颈部大血管爆炸伤研究现状
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摘要
单兵防护装备在现代战争中普遍使用,头盔、防弹衣的保护,减少了头部、胸腹部战创伤的发生率。颈部需要灵活转动而易于暴露,使得颈部损伤更突出,故颈部战伤发生率呈上升趋势。颈部含有众多大血管,其损伤发生率也随之增加。现代战争中爆炸伤成为战斗减员的主要因素,爆炸所致颈部血管伤的致伤因素主要有破片、冲击波和钝性撞击等。如何提高颈部大血管战创伤的存活率是创伤救治中面临的一个挑战。本文综述了颈部爆炸伤亡流行病学特征和血管致伤机制,为加强对这类创伤的认识和提高救治水平提供参考。
In modern warfare,the personal protective equipment is widely used,and the protection of helmet and body armor reduces the incidence of head injuries and thoracoabdominal trauma. The neck is so flexibly rotated and easily exposed that the neck injuries are more prominent,and the incidence of combat neck injuries is on the rise. The neck contains many important blood vessels,and the incidence of major cervical vessels injuries also has increased. The explosive injuries have become the main factor of combat casualty. The neck blood vessel blast injuries are mainly caused by shock wave,fragmentation and blunt trauma. How to improve the survival rate of major cervical vascular injuries is a challenge in combat neck injuries. In order to strengthen the understanding of this kind of trauma and improve the treatment level,this paper reviews the epidemiology and the mechanism of major neck vascular explosive injury.
In modern warfare,the personal protective equipment is widely used,and the protection of helmet and body armor reduces the incidence of head injuries and thoracoabdominal trauma. The neck is so flexibly rotated and easily exposed that the neck injuries are more prominent,and the incidence of combat neck injuries is on the rise. The neck contains many important blood vessels,and the incidence of major cervical vessels injuries also has increased. The explosive injuries have become the main factor of combat casualty. The neck blood vessel blast injuries are mainly caused by shock wave,fragmentation and blunt trauma. How to improve the survival rate of major cervical vascular injuries is a challenge in combat neck injuries. In order to strengthen the understanding of this kind of trauma and improve the treatment level,this paper reviews the epidemiology and the mechanism of major neck vascular explosive injury.
引文
[1]Wolf SJ,Bebarta VS,Bonnett CJ,et al.Blast injuries[J].Lancet,2009,374(9687):405-415.
[2]Schoenfeld AJ,Dunn JC,Bader JO,et al.The nature and extent of war injuries sustained by combat specialty personnel killed and wounded in Afghanistan and Iraq,2003-2011[J].J Trauma Acute Care Surg,2013,75(2):287-291.
[3]杨策,蒋建新,杜娟,等.2000年至2015年国内174起爆炸事故冲击伤诊治分析[J].中华诊断学电子杂志,2016,4(1):36-40.
[4]Yu M,Lv Q,Ding H,et al.Evaluation of blast injury patients from the 2015 Tianjin explosions in China[J].Burns,2016,42(5):1133-1140.
[5]张连阳.爆炸冲击伤的诊断[J].创伤外科杂志,2017,19(2):157-160.
[6]Tisherman SA,Bokhari F,Collier B,et al.Clinical practice guideline:penetrating zone II neck trauma[J].J Trauma,2008,64(5):1392-1405.
[7]Lanigan A,Lindsey B,Maturo S,et al.The joint facial and invasive neck trauma(J-FAINT)project,Iraq and Afghanistan:2011-2016[J].Otolaryngol Head Neck Surg,2017,157(4):602-607.
[8]Owens BD,Jr KJ,Wenke JC,et al.Combat wounds in operation Iraqi freedom and operation enduring freedom[J].J Trauma,2008,64(2):295-299.
[9]Breeze J,Gibbons AJ,Shieff C,et al.Combat-related craniofacial and cervical injuries:a 5-year review from the British military[J].JTrauma,2011,71(1):108-113.
[10]Breeze J,Allanson-Bailey LS,Hunt NC,et al.Mortality and morbidity from combat neck injury[J].J Trauma Acute Care Surg,2012,72(4):969-974.
