颌面部高速破片+冲击波复合伤致伤机制实验研究
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摘要
颌面部为身体的暴露部位，其解剖结构复杂，生理功能特殊，无论战时平时均易遭受创伤。临床资料表明，由于爆炸物的广泛应用，口腔颌面部的爆炸性损伤在平战时均呈上升趋势。同高速投射物致伤相比，爆炸伤更为复杂。具有伤口污染明显、感染发生率高；局部毁损严重、受累部位广泛；休克发生率高；全身挫伤、震荡伤综合征明显等特点，其临床救治具有相当大的困难并有其特殊性，长期以来一直为临床医生所关注。有关颌面部爆炸伤的报道，多为临床研究，其基础研究开展较少。由于临床救治水平的提高，不仅取决于临床救治经验的总结和积累，更取决于基础理论研究的进展，基础理论的缺乏往往限制了临床救治水平的提高。因此，对颌面部爆炸性损伤的致伤机理和特点进行前瞻性研究，有利于为临床救治提供理论依据，促进临床救治水平的提高。
本实验的目的在于建立实验室可控条件下的颌面部爆炸伤模型，并在此基础上对爆炸伤的发生机制从物理及生物学方面进行探讨，以期为临床救治提供理论依据。
本实验包括四部分：
第·浑区大甘傅士磅住兑戈
实验一颌面部破片＋冲击波复合模拟爆炸伤模型的建立与评价
采用纸质电雷管作爆炸源，滑膛枪发射钢珠模拟爆炸破片，同步测速及测
压系统检测致伤参数，建立颌面部破片＋冲击波复合致伤模型。整个致伤模型在
同步系统控制下，雷管爆炸同时高速破片对犬颌面部伤致伤。本实验破片速度
叫，在不同爆距6．0、10．0、15．cos）对犬颌面部致伤，发现该模型能
稳定地致犬颌面部的破片＋冲击波复合伤，犬颌面部伤情严重，损伤范围广，并
可合并心、肺、脑等脏器的损伤，损伤程度随能量吸收与冲击波压力的升高而
加重。结果表明该破冲复合伤模型能较真实地模拟爆炸伤的致伤效果，能有效
的模拟爆炸致伤的两大主要因素，基本上可实现能量测试的标准化。具有简单、
安全、可靠的特点，能较好地模拟爆炸伤的主要因素，适于在实验室条件下进
行颌面部爆炸伤的研究，可用于颌面部爆炸伤的基础理论及临床救治研究c颌
面部爆炸伤具有伤情重、致伤因素复杂的特点。
同时，实验中首次应用简明损伤定级标准（AIS－90）评分系统对动物伤情
进行了分级，通过其与临床分级的相关研究，表明创伤评分系统可用于量化创
；；
伤实验中的动物伤情，有利于实验更好的结合临床实际。
实验二不同时相下颌面删片＋冲击彼复合致伤的特点崛
利用实验一建立的颌面部破冲复合伤模型模拟爆炸伤，由同步系统控制不
同致伤时相，将重庆当地成年犬15只，随机分为三组M组为破片先与冲击波
到达目标，B组为二者同时到达，C组为冲击波先于破片到达），每组5只。雷
管爆距设计为10．ocm，高速破片对犬咬肌区致伤，实验发现在相同致伤条件（同
等撞击速度及吸收能量、同等冲击波压力）下，A组颌面部皮肤与肌肉分离明
显，污染严重，创面最大，B组次之，C组最小。镜下观察，B组局部损伤最
为严重，组织坏死及挫伤范围均较其它两组明显，并有心。肺、脑等脏器的损
3
毒。军医大磅傅士磅住公么
伤。同时记录到了B组致伤时的冲击波波形具有双波峰。说明颌面部破冲复合
伤并非破片及冲击波致伤的简单相加，高速破片产生的冲击波与爆炸冲击波的
叠加致使冲击波正压作用时间延长，为加重伤情的原因，二者具有协同致伤作
用。同时，在不同致伤时相下，界面处的不同组织对冲击波传递的反应不同也
是伤情不同的原因。
实验三颌面部爆炸伤组织损伤特点及病理机制研究
本实验利用颌面部破冲复合伤模型，对犬颌面部致伤，对伤后不同时间点、
距伤道不同距离组织的病理变化进行了观察，同时分别用免疫组织化学及原位
杂交的方法检测了HSP70与TGF小 IInRNA于伤后不同时间的表达变化。结果
发现组织损伤范围较单纯枪弹伤及爆炸冲击伤严重，且呈删行性加重趋势。
组织震荡伤可波及到距离伤道1．6cm范围外，而炎细胞浸润及小血管损伤亦很
明显，其引起的血液循环障碍，可能是组织进行性损伤加重的因素。实验中，
HSP70在伤后6h即在创伤周围组织表达，并可持续至伤后7d，表明其表达与
组织损伤有关。TGF－pl InRNA伤后早期于创伤周围组织中表达增高可能与组
织保护有关，而其后期表达的降低可能与爆炸伤的?
