颈部贯通伤远达效应的病理变化及致伤机理探讨

用2.74g和1.03g钢球分别射击10只猪的颈背部,造成软组织贯通伤。位于伤道外的脊髓(10只)、脑(10只)、心脏(9只)和肺(3只)见到出血和肺大泡(1只),其中2.74g组伤情较1.03g组更为严重。2只实验猪分别于伤后3和5min死于严重的脑脊髓震荡伤(脊髓休克)。分析了颈部贯通伤远达效应病变特点:脑脊髓致伤机率增加,脑脊髓出血波及范围广泛,出血病变呈跳跃式分布,预后较差,多见早期死亡。前颅腔内压力峰值可达到1300～1810kPa,其压力值与邻近的颈后部软组织内压力值(1600～1810kPa)接近。认为颈部椎管外贯通伤时,伤道外脑脊髓病变的致伤机理主要是压力波和瞬时空腔作用的结果,但作用途径有差别。

Investigation on pathological changes and mechanism of distant effect in swine with penetrating injury of neck

10 swine of both sexes, weighing 85-101 kg, were used. The cervicodorsal regionwas hit and penetrated by a steel ball of 1.03 or 2.74 g in weight with a velocity of about 900m / s.Hemorrhage of organs away from the wounded channel occurred in spinal cord (10 cases), brain(10 cases), heart (9 cases), and lung (3 cases). The degree of hemorrhage in the 2.74 g group wasmore severe than that in the 1.03 g group. Two swine died of severe brain - spinal cord concussionwithin 3-5 minutes after injury. The characteristics of distant effect in penetrating injury of neckinduced by firearms included: (1) the incidence was high, i.e. about 100% (10/10 cases); (2) thescope of hemorrhage of brain - spinal cord was extensive and segmental in distribution; (3) thedeath induced by severe brain - spinal cord indirect trauma was frequent and early. The authourssuggest that, when soft tissue of neck (outside canalis vertebralis) is penetrated by a high - velocitymissile, the indirect injury away from wound channel is caused by combined effects of pressurewave and temporary cavity. The peak value of pressure wave in the fossa cranii anterior was about1 300-1 810 kPa.