Shvyrkov M B, Shamsudinov A Kh, Sumarokov D D, Shvyrkova I I
Maxillofacial Traumatology Department, Moscow Medical Stomatological Institute, Russia.
Br J Oral Maxillofac Surg. 1999 Aug;37(4):261-7. doi: 10.1054/bjom.1999.0120.
We have treated 33 young men with medium to large (3-8 cm) bony and soft tissue defects of the lower third of the face caused by gunshot wounds. After debridement, collapsing the proximal segments for primary approximation of soft and hard tissues and a closed osteotomy of a small fragment of mandible, we used an original compression-distraction device, designed in 1982 and tested during 1983 (analogous devices were absent at that time) to reposition the mandible and cause callus to form (during distraction) between the fragment and to use the remaining stumps of bone to fill in the defect. The soft tissues were repaired at the same time. Twenty-eight of the patients presented within a few hours of injury, and the remaining five had old injuries. The only complications were in the group with old injuries where four patients developed abscesses that required drainage, but these did not interfere with the process of osteogenesis. All 33 patients had good functional and aesthetic results within 3-4.5 months. The method allows a bloodless minimally traumatic procedure which can be carried out in one stage. The results compare very favourably with the classic methods of the treatment of mandibular gunshot injuries.
我们已治疗了33名因枪伤导致面下部三分之一处出现中到大（3 - 8厘米）骨与软组织缺损的年轻男性。清创后，将近端骨段复位以初步闭合软硬组织，对一小段下颌骨进行闭合截骨术，然后我们使用了一种1982年设计并于1983年进行测试的原创性加压 - 牵张装置（当时尚无类似装置）来重新定位下颌骨，并在骨碎片之间（牵张过程中）促使骨痂形成，利用剩余的骨残端填充缺损。同时对软组织进行修复。28名患者在受伤后数小时内就诊，其余5名患者为陈旧性损伤。唯一的并发症出现在陈旧性损伤组，有4名患者出现脓肿需要引流，但这些并未干扰骨生成过程。所有33名患者在3 - 4.5个月内均获得了良好的功能和美学效果。该方法允许进行无血的微创操作，且可在一个阶段完成。其结果与治疗下颌骨枪伤的经典方法相比非常有利。
