Raiteb Mohamed, Opoko Ulrich, Sabr Ayoub, Elmrini Sanaa, Maadane Amina, Slimani Faiçal
Department of Stomatology and Maxillofacial Surgery, Hospital 20 Aout, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco.
Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P 5696, Casablanca, Morocco.
Ann Med Surg (Lond). 2021 Sep 13;70:102852. doi: 10.1016/j.amsu.2021.102852. eCollection 2021 Oct.
Injuries by ballistic projectiles concern nowadays more and more frequently civilian populations. If the vital prognosis is rarely put at risk, the functional after-effects are frequent and important. The management of these injuries follows specific rules that must be known because they are sometimes different from the usual traumatology. However, it is important for any surgeon to understand the basic principles of ballistic injury. Indeed, the knowledge of the trajectory of the bullet and its final location allows to consider the potential injuries and to evaluate the management of the patient. CT is the examination of choice for penetrating foreign bodies, allowing for viewing of the entry site, bullet trajectory, possible scattered fragments, and, most importantly, a possible skull base breach, as well as providing useful information for planning the surgical procedure and, generally, for prognosis. The primary surgery must ensure an early and rigorous trimming associated with antibiotic therapy because the quality of the initial trimming significantly influences the final result, so this approach to the removal of the foreign body depends on its size, its anatomical location, the structures involved and the preference of the surgeon.
如今,弹道射弹造成的伤害越来越频繁地涉及平民群体。虽然生命预后很少受到威胁,但功能后遗症却很常见且严重。这些损伤的处理遵循特定规则,必须了解这些规则,因为它们有时与普通创伤学不同。然而,任何外科医生了解弹道损伤的基本原则都很重要。事实上,了解子弹的轨迹及其最终位置有助于考虑潜在损伤并评估患者的治疗方案。CT是检查穿透性异物的首选方法,它可以显示入口部位、子弹轨迹、可能散落的碎片,最重要的是,还能显示是否可能存在颅底破裂,同时为手术方案的制定以及总体预后提供有用信息。一期手术必须确保早期严格清创并联合抗生素治疗,因为初始清创的质量会显著影响最终结果,所以这种异物取出方法取决于其大小、解剖位置、涉及的结构以及外科医生的偏好。