兰州大学机构库 >学院待认领
MRI与病理学评价封闭式负压引流技术早期治疗肢体枪弹伤疗效
Alternative TitleMagnetic resonance imaging and pathological evaluation of vacuum sealing drainage efficacy of early treated limb gunshot
李荣刚
Thesis Advisor刘兴炎
2010-05-19
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword枪弹伤 封闭式负压引流伤后 MRI 病理学检查
AbstractMRI与病理学评价封闭式负压引流技术早期治疗肢体枪弹伤疗效 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,但常引起正常组织的损伤与并发症。探讨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25 m 距离射击致双后肢贯通伤,共8 对16 个,随机取左侧为实验组(n=16),右侧为对照组(n=16)。于伤后6 h 行弹道出、入口清创消毒后,实验组行VSD 治疗,敷料贯穿于整个弹道;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、72 h行MRI检查及取材行组织学观察,0、12、24、48、72 h 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72 h 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5h T1WI 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、72 h 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72 h 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。
Other AbstractMagnetic resonance imaging and pathological evaluation of vacuum sealing drainage efficacy of early treated limb gunshot Objective Gunshot wound spreads to the surrounding tissues and organs, it is difficult to debride and easy to infect. The conventional treatment is thorough, extensive debridement, fully open drainage, which often causes normal tissue damage and compl ications. To evaluate the effectiveness of vacuum seal ing drainage (VSD) treating the penetrating wound in porcine extremity by MRI and pathological methods so as to provide theoretical basis for future cl inical use. Methods Eight healthy adult pigs, weighing (45 ± 5) kg, were selected. Eight pairs of hind l imb penetrating wounds (16 wounds) were made by using Chinese-made 95-type rifle at 25 meters distance, which were randomly divided into experimental group (left side, n=8) and the control group (right side, n=8). After debriding and disinfecting the penetratingwounds at 6 hours after injury, wounds were treated with VSD in experimental group. The ball istics exports of the wounds were covered with single-layer gauze and imports were directly sutured and covered with sterile gauze in control group. The trajectory and the general condition of the adjacent skin were observed. MRI and histological observation were taken at 5, 24, 48, and 72 hours after injury, bacterial counting analysis was done at 0, 12, 24, 48, and 72 hours after injury. Results The aperture of the trajectory exit and entry were (5.00 ± 2.50) cm and (0.30 ± 0.15) cm immediately after injury. The wound surface was clean,rosy without leakage and swell ing after 72 hours in experimental group; wound and adjacent tissue were swell ing obviously, pus,muscle necrosis and exfol iative tissue was observed, and deep defect cavity at the trajectory exit could be seen in control group MRI showed that pairs of l inear low signal in T1WI and T2WI was seen in trajector of experimental group at 5 hours after injury, and signal in T1WI gradually increased at disrupted area and tissue deformation area at 24, 48, and 72 hours; in control group, low signal in T1WI was observed at 5 hours after injury, and signal in T2WI gradually increased and a clear boundari between edema and surrounding tissue, and the increase of signal in T1WI was not obvious at 24, 48, and 72 hours. The histological observation showed that wound was dominated by effusion at 5 hours after injury, granulation tissue gradually increased, muscle tissue ...
URL查看原文
Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/224036
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
李荣刚. MRI与病理学评价封闭式负压引流技术早期治疗肢体枪弹伤疗效[D]. 兰州. 兰州大学,2010.
Files in This Item:
There are no files associated with this item.
Related Services
Recommend this item
Bookmark
Usage statistics
Export to Endnote
Altmetrics Score
Google Scholar
Similar articles in Google Scholar
[李荣刚]'s Articles
Baidu academic
Similar articles in Baidu academic
[李荣刚]'s Articles
Bing Scholar
Similar articles in Bing Scholar
[李荣刚]'s Articles
Terms of Use
No data!
Social Bookmark/Share
No comment.
Items in the repository are protected by copyright, with all rights reserved, unless otherwise indicated.