[11]Belmont PJ Jr,Goodman GP,Zacchilli M,et al.Incidence and epidemiology of combat injuries sustained during"the surge"portion of operation Iraqi Freedom by a U.S.Army brigade combat team[J].J Trauma,2010,68(1):204-210.
[12]Tong D,Beirne R.Combat body armor and injuries to the head,face,and neck region:a systematic review.[J].Mil Med,2013,178(4):421-426.
[13]Breeze J.The problems of protecting the neck from combat wounds[J].J R Army Med Corps,2010,156(3):137-138.
[14]Breeze J,Leason J,Gibb I,et al.Characterisation of explosive fragments injuring the neck[J].Br J Oral&Maxillofac Surg,2013,51(6):E263-E266.
[15]Wahlberg E,Goldstone J.Vascular Injuries to the Neck[M].Spving Berlin Heidelbery,2017:3-15.
[16]Greer LT,Kuehn RB,Gillespie DL,et al.Contemporary management of combat-related vertebral artery injuries[J].J Trauma Acute Care Surg,2013,74(3):818-824.
[17]符伟国,王利新.颈部血管损伤处理原则[J].中国实用外科杂志,2007,27(7):510-513.
[18]White JM,Stannard A,Burkhardt GE,et al.The epidemiology of vascular injury in the wars in Iraq and Afghanistan[J].Ann Surg,2011,253(6):1184-1189.
[19]Breeze J,Fryer R,Hare J,et al.Clinical and post mortem analysis of combat neck injury used to inform a novel coverage of armour tool[J].Injury,2015,46(4):629-633.
[20]付小兵.中华战创伤学.第3卷,口腔颌面部战创伤[M].郑州:郑州大学出版社,2016:315-320.
[21]Eastridge BJ,Mabry RL,Seguin P,et al.Death on the battlefield(2001-2011):implications for the future of combat casualty care[J].J Trauma Acute Care Surg,2012,73(6S5):S431-437.
[22]Eastridge BJ,Hardin M,Cantrell J,et al.Died of wounds on the battlefield:causation and implications for improving combat casualty care[J].J Trauma,2011,71(1S):S4-S8.
[23]Sims K,Montgomery HR,Dituro P,et al.Management of external hemorrhage in tactical combat casualty care:the adjunctive use of XStatTMcompressed hemostatic sponges:TCCC Guidelines change15-03[J].J Spec Oper Med,2016,16(1):19-28.
[24]范乃军,宋薇,张淼丹,等.原发性冲击伤的研究进展[J].实用医药杂志,2016,33(3):193-195.
[25]刘建敏,袁志,刘建,等.爆炸冲击波致肢体周围大血管损伤的病理学研究[J].中华创伤杂志,2009,25(8):751-754.
[26]刘彦普,刘瑞峰,周树夏,等.爆炸物对家兔颈部大血管损伤机制的实验研究[J].解放军医学杂志,2003,28(4):330-331.
[27]刘瑞峰,刘彦普,周树夏,等.爆炸冲击波对家兔颈部大血管损伤机制研究[J].中国组织工程研究,2003,7(11):1638-1639.
[28]王昭领,刘桂才,白振西,等.颌面部爆炸伤并发心脑损伤的实验研究[J].中华急诊医学杂志,2005,14(11):910-912.
[29]吴坡,谭颖徽.颌面、颈部战伤时效救治研究[J].实用口腔医学杂志,2017,(5):695-701.
[30]刘瑞峰,马全利.颈部大血管火器伤[J].中国急救医学,2001,21(11):60-61.
[31]龚维熙.头颈外科战伤救治系列讲座(3)颌面颈部战伤的救治[J].人民军医,2009,11:733-735.
[32]Steenburg SD,Sliker CW.Craniofacial gunshot injuries:an unrecognised risk factor for blunt cervical vascular injuries[J].Eur Radiol,2012,22(9):1837-1843.
[33]Murray DS.Post-traumatic thrombosis of the internal carotid and vertebral arteries after non-penetrating injuries of the neck[J].Br JSurg,2010,44(188):556-561.
[34]李丹,李兵仓,雷德林,等.犬颈部模拟爆炸条件下颈总动脉的病理改变[J].第四军医大学学报,2001,22(13):1194-1197.
