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中华神经创伤外科电子杂志 ›› 2022, Vol. 08 ›› Issue (01) : 47 -50. doi: 10.3877/cma.j.issn.2095-9141.2022.01.010

经验交流

颅脑火器伤四例救治体会
陈宇晖1, 望家兴2, 田君1, 魏梁锋1, 王守森1,()   
  1. 1. 350025 福州,联勤保障部队第九〇〇医院神经外科
    2. 443099 宜昌市第一人民医院神经外科
  • 收稿日期:2021-01-11 出版日期:2022-02-15
  • 通信作者: 王守森
  • 基金资助:
    联勤保障部队第九〇〇医院院内课题(2020Z04)

Surgical treatment of craniocerebral firearm injury with clinical anlysis of 4 cases

Yuhui Chen1, Jiaxing Wang2, Jun Tian1, Liangfeng Wei1, Shousen Wang1,()   

  1. 1. Department of Neurosurgery, the 900h Hospital of Joint Logistics Team, Fuzhou 350025, China
    2. Department of Neurosurgery, The First Hospital of Yichang, Yichang 443099, China
  • Received:2021-01-11 Published:2022-02-15
  • Corresponding author: Shousen Wang
引用本文:

陈宇晖, 望家兴, 田君, 魏梁锋, 王守森. 颅脑火器伤四例救治体会[J]. 中华神经创伤外科电子杂志, 2022, 08(01): 47-50.

Yuhui Chen, Jiaxing Wang, Jun Tian, Liangfeng Wei, Shousen Wang. Surgical treatment of craniocerebral firearm injury with clinical anlysis of 4 cases[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(01): 47-50.

目的

探讨颅脑火器伤(CFI)的救治策略和效果。

方法

选取联勤保障部队第九〇〇医院神经外科自2018年1月至2021年12月收治的4例CFI患者为研究对象,回顾性分析患者的临床资料,采用GOS评分评估患者的预后。

结果

所有患者均接受及时开颅清创手术和术后综合治疗。存活3例,其中1例术后左上肢肌力3级,左下肢肌力1级,右侧肌力正常;另2例患者恢复良好,其中1例留有轻微精神症状,1例随访期间无并发症及神经功能障碍。死亡1例,于术后2年因肺部感染、急性肾衰而死亡。

结论

CFI病情凶险,院前急救能为手术赢得先机,恰当的手术处理能增加生存概率,围术期管理有助于提高生存质量。

Objective

To investigate the treatment strategy and effect of craniocerebral firearm injury (CFI).

Methods

A total of 4 patients with CFI admitted to Neurosurgery Department of the 900th Hospital of Joint Logistics Team from January 2018 to December 2021 were selected. The clinical data of patients were analyzed retrospectively, and the prognosis of patients was evaluated by GOS score.

Results

All patients underwent craniotomy debridement and postoperative comprehensive treatment, 3 patients survived, 1 patient had left upper limb muscle strength grade 3, left lower limb muscle strength grade 1, and normal muscle strength of right side; 2 patients recovered well, 1 patient had mild psychiatric symptoms, and 1 patient had no complications and neurological dysfunction during follow-up. One patient died due to pulmonary infection and acute renal failure 2 years after operation.

Conclusion

The condition of CFI is dangerous, prehospital emergency can win the opportunity for surgery, and appropriate surgical treatment can increase the probability of survival, perioperative management can help to improve the quality of survival.

表1 4例颅脑火器伤患者的临床资料
图1 4例颅脑火器伤患者术前术后CT图A~B:右额部颅脑火器性穿通伤(病例1);A:CT矢状位,可见右侧额部和枕部子弹出入口及创道;B:术后30 min复查CT,提示侧脑室和第三脑室少量积血;C~D右侧颞部火器性盲管伤(病例2);C:CT横断位,示右侧额颞叶深部和基底核区血肿伴多发铅弹残留;D:术后1 d CT提示脑肿胀明显,多处铅弹残留;E~F:右侧颞顶部火器性反跳伤(病例3);E:CT横断位,可见右侧颞叶血肿形成,内有碎骨片,弹丸位于左侧颞叶,反跳轨迹贯穿大脑半球;F:术后1 d CT示右侧颞顶部少量血肿伴少量颅内积气;G~H:右额部火器性盲管伤(病例4);G:CT横断位,示右侧额叶血肿并散在骨碎片,枕叶可见一个金属碎片;H:术后1 d复查示右侧额叶骨碎片已清除,少量血肿残留
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