临床病例一名3岁儿童因外伤性枪支造成颅颌面损伤
- 作者: Petlakh V.I.1, Gorchakov S.A.2, Divilina Y.V.2
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隶属关系:
- Veltishchev Research Institute of Pediatrics and Pediatric Surgery, Pirogov Russian National Recech Medical University
- G.N. Speransky Children’s Hospital No. 9
- 期: 卷 13, 编号 4 (2023)
- 页面: 599-608
- 栏目: Case reports
- URL: https://bakhtiniada.ru/2219-4061/article/view/249869
- DOI: https://doi.org/10.17816/psaic1573
- ID: 249869
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随着俄罗斯平民中出现创伤性自卫武器（有限杀伤性武器、非致命动能武器），医学文献中发表了大量关于成年人受伤情况的论文。最严重的往往是致命的颅脑损伤。迄今为止，只有零星的关于儿童此类伤害的描述。
观察描述。据家长称，一名3岁儿童在家中用Osa-4手枪朝自己的脸部开枪。他没有失去知觉，出血也不多。他被送往中心区医院住院治疗，随后被救护车送往 G.N.Speransky Children's City Clinical Hospital No.9（莫斯科）。入院时，他的病情严重，意识清醒，昏睡不醒，对检查反应消极，格拉斯哥昏迷量表评分为14分，血流动力学稳定。局部状况：在鼻背上部可见子弹入口为不规则形状的挫伤伤口，呈淤血状，左眼窝明显水肿，上眼睑有血肿。头颅 X 光片显示：左眼眶和迷宫格状突起处有异物（子弹）阴影。计算机断层扫描明确了受伤的位置和程度。在气管内麻醉下，从左侧眶上经眉毛入路，沿伤口通道逐层切除组织，暴露出部分子弹，子弹已切入眼眶内侧壁和格骨细胞。子弹取出，骨头碎片移除，逐层缝合。诊断：鼻背及左眼眶区枪械性盲颅面非穿透性伤，晶格骨、左眼眶上、内侧壁多处多粉碎性骨折，左额脑区基底物质挫伤。钝性OS2t创伤，局部挫伤和视网膜出血。术后没有出现并发症。患儿接受了综合抗菌和修复治疗。视力得以保持，没有发现神经系统疾病，美容效果良好。在眼科医生、神经科医生和颌面外科医生的监督下，患儿康复出院，情况令人满意。
结论。本观察结果表明了外伤性武器对颅脑结构造成的损害，并将有助于进一步推广儿童此类伤害的治疗结果。防止儿童遭受创伤性武器伤害需要对拥有这些武器的父母进行广泛的教育。
作者简介
Vladimir I. Petlakh
Veltishchev Research Institute of Pediatrics and Pediatric Surgery, Pirogov Russian National Recech Medical University
编辑信件的主要联系方式.
Email: vladimirip1@gmail.com
ORCID iD: 0000-0001-5403-313X
SPIN 代码: 9100-6976
MD, Dr. Sci. (Medicine)
俄罗斯联邦, MoscowSergei A. Gorchakov
G.N. Speransky Children’s Hospital No. 9
Email: sagorchakov@mail.ru
ORCID iD: 0000-0003-0795-6921
Cand. Sci. (Medicine)
俄罗斯联邦, MoscowYulia V. Divilina
G.N. Speransky Children’s Hospital No. 9
Email: divo74@mail.ru
SPIN 代码: 8662-2050
俄罗斯联邦, Moscow
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Fig. 1. View of the child’s face upon admission. Entry hole of the wound canal in the dorsum of the nose
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Fig. 2. X-ray images of the skull bones revealed an embedded foreign body, identified during subsequent surgery as a bullet from the 18 × 45T cartridge: а — shadow of a foreign body, direct projection; b — shadow of a foreign body, lateral projection
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Fig. 3. Computed tomography of the skull (visualization in the bone mode): a — lateral projection — foreign body in the area of the left orbit and ethmoidal labyrinth; b — transverse section at the level of a foreign body; c — transverse section — the arrow points to the comminuted fractures of the medial wall of the orbit on the left
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Fig. 4. Stages of surgery: a — marking of the supraorbital trans-eyebrow approach; b — incision of the skin and subcutaneous tissue; c — layer-by-layer tissue dissection; d — at the bottom of the wound is a bullet from a traumatic pistol; e — blunt extraction and bullet removal; f — view of the face after surgery
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Fig. 5. Removed rubber bullet with metal core
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Fig. 6. Computed tomography of the skull with 3D reconstruction and frontal projection
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Fig. 7. Patient’s face upon hospital discharge
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Fig. 8. Screenshot collage from news feeds of new
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