Since the world war II, numerous reports have been published on the subject of war injuries from various wars and conflicts throughout the world. Much of those articles were related to the explosive injuries. Today in modern conflicts or wars the explosive ammunitions are widely used, and the incidence of explosive injuries is getting higher. And it is also reported that the explosive injuries more frequently occurred among civilians than before due to the application of explosive devices for the industry, agriculture, and sometimes the terrorism. According to the published papers, the damages or injuries caused by explosion were very serious. The local tissue damages were comprehensive and always combined with multiple organ injuries, mostly with the injury of lung. Blast waves and the high velocity projectiles are accepted as the dominant factors resulting in damage. In addition, the denotation, high temperature and so on are also thought of as the wound factors. Since so many factors are involved in the p
rocedure of explosive injuries, there are still a lot uncertain on the mechanism of wound and the treatment. Among the parts of the
body, maxillofacial region is more susceptible to injuries because of its lack of safeguard or armor. As the anatomical structures and the physiological functions in this region are complex and important, it's necessary to reconstruct the tissue defects and rehabilitate the functions at the early time after injuries for the relief of the suffering.
In this study, we intended to establish an animal model of compound injury induced by blast waves and high velocity projectiles in maxillofacial region for further study in this field. And with this kind of model, the mechanism of explosive injury, the injury characteristics were also studied. Four parts were included in this study.
Part 1 Establishment of an animal model of compound injury induced by blast waves and high velocity projectiles in maxillofacial region and the study of its characteristics
The detonators, steel spheres as simulant fragments shot by smooth-bore barrel and synchronizer were used to define the wound model and the maxillofacial regions of dogs were used as targets. The whole system was triggered when shooting. 30 dogs were used in this study and designed to detect the injury effects of the new model at different distances to the explosives. Wounding parameters and the changes of targets after explosion were observed and recorded. In this study, the values of overpressure of blast waves decreased exponentially according to the increasing of distance to the explosive. After wounds, the local traumas of dogs were very serious with extensive tissue damages compounded with injuries of hearts, lungs and brains. The injury was aggravated with the increasing of overpressure and energy absorption. According to the results, conclusions could be drawn that the new wound model can be used for the
study of explosive injury in maxillofacial region under laboratory conditions, and the
explosive injuries in this regions were characterized by serious tissue damages and
multi-etiology.
In addition, the injury severity score (ISS) system were first applied to value the
severity of animals wounds in this study. Results indicated that this system could be
used in traumatical experiments of animals to quantify the severity of injury
corresponding to that of the clinical researches.
Part 2 Characteristics of compound injuries in maxillofacial regions induced by blast waves and projectiles occurring at different time phases
In this study, 15 dogs were randomly divided into 3 groups and wounded with the new wound model. In group A, animals were injured first by the projectiles and then by blast waves. In group B, they were wounded by the blast waves and the high velocity projectiles at the same time. And in group C, first blast waves and then projectiles. The time phases were controlled by the synchronizer. Double peak of blast waves in group B were recorded but not found in others. After injury, it was
本实验的目的在于建立实验室可控条件下的颌面部爆炸伤模型，并在此基础上对爆炸伤的发生机制从物理及生物学方面进行探讨，以期为临床救治提供理论依据。
本实验包括四部分：
第·浑区大甘傅士磅住兑戈
实验一颌面部破片＋冲击波复合模拟爆炸伤模型的建立与评价
采用纸质电雷管作爆炸源，滑膛枪发射钢珠模拟爆炸破片，同步测速及测
压系统检测致伤参数，建立颌面部破片＋冲击波复合致伤模型。整个致伤模型在
同步系统控制下，雷管爆炸同时高速破片对犬颌面部伤致伤。本实验破片速度
叫，在不同爆距6．0、10．0、15．cos）对犬颌面部致伤，发现该模型能
稳定地致犬颌面部的破片＋冲击波复合伤，犬颌面部伤情严重，损伤范围广，并
可合并心、肺、脑等脏器的损伤，损伤程度随能量吸收与冲击波压力的升高而
加重。结果表明该破冲复合伤模型能较真实地模拟爆炸伤的致伤效果，能有效
的模拟爆炸致伤的两大主要因素，基本上可实现能量测试的标准化。具有简单、
安全、可靠的特点，能较好地模拟爆炸伤的主要因素，适于在实验室条件下进
行颌面部爆炸伤的研究，可用于颌面部爆炸伤的基础理论及临床救治研究c颌
面部爆炸伤具有伤情重、致伤因素复杂的特点。
同时，实验中首次应用简明损伤定级标准（AIS－90）评分系统对动物伤情
进行了分级，通过其与临床分级的相关研究，表明创伤评分系统可用于量化创
；；
伤实验中的动物伤情，有利于实验更好的结合临床实际。
实验二不同时相下颌面删片＋冲击彼复合致伤的特点崛
利用实验一建立的颌面部破冲复合伤模型模拟爆炸伤，由同步系统控制不
同致伤时相，将重庆当地成年犬15只，随机分为三组M组为破片先与冲击波
到达目标，B组为二者同时到达，C组为冲击波先于破片到达），每组5只。雷
