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目的枪弹伤对周围组织器官波及范围较大,不易清创,极易感染。传统治疗是彻底清创,充分开放引流,但可引起正常组织的损伤与并发症。通过MRI、病理学方法评价封闭式负压引流技术(vacuum sealing drainage,VSD)对猪肢体枪弹软组织贯通伤早期处理效果,为临床枪弹伤早期救治提供实验依据。方法取健康成年长白猪8只,体重(45±5)kg,采用国产95式步枪于25m距离射击致双后肢贯通伤,共8对16个,取左侧为实验组(n=8),右侧为对照组(n=8)。于伤后6h行弹道出、入口清创消毒后,实验组行VSD治疗,敷料贯穿整个弹道;对照组采用单层油纱覆盖弹道出口创面,入口直接拉拢缝合后无菌纱布覆盖。大体观察两组弹道及周围皮肤情况。伤后5、24、48、72h行MRI检查及取材行组织学观察,0、12、24、48、72h行细菌学计数。结果伤后即刻两组弹道入口口径为(0.30±0.15)cm,出口为(5.00±2.50)cm。伤后72h实验组弹道表面清洁、红润,未见渗出及肿胀;对照组弹道周围肿胀明显,弹道内见脓液、坏死肌肉及组织脱落,出口处可见弹道缺损空腔。MRI检查:实验组伤后5h原发弹道外缘见一线性T1WI结合T2WI双低信号,随时间延长碎裂区及组织变形区T1WI信号逐渐增强;对照组伤后5hT1WI呈低信号,之后碎裂区、组织变形区T2WI信号逐渐增高,T1WI增强不明显。组织学观察实验组伤后5h以渗出为主,24～72h肉芽组织逐渐增多,肌纤维溶解,炎性细胞浸润不明显;对照组伤后5～48h肌纤维逐渐溶解,炎性细胞浸润,至72h肌组织肿胀溶解变性,大量炎性细胞浸润聚集成菌团。伤后0h实验组及对照组细菌数差异无统计学意义(P>0.05);12、24、48、72h对照组细菌数较实验组明显升高,差异均有统计学意义(P<0.05)。结论MRI结合病理学对VSD早期处理肢体枪弹伤具有指导意义。MRI在伤后72h内能准确反映枪弹伤组织损伤范围,VSD可推迟感染时间,缩短创面愈合时间,促进健康肉芽组织生长。
The purpose of the bullet wound on the surrounding tissues and organs affected a larger range, not easy to debridement, easily infected. Traditional treatment is completely debridement, full open drainage, but can cause damage to normal tissue and complications. The effect of closed vacuum drainage drainage (VSD) on the early treatment of bullet soft tissue penetrating injury in pig limbs was evaluated by MRI and pathological methods, which provided experimental evidence for the early treatment of clinical bullet wounds. Methods Eight healthy adult White Landrace pigs (body weight 45 ± 5 kg) were randomly divided into four groups (n = 8) The right side of the control group (n = 8). The wounds were traced at 6h after injury. After debridement and disinfection of the entrance, the experimental group was treated with VSD. The dressings ran through the entire trajectory. In the control group, single-layer oil gauze was used to cover the wounds of the ballistic outlet. The wounds were covered with sterile gauze directly after suturing. General observation of the two groups of trajectories and the surrounding skin conditions. MRI examination at 5,24,48,72h after injury and histological observation of the samples were performed. Bacteriological counts were performed at 0,12,24,48 and 72h. Results The diameter of the two ballistic entrances was (0.30 ± 0.15) cm immediately after the injury and was (5.00 ± 2.50) cm at the exit. At 72h after injury, the ballistic surface of the experimental group was clean, ruddy and no exudation and swelling were observed. In the control group, the swelling around the ballistic trajectory was obvious. Pus, necrotic muscle and tissue were found inside the ballistic path. MRI examination: The experimental group showed a linear T1WI combined with T2WI dual low signal at the outer edge of the primary trajectory 5h after injury. The T1WI signal of the lesion and the tissue deformation zone gradually increased with time prolonging. In the control group, the signal of T1WI showed low signal 5h after injury, District, T2WI tissue deformation signal gradually increased, T1WI enhancement is not obvious. Histological observation 5h after injury, the exudate was the main component in the experimental group. The granulation tissue gradually increased in 24-72h, the muscle fibers were dissolved and infiltration of inflammatory cells was insignificant. In the control group, the muscle fiber gradually dissolved and the inflammatory cells infiltrated to 72h Muscle swelling and swelling of the degeneration, a large number of inflammatory cell infiltration aggregation bacteria group. There was no significant difference in bacterial counts between the experimental group and the control group at 0h after injury (P> 0.05). The number of bacteria in the control group at 12, 24, 48 and 72h was significantly higher than that in the experimental group (P <0.05) . Conclusion MRI combined with pathology is instructive for early treatment of limb bullet wounds in VSD. MRI within 72h after injury can accurately reflect the scope of gunshot wound damage, VSD can delay the infection time, shorten the wound healing time and promote the growth of healthy granulation tissue.