1、下颌骨高速投射物损伤病理学及早期修复的实验研究 2、下颌骨骨折加压内固定的实验和临床初步应用研究
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摘要
本实验采用高速投射物致伤犬下颌骨，观察软硬组织的创伤弹道学特点，病理形态学改变，以及应用单纯游离髂骨和吻合臀前动、静脉的髂骨移植在伤后1周早期修复下颌骨缺损型骨折，以期为临床运用显微再造手段早期修复颌面部火器性骨缺损提供实验依据。实验采用标准瑞典致伤模型，以0.7g钢珠致伤，射速为1300m／s，射距6米。致伤部位为犬下颌骨体部。致伤时采用高速X光机记录软硬组织的瞬时空腔效应，并观察其创伤弹道学特点，全部动物均在伤后6小时，3天，7天分别距伤缘1，2，3cm取软硬组织标本，观察其病理学及超微结构变化，用墨汁灌注观察伤区骨组织的微循环变化。部分动物于致伤后6小时常规清创缝合伤口，清创后7天再次清创采用单纯游离植骨和吻合血管的骨移植两种方法修复下颌骨缺损术后均于8周取材，采用X线，血管造影，四环素萤光，病理组织学等方法比较两种方法早期修复的可行性。实验表明；在高速投射物条件下，同样有瞬时空腔形成，其直径为投射物的十余倍，复合组织伤能量吸收率，清创量均比单纯软组织大，且有直线关系。病理学观察发现，复合组织伤清创后，距创缘0.5cm处软组织仍有变性坏死，但随时间延长，并不影响伤口愈合。硬组织病理变化发生较慢，伤后3天才出现骨细胞坏死，7天时坏死完全，但3天7天时出现较活跃
Experimental Study of Mandibular Injury and Early Repair of the Mandibular Defects Following High-Velocity Missiles Wound In Dogs.
With the Development of the microreconstruction and trauma treatment techniques, Some experts advocated early repair to the maxillofacial firearm defect. But, there were many controversies to this problem. In order to provide experimental and pathological foundation of madible injury for the early repair of the mandibular defects with the microsugical techniques. this experiment was designed to evaluated the effects of wound ballistic, pathological changes and possibility of early repair of mandibular defect wounded by high velocity missiles.
Mandibular body of fourty one dogs were wounded by 0.7g steel spheres with the muzzle velocity 1300m/s. The distance from gun to animal was six meters. Experiment was divided into two groups. One group obersered temporary cavitation formation and pathological changes of soft and composite tissue after wounding. Injuried parameter was collected and analysed, and then, Bone tissue specimens were collected respectively from wound edge 1, 2, 3cm at 6 hours, 3 and 7 days after wounding. Another group, after wounding, the wound was debrided and sutured at the 6 hours. According to principle of delayed primary repair, Mandibular defects were repaired with the vascu-larized iliac bone and nonvascularized iliac bone grafts at 7 days after debridment. Postoperation, Possibility of the early repair and feasibility of two methods in the firearm mandibular bone defects were evaluated. Repair effects of two methods were comparied.
Experimental Study of Mandibular Injury and Early Repair of the Mandibular Defects Following High-Velocity Missiles Wound In Dogs.
With the Development of the microreconstruction and trauma treatment techniques, Some experts advocated early repair to the maxillofacial firearm defect. But, there were many controversies to this problem. In order to provide experimental and pathological foundation of madible injury for the early repair of the mandibular defects with the microsugical techniques. this experiment was designed to evaluated the effects of wound ballistic, pathological changes and possibility of early repair of mandibular defect wounded by high velocity missiles.
Mandibular body of fourty one dogs were wounded by 0.7g steel spheres with the muzzle velocity 1300m/s. The distance from gun to animal was six meters. Experiment was divided into two groups. One group obersered temporary cavitation formation and pathological changes of soft and composite tissue after wounding. Injuried parameter was collected and analysed, and then, Bone tissue specimens were collected respectively from wound edge 1, 2, 3cm at 6 hours, 3 and 7 days after wounding. Another group, after wounding, the wound was debrided and sutured at the 6 hours. According to principle of delayed primary repair, Mandibular defects were repaired with the vascu-larized iliac bone and nonvascularized iliac bone grafts at 7 days after debridment. Postoperation, Possibility of the early repair and feasibility of two methods in the firearm mandibular bone defects were evaluated. Repair effects of two methods were comparied.
引文
1．陈华等主编：颌面颈部创伤学 人民军医出版社 北京．1984
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4．周训银等：感染条件下大块下颌骨缺损一期修复的研究 解放军医学杂志 1989；14：17
5. Satko, LL. Arterial cutaneous and myocutaneous flaps in the reconstruction of devastation tissue-loss surgery. Acta Chir Plast 1988; 30(4): 240.
6．刘荫秋主编：创伤弹道学概论，新时代出版社 北京 1985
7. Owen-Smith, MS. High-Velocity missile wound. Edward Arnold Ltd London. 1981; 22.
8．付小兵：现代火器伤，大自然探索 1988；7：65
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10. Fackler, ML. Wonud Ballistics, A review of common misconception. JAMA 1988; 259(18): 2730.
11. Shelton, DW. Study in wound ballistics. J Oral Surg 1967; 25: 341
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13. Holt, GR. Wound ballistics of gunshot injuries to head and neck. Arch Otolaryngol 1983; 109: 313.
14. Walker, RV. Civilian maxillofacial gunshot injuries. Int J Oral Maxillofac Surg 1984; 13: 263.
15. Andrews, JL. Maxillofacial trauma in Vienam. J Oral Surg 1968; 26: 457.
16. Marshall, WG, An analysis of firearm injuries to the head and face in Belfast 1969-1977. Br J Oral Maxillofac Surg 1986; 39: 233.