管爆距设计为10．ocm，高速破片对犬咬肌区致伤，实验发现在相同致伤条件（同
等撞击速度及吸收能量、同等冲击波压力）下，A组颌面部皮肤与肌肉分离明
显，污染严重，创面最大，B组次之，C组最小。镜下观察，B组局部损伤最
为严重，组织坏死及挫伤范围均较其它两组明显，并有心。肺、脑等脏器的损
3
毒。军医大磅傅士磅住公么
伤。同时记录到了B组致伤时的冲击波波形具有双波峰。说明颌面部破冲复合
伤并非破片及冲击波致伤的简单相加，高速破片产生的冲击波与爆炸冲击波的
叠加致使冲击波正压作用时间延长，为加重伤情的原因，二者具有协同致伤作
用。同时，在不同致伤时相下，界面处的不同组织对冲击波传递的反应不同也
是伤情不同的原因。
实验三颌面部爆炸伤组织损伤特点及病理机制研究
本实验利用颌面部破冲复合伤模型，对犬颌面部致伤，对伤后不同时间点、
距伤道不同距离组织的病理变化进行了观察，同时分别用免疫组织化学及原位
杂交的方法检测了HSP70与TGF小 IInRNA于伤后不同时间的表达变化。结果
发现组织损伤范围较单纯枪弹伤及爆炸冲击伤严重，且呈删行性加重趋势。
组织震荡伤可波及到距离伤道1．6cm范围外，而炎细胞浸润及小血管损伤亦很
明显，其引起的血液循环障碍，可能是组织进行性损伤加重的因素。实验中，
HSP70在伤后6h即在创伤周围组织表达，并可持续至伤后7d，表明其表达与
组织损伤有关。TGF－pl InRNA伤后早期于创伤周围组织中表达增高可能与组
织保护有关，而其后期表达的降低可能与爆炸伤的?
Since the world war II, numerous reports have been published on the subject of war injuries from various wars and conflicts throughout the world. Much of those articles were related to the explosive injuries. Today in modern conflicts or wars the explosive ammunitions are widely used, and the incidence of explosive injuries is getting higher. And it is also reported that the explosive injuries more frequently occurred among civilians than before due to the application of explosive devices for the industry, agriculture, and sometimes the terrorism. According to the published papers, the damages or injuries caused by explosion were very serious. The local tissue damages were comprehensive and always combined with multiple organ injuries, mostly with the injury of lung. Blast waves and the high velocity projectiles are accepted as the dominant factors resulting in damage. In addition, the denotation, high temperature and so on are also thought of as the wound factors. Since so many factors are involved in the p
rocedure of explosive injuries, there are still a lot uncertain on the mechanism of wound and the treatment. Among the parts of the
body, maxillofacial region is more susceptible to injuries because of its lack of safeguard or armor. As the anatomical structures and the physiological functions in this region are complex and important, it's necessary to reconstruct the tissue defects and rehabilitate the functions at the early time after injuries for the relief of the suffering.
In this study, we intended to establish an animal model of compound injury induced by blast waves and high velocity projectiles in maxillofacial region for further study in this field. And with this kind of model, the mechanism of explosive injury, the injury characteristics were also studied. Four parts were included in this study.
Part 1 Establishment of an animal model of compound injury induced by blast waves and high velocity projectiles in maxillofacial region and the study of its characteristics
The detonators, steel spheres as simulant fragments shot by smooth-bore barrel and synchronizer were used to define the wound model and the maxillofacial regions of dogs were used as targets. The whole system was triggered when shooting. 30 dogs were used in this study and designed to detect the injury effects of the new model at different distances to the explosives. Wounding parameters and the changes of targets after explosion were observed and recorded. In this study, the values of overpressure of blast waves decreased exponentially according to the increasing of distance to the explosive. After wounds, the local traumas of dogs were very serious with extensive tissue damages compounded with injuries of hearts, lungs and brains. The injury was aggravated with the increasing of overpressure and energy absorption. According to the results, conclusions could be drawn that the new wound model can be used for the
study of explosive injury in maxillofacial region under laboratory conditions, and the
explosive injuries in this regions were characterized by serious tissue damages and
multi-etiology.
In addition, the injury severity score (ISS) system were first applied to value the
severity of animals wounds in this study. Results indicated that this system could be
used in traumatical experiments of animals to quantify the severity of injury
corresponding to that of the clinical researches.
Part 2 Characteristics of compound injuries in maxillofacial regions induced by blast waves and projectiles occurring at different time phases
In this study, 15 dogs were randomly divided into 3 groups and wounded with the new wound model. In group A, animals were injured first by the projectiles and then by blast waves. In group B, they were wounded by the blast waves and the high velocity projectiles at the same time. And in group C, first blast waves and then projectiles. The time phases were controlled by the synchronizer. Double peak of blast waves in group B were recorded but not found in others. After injury, it was
引文
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