[35]王昭领,刘桂才,白振西,等.不同时相下颌面部破片+冲击波复合伤特点研究[J].中国急救医学,2004,24(8):577-578.
[36]朱海彬,赵会民.颈部大血管创伤性血栓二例[J].中华创伤杂志,2013,29(10):1022-1023.
[37]刘保池.创伤鉴别与急救[M].北京:科学技术文献出版社,2009:164-165.
[38]Eskridge SL,Macera CA,Galarneau MR,et al.Injuries from combat explosions in Iraq:injury type,location,and severity[J].Injury,2012,43(10):1678.
[39]伍伟景.颈部穿透伤[J].国际耳鼻咽喉头颈外科杂志,1994(5):269-273.
[40]Kasbekar AV,Combellack EJ,Derbyshire SG,et al.Penetrating neck trauma and the need for surgical exploration:six-year experience within a regional trauma centre[J].J Laryngol Otol,2017,131(1):8-12.
[41]Breeze J,Newbery T,Pope D,et al.The challenges in developing a finite element injury model of the neck to predict the penetration of explosively propelled projectiles[J].J R Army Med Corps,2014,160(3):220-225.
[2]Schoenfeld AJ,Dunn JC,Bader JO,et al.The nature and extent of war injuries sustained by combat specialty personnel killed and wounded in Afghanistan and Iraq,2003-2011[J].J Trauma Acute Care Surg,2013,75(2):287-291.
[3]杨策,蒋建新,杜娟,等.2000年至2015年国内174起爆炸事故冲击伤诊治分析[J].中华诊断学电子杂志,2016,4(1):36-40.
[4]Yu M,Lv Q,Ding H,et al.Evaluation of blast injury patients from the 2015 Tianjin explosions in China[J].Burns,2016,42(5):1133-1140.
[5]张连阳.爆炸冲击伤的诊断[J].创伤外科杂志,2017,19(2):157-160.
[6]Tisherman SA,Bokhari F,Collier B,et al.Clinical practice guideline:penetrating zone II neck trauma[J].J Trauma,2008,64(5):1392-1405.
[7]Lanigan A,Lindsey B,Maturo S,et al.The joint facial and invasive neck trauma(J-FAINT)project,Iraq and Afghanistan:2011-2016[J].Otolaryngol Head Neck Surg,2017,157(4):602-607.
[8]Owens BD,Jr KJ,Wenke JC,et al.Combat wounds in operation Iraqi freedom and operation enduring freedom[J].J Trauma,2008,64(2):295-299.
[9]Breeze J,Gibbons AJ,Shieff C,et al.Combat-related craniofacial and cervical injuries:a 5-year review from the British military[J].JTrauma,2011,71(1):108-113.
[10]Breeze J,Allanson-Bailey LS,Hunt NC,et al.Mortality and morbidity from combat neck injury[J].J Trauma Acute Care Surg,2012,72(4):969-974.
[11]Belmont PJ Jr,Goodman GP,Zacchilli M,et al.Incidence and epidemiology of combat injuries sustained during"the surge"portion of operation Iraqi Freedom by a U.S.Army brigade combat team[J].J Trauma,2010,68(1):204-210.
[12]Tong D,Beirne R.Combat body armor and injuries to the head,face,and neck region:a systematic review.[J].Mil Med,2013,178(4):421-426.
[13]Breeze J.The problems of protecting the neck from combat wounds[J].J R Army Med Corps,2010,156(3):137-138.
[14]Breeze J,Leason J,Gibb I,et al.Characterisation of explosive fragments injuring the neck[J].Br J Oral&Maxillofac Surg,2013,51(6):E263-E266.
[15]Wahlberg E,Goldstone J.Vascular Injuries to the Neck[M].Spving Berlin Heidelbery,2017:3-15.
[16]Greer LT,Kuehn RB,Gillespie DL,et al.Contemporary management of combat-related vertebral artery injuries[J].J Trauma Acute Care Surg,2013,74(3):818-824.
[17]符伟国,王利新.颈部血管损伤处理原则[J].中国实用外科杂志,2007,27(7):510-513.
