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目的 :比较面神经枪弹伤和爆炸伤的损伤及恢复情况间的差异 ,为临床上分类处理不同致伤因素导致的外周神经战伤提供理论依据。方法 :选用成年犬 40只 ,随机分为枪伤组和爆炸伤组 ,每组各 2 0只。麻醉下爆炸伤组在距犬面部 10cm处放置雷管模拟爆轰波致伤效应 ,并在雷管爆炸同时 ,用滑膛枪发射钢珠弹致伤犬面下部以模拟破片伤。枪伤组不放置雷管 ,分别于伤后即刻、6h、1d、3d、7d取两组面神经进行HE和免疫组化染色 ,并检测伤后 6h、3d、7d面神经动作电位传导速度 ,观察面神经的病理改变和功能恢复情况。结果 :伤后即刻大体观察两组动物面神经干水肿 ,枪伤组神经外膜下有散在出血和小血肿 ;爆炸伤组外膜下弥散出血 ,血肿范围也较大。镜下观察爆炸伤组面神经全颅外段轴突均发生广泛断裂 ,神经干内高度水肿 ,断裂的轴突呈小片段或碎片样 ,大量炎细胞浸润 ,免疫组化染色只有少量轴突神经纤维细丝蛋白阳性 ;而枪伤组在距伤道 2cm以内神经可见散在结构破坏 ,距伤道 2～ 3cm结构改变很轻。结论 :枪弹所致面神经伤随距伤道的距离增加而减轻 ,爆炸所致损伤与距伤道的距离没有明显关系 ,损伤程度更重 ,范围更广。提示临床救治神经火器伤过程中应参考致伤因素确定神经受损伤的范围
OBJECTIVE: To compare the differences between the injury and recovery of facial nerve bullet and blast injury, and to provide a theoretical basis for clinical classification and treatment of peripheral nerve injury caused by different injury factors. Methods: Forty adult dogs were randomly divided into gunshot wound group and blast injury group, 20 in each group. Under the anesthesia blast injury group, a detonator wave detonation wave injury effect was placed at a distance of 10 cm from the face of the dog. Simultaneously with the explosion of the detonator, the lower part of the dog face was fired with a steel ball projectile guided by a musket and a simulated fragment injury. Detonators were not placed in the group of gunshot wounds. HE and immunohistochemistry staining were performed on the two groups of facial nerve immediately after injury for 6h, 1d, 3d and 7d respectively. The facial nerve conduction velocity was measured at 6h, 3d and 7d after injury. The facial nerve Pathological changes and functional recovery. Results: Immediately after the injury, the rats were observed for dry epidermal edema. There were scattered hemorrhage and small hematoma beneath the epicardium in the gunshot wound group. Microscopically, the axons of the whole cranial nerves of the blast injury group were extensively ruptured, and the edema of the nerve trunk was highly edema. The axons of the ruptured axons showed small fragments or fragments, and a large number of inflammatory cells infiltrated. There were only a few axon fibers in the immunohistochemical staining Filament protein positive; and gunshot wound group 2cm away from the injury within the visible nerve damage scattered structure, 2 ~ 3cm away from the injury structure changes very light. CONCLUSION: The facial nerve injury caused by bullets is lessened with the increase of the distance from the injured area. There is no obvious relationship between the damage caused by the explosion and the distance from the injured area, with a greater degree of damage and wider scope. Prompts the clinical treatment of neural firearm injury should refer to the injury factors to determine the scope of nerve damage