To study the clinical characteristics of missile head injury.Method:201 cases who had suffered from missile head injury in 31 years were analysed.Results:There were 179 cases of male and 22 cases of female.Among these cases,119 were perforating wounds,70 were penerating wounds,7 were shallow tangent wounds and 5 were cranial-facial wounds.The main early mobidity was:brain contusion 88.6%;intracranial hematoma 19.4%;infection 21.0%.main late mobidity was foreign body retain and epilepsy.in this group,26 patients died after injury.The mortality was 12.9%.Conclusion:In missile head injury,the projectile have a strong pressure wave which can create a big temporary wound in the brain,the head injury are always severe and diffused.It should be avoid for a neurosurgeon to diagnose and manage a missile head injure case with the common head trauma mechanism and experiences.for decreasing the mortality and mobidity.it is very important to make a accurate judgement as early as possible,debridement completely,protect the brain tissue from secondary injury and any complication,pay more attention to the selection of approach and the principle in surgery.