颌面部高速投射物伤致下牙槽神经血管束间接损伤的实验研究

目的研究颌面部高速投射物伤导致的下牙槽神经血管束间接损伤的特点。方法18只实验犬随机均分为6组,以直径6.0 mm、质量0.88 g的不锈钢珠高速投射致伤犬右下颌骨体部,但不直接伤及下牙槽神经血管束;分别于伤后6 h、24 h、3天、7天、2周及4周处死实验犬,对下牙槽神经、动脉的间接损伤进行组织病理学研究。结果弹道附近下牙槽神经、动脉损伤较重,但未发生断裂、坏死;随着与伤道距离的增加,损伤程度递减;对侧神经、动脉仅发生轻度一过性损伤。结论在救治颌面部高速投射物伤的伤员时,下牙槽神经血管束应予以妥善保护;伤后早期彻底清创是关键,神经干探查松解范围应在伤道外2 cm以上。

Indirect Injury of Inferior Alveolar Neurovascular Bundle Caused by High Speed Projectile in Maxillofacial Region of Dogs

Objective To investigate the characteristics of indirect injury of inferior alveolar neurovaseular bundle caused by high speed projectile in maxillofacial region of dogs. Methods 18 dogs were divided equally into six groups with random allocation. A high speed projectile （a stainless steel bead, φ 6.0 mm, 0. 88 g） was shot at the right mandible body of each dog, but the inferior alveolar neurovascular bundle was not injured directly. The experimental dogs were sacrificed 6h, 24h, 3d, 7d, 2w and 4w respectively after the injury. The histopathologic changes of inferior alveolar nerve and inferior alveolar artery were observed through light microscope. Results The inferior alveolar nerve and inferior alveolar artery close to the ballistic curve were seriously wounded, but they were not broken. When the distance to the ballistic curve increased, degree of injury degree decreased gradually. The inferior alveolar nerve and inferior alveolar artery of the opposite side were injured slightly and temporarily. Conclusion When treating a patient with maxillofacial firearm wound, the inferior alveolar neurovascular bundle should be well protected, and thorough debridement in early stage after wound is fairly important.