17. Hua, ZQ. Wound Ballistics: Sixth International Sympo- sium ChongQing China. 1988; 48.
18．李玉莉等：火器伤下颌骨及软组织缺损早期修复病理实验研究，第一届全国创伤学术会议论文汇编，重庆；1988；99．
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2．李伟忠等：火器性下颌骨骨缺损的早期修复问题 国外医学军事医学分册 1988；5：257
3. Baker, SR. Single-stage reconstruction of the mandible following gunshot injury using a free osteomyocutaneous groin flap. Maxillofacial Trauma. An international perspective. Praege Publisher New york. 1983; 219.
4．周训银等：感染条件下大块下颌骨缺损一期修复的研究 解放军医学杂志 1989；14：17
5. Satko, LL. Arterial cutaneous and myocutaneous flaps in the reconstruction of devastation tissue-loss surgery. Acta Chir Plast 1988; 30(4): 240.
6．刘荫秋主编：创伤弹道学概论，新时代出版社 北京 1985
7. Owen-Smith, MS. High-Velocity missile wound. Edward Arnold Ltd London. 1981; 22.
8．付小兵：现代火器伤，大自然探索 1988；7：65
9. Hollerman, jj. Gunshot wounds: 1. Bullets, Ballistics and Mechanism of injury. AJR 1990; 155: 685.
10. Fackler, ML. Wonud Ballistics, A review of common misconception. JAMA 1988; 259(18): 2730.
11. Shelton, DW. Study in wound ballistics. J Oral Surg 1967; 25: 341
12. Kostohry, G. Wound ballistics of soft-tissue injuries to head and neck. Maxillofacial trauma: An international perspective. Praege Publisher New York. 1983; 33.
13. Holt, GR. Wound ballistics of gunshot injuries to head and neck. Arch Otolaryngol 1983; 109: 313.
14. Walker, RV. Civilian maxillofacial gunshot injuries. Int J Oral Maxillofac Surg 1984; 13: 263.
15. Andrews, JL. Maxillofacial trauma in Vienam. J Oral Surg 1968; 26: 457.
16. Marshall, WG, An analysis of firearm injuries to the head and face in Belfast 1969-1977. Br J Oral Maxillofac Surg 1986; 39: 233.
17. Hua, ZQ. Wound Ballistics: Sixth International Sympo- sium ChongQing China. 1988; 48.
18．李玉莉等：火器伤下颌骨及软组织缺损早期修复病理实验研究，第一届全国创伤学术会议论文汇编，重庆；1988；99．
19. Tan, YH. Wound Ballistics: Sixth International Symposium. ChongQing China 1988; 48.
20. Ragsdate, BD. Gunshot Wounds. A historical Perspective. Milit Med 1984; 149: 301.
21. Adaws, LB. Wound ballistics: A review. Milit Med 1982; 147: 831.
22. Daniel, RK. Mandibular reconstruction with the free tissue transfer. Ann Plast Surg 1978; 1: 346.
23. Franklin, JD. Single-stage reconstruction of mandibular and soft tissue defects using a free osteocutaneous groin flap. Am J Surg 1980; 140: 492.
24. Salibian, AH. Microvascular reconstruction of mandible. Am J Surg 1980; 140: 499.
25. Silverberg, B. Mandible reconstruction with microvascular bone transfer. Am J Surg 1985; 150: 440.
26. Calbonn, KH. Surgical care of submantal gunshot wounds. Arch Otolaryngol 1988; 114: 513.
27. Spira, MS. Shotgun injuries of the face. Plast Reconstr Surg 1967; 39: 449.
28. Zide, MF. Short-range shotgun wounds of the face. J Oral Surg 1979; 37: 319.
29. DeChamplain, RW. Mandibular reconstruction. J Oral Surg 1973; 31: 448.
30. Broadbent, TR. Gunshot wounds of the face initial care. J Trauma 1972; 12: 229.
31. Finch, DR. Immediate reconstruction of gunshot injuries to the faca. J Trauma 1979; 19: 965.
32. Goodstein, WA. Primary treatment of shotgun injuries to the face. J Trauma 1979; 19: 961.
33. Williams, CN. Immediate and long-trem management of gunshot wounds to the lower face. Plast Reconstr Surg 1988; 82: 433
34. Landra, AP. One-stafe reconstruction of a massive gun- shot wound of the lower face with a local compound osteo-masculocutaneous flap. Br J Oral Maxillofac Surg 1981; 34: 395.
35. Morgan, HH. Maxillofacial war injuries. J Oral Surg 1968; 26: 727.
36. Peled, IP. Primary repair of soft tissue war wounds. Br J Plast Surg. 1976; 29: 315.
37．孙弘等：下颌骨火器伤组织缺损早期修复的实验研究，第一届全国创伤学术会议论文汇编 重庆，1988；48。
38. Reinisch, JF. The use of the osteocutaneous groin flap in gunshot wounds of the hand. J Hand Surg 1984; 9: 12
39. Finseth, F. Composite groin flap with illac bone flap for primary thumb reconstruction. J Bone Joint Surg 1976; 58A: 130.
40. Salibian, AH. Microvascular reconstruction for closerange gunshot injuries to the distal forearm. J Hand Surg 1984; 9A: 799.
41. Freeland, AE. Delayed primary bone grafting in the hand and wrist after treatment bone loss. J Hand Surg 1984; 9A: 22.
42. Gordon, BL. Free vascularized osteocutaneous transplants from the groin for delayed primary closure in the management of loss of soft-tissue and bone in the hand and wrist. J Bone Joint Surg 1985; 67A: 958.
43．陈鸣九等：下颌骨火器伤游离骨片的保留再植 解放军医学杂志 1980；5：267．
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