[18]White JM,Stannard A,Burkhardt GE,et al.The epidemiology of vascular injury in the wars in Iraq and Afghanistan[J].Ann Surg,2011,253(6):1184-1189.
[19]Breeze J,Fryer R,Hare J,et al.Clinical and post mortem analysis of combat neck injury used to inform a novel coverage of armour tool[J].Injury,2015,46(4):629-633.
[20]付小兵.中华战创伤学.第3卷,口腔颌面部战创伤[M].郑州:郑州大学出版社,2016:315-320.
[21]Eastridge BJ,Mabry RL,Seguin P,et al.Death on the battlefield(2001-2011):implications for the future of combat casualty care[J].J Trauma Acute Care Surg,2012,73(6S5):S431-437.
[22]Eastridge BJ,Hardin M,Cantrell J,et al.Died of wounds on the battlefield:causation and implications for improving combat casualty care[J].J Trauma,2011,71(1S):S4-S8.
[23]Sims K,Montgomery HR,Dituro P,et al.Management of external hemorrhage in tactical combat casualty care:the adjunctive use of XStatTMcompressed hemostatic sponges:TCCC Guidelines change15-03[J].J Spec Oper Med,2016,16(1):19-28.
[24]范乃军,宋薇,张淼丹,等.原发性冲击伤的研究进展[J].实用医药杂志,2016,33(3):193-195.
[25]刘建敏,袁志,刘建,等.爆炸冲击波致肢体周围大血管损伤的病理学研究[J].中华创伤杂志,2009,25(8):751-754.
[26]刘彦普,刘瑞峰,周树夏,等.爆炸物对家兔颈部大血管损伤机制的实验研究[J].解放军医学杂志,2003,28(4):330-331.
[27]刘瑞峰,刘彦普,周树夏,等.爆炸冲击波对家兔颈部大血管损伤机制研究[J].中国组织工程研究,2003,7(11):1638-1639.
[28]王昭领,刘桂才,白振西,等.颌面部爆炸伤并发心脑损伤的实验研究[J].中华急诊医学杂志,2005,14(11):910-912.
[29]吴坡,谭颖徽.颌面、颈部战伤时效救治研究[J].实用口腔医学杂志,2017,(5):695-701.
[30]刘瑞峰,马全利.颈部大血管火器伤[J].中国急救医学,2001,21(11):60-61.
[31]龚维熙.头颈外科战伤救治系列讲座(3)颌面颈部战伤的救治[J].人民军医,2009,11:733-735.
[32]Steenburg SD,Sliker CW.Craniofacial gunshot injuries:an unrecognised risk factor for blunt cervical vascular injuries[J].Eur Radiol,2012,22(9):1837-1843.
[33]Murray DS.Post-traumatic thrombosis of the internal carotid and vertebral arteries after non-penetrating injuries of the neck[J].Br JSurg,2010,44(188):556-561.
[34]李丹,李兵仓,雷德林,等.犬颈部模拟爆炸条件下颈总动脉的病理改变[J].第四军医大学学报,2001,22(13):1194-1197.
[35]王昭领,刘桂才,白振西,等.不同时相下颌面部破片+冲击波复合伤特点研究[J].中国急救医学,2004,24(8):577-578.
[36]朱海彬,赵会民.颈部大血管创伤性血栓二例[J].中华创伤杂志,2013,29(10):1022-1023.
[37]刘保池.创伤鉴别与急救[M].北京:科学技术文献出版社,2009:164-165.
[38]Eskridge SL,Macera CA,Galarneau MR,et al.Injuries from combat explosions in Iraq:injury type,location,and severity[J].Injury,2012,43(10):1678.
[39]伍伟景.颈部穿透伤[J].国际耳鼻咽喉头颈外科杂志,1994(5):269-273.
[40]Kasbekar AV,Combellack EJ,Derbyshire SG,et al.Penetrating neck trauma and the need for surgical exploration:six-year experience within a regional trauma centre[J].J Laryngol Otol,2017,131(1):8-12.
[41]Breeze J,Newbery T,Pope D,et al.The challenges in developing a finite element injury model of the neck to predict the penetration of explosively propelled projectiles[J].J R Army Med Corps,2014,160(3):220-225.