Gröbe A, Klatt J, Heiland M, Schmelzle R, Pohlenz P
Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Oral and Maxillofacial Surgery, General Hospital of Bremerhaven-Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Germany.
Eur J Trauma Emerg Surg. 2011 Feb;37(1):41-7. doi: 10.1007/s00068-010-0023-z. Epub 2010 May 11.
Gunshot wounds of the viscerocranium are a rare occurrence during times of peace in Europe. The removal of projectiles is recommended; in some cases, however, this is controversial. The material properties of projectiles and destruction of anatomical landmarks make it difficult to determine their precise location. Therefore, navigation systems and cone-beam computed tomography (CT) provide the surgeon with continuous intraoperative orientation in real-time. The aim of this study was to report our experiences for image-guided removal of projectiles, the use of cone-beam computed tomography and the resulting intra- and postoperative complications. We investigated 50 patients with gunshot wounds of the facial skeleton retrospectively, 32 had image-guided surgical removal of projectiles in the oral and maxillofacial region, 18 had surgical removal of projectiles without navigation assistance and in 28 cases we used cone-beam CT in the case of dislocated projectiles and fractured bones. There was a significant correlation (p = 0.0136) between the navigated versus not navigated surgery and complication rate (8 vs. 32%, p = 0.0132) including major bleeding, soft tissue infections and nerve damage. Furthermore, we could reduce operating time while using a navigation system and cone-beam CT (p = 0.038). A high tendency between operating time and navigated surgery (p = 0.1103) was found. In conclusion, there is a significant correlation between reduced intra- and postoperative complications including wound infections, nerve damage and major bleeding and the appropriate use of a navigation system. In all these cases we were able to present reduced operating time. Cone-beam CT plays a key role as a useful diagnostic tool in detecting projectiles or metallic foreign bodies intraoperatively.
在欧洲和平时期，面颅骨枪伤是一种罕见的情况。建议取出射弹；然而，在某些情况下，这存在争议。射弹的材料特性和解剖标志的破坏使得难以确定其精确位置。因此，导航系统和锥形束计算机断层扫描（CT）为外科医生提供实时的术中连续定位。本研究的目的是报告我们在图像引导下取出射弹、使用锥形束CT以及由此产生的术中和术后并发症方面的经验。我们回顾性研究了50例面部骨骼枪伤患者，32例在口腔颌面区域接受了图像引导下的射弹手术取出，18例在没有导航辅助的情况下进行了射弹手术取出，28例在射弹移位和骨折的情况下使用了锥形束CT。导航手术与非导航手术之间以及并发症发生率（8%对32%，p = 0.0132）之间存在显著相关性（p = 0.0136），并发症包括大出血、软组织感染和神经损伤。此外，在使用导航系统和锥形束CT时，我们能够缩短手术时间（p = 0.038）。发现手术时间与导航手术之间存在高度相关性（p = 0.1103）。总之，包括伤口感染、神经损伤和大出血在内的术中和术后并发症的减少与导航系统的适当使用之间存在显著相关性。在所有这些病例中，我们都能够缩短手术时间。锥形束CT作为术中检测射弹或金属异物的有用诊断工具发挥着关键作用。
