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[基于炸药的田鼠陷阱——眼部区域一种新的损伤模式]

[Explosives-based vole traps-A novel injury pattern in the eye region].

作者信息

Framme C, Volkmann I, Kern T

机构信息

Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland.

出版信息

Ophthalmologie. 2024 Jan;121(1):36-42. doi: 10.1007/s00347-023-01926-1. Epub 2023 Sep 21.

DOI:10.1007/s00347-023-01926-1
PMID:37733261
Abstract

BACKGROUND

A novel method for trapping voles is the use of pistol-like explosive tools loaded with bolt-action ammunition. When triggered the vole is killed by the very high gas pressure created. Accidental releases can result in facial and/or eye injuries. The aim of this work was to describe the injury pattern in the patient and to experimentally verify whether there is a risk of penetrating eye injuries.

METHODS

Two emergency patients presented to our eye clinic with eye injuries after unintentional triggering of the explosive trap. Based on the new pattern of injury noted, experiments were performed on enucleated porcine eyes to determine the possible severity. For this purpose, a vole trap was clamped in a holder and loaded with a Cal. 9 × 17 mm cartridge in each case. In front of the muzzle opening, 3 pig eyes each were fixed on Styrofoam at a distance of 20, 40, 60 and 80 cm. The foreign body indentations in the cornea were visualized and measured by spectral domain optical coherence tomography (SD-OCT). The pig eyes were then dissected and searched for foreign bodies using microscopy. The SD-OCT images of an injured patient were also included for human comparison.

RESULTS

On patient examination, in addition to the usual fine gunshot marks on the face and conjunctiva/eye area, wax-like, larger and heavier particles of approximately 0.1-0.2 mm in size were found, which originated from the cartridge end cap. Removal of these foreign bodies, some of which were injected more deeply into the cornea, conjunctiva, and tenon, is much more difficult and extensive than in usual blast trauma. There was no evidence of intraocular foreign bodies in either patient. Likewise, no intraocular foreign bodies could be detected experimentally in any pig eyeball (n = 12). Remnants of the wax-like cartridge end were found deeply penetrating into the corneal stroma. The maximum penetration depth measured against the total corneal thickness was 46% at 20 cm device distance and decreased with greater distance to the vole trap (penetration depth at 40 cm at 37%, at 60 cm at 28% and at 80 cm at 19%). For comparisons on the human eye, a penetration depth of 54% was measured at a distance of about 40 cm. In pig eyes the number of foreign bodies per cm decreased with increasing distance from the vole trap (mean: n = 174 foreign bodies, FB, at 20 cm distance, n = 46 FB at 40 cm, n = 23 FB at 60 cm, and n = 9 FB at 80 cm). The largest penetrating foreign bodies measured a mean of 383 ± 43 μm with a maximum of 451 μm.

CONCLUSION

New vole traps with gas-powered mechanisms result in larger deeply penetrating wax-like foreign bodies in the cornea, conjunctiva, and tenon of the eye, which are difficult to remove and only surgically possible. Despite the significant explosion during triggering, there was no evidence of penetrating ocular injury from the foreign bodies either in the patient or experimentally in the pig eyes. Safety goggles should be worn when handling the traps to avoid penetration of foreign bodies into the eye.

摘要

背景

一种捕捉田鼠的新方法是使用装有栓动式弹药的手枪状爆炸工具。触发时,田鼠会被产生的极高气压杀死。意外触发可能导致面部和/或眼部受伤。这项工作的目的是描述患者的损伤模式,并通过实验验证是否存在穿透性眼外伤的风险。

方法

两名急诊患者因意外触发爆炸陷阱后眼部受伤前来我们的眼科诊所。基于所观察到的新损伤模式,对摘除的猪眼进行实验,以确定可能的严重程度。为此,将一个田鼠陷阱固定在一个支架上,每次装入一发9×17毫米口径的子弹。在枪口前方,分别在20、40、60和80厘米的距离将3只猪眼固定在泡沫聚苯乙烯上。通过光谱域光学相干断层扫描(SD - OCT)观察并测量角膜中的异物压痕。然后解剖猪眼,用显微镜寻找异物。还纳入了一名受伤患者的SD - OCT图像用于人体对比。

结果

对患者检查时,除了面部和结膜/眼部区域常见的细微枪伤痕迹外,还发现了大小约为0.1 - 0.2毫米的蜡状、更大且更重的颗粒,这些颗粒来自弹壳端盖。去除这些异物比通常的爆炸伤更困难且范围更广,其中一些异物更深地嵌入角膜、结膜和眼球筋膜。两名患者均未发现眼内异物。同样,在任何猪眼球(n = 12)中通过实验也未检测到眼内异物。发现蜡状弹壳端的残余物深深穿透角膜基质。以角膜总厚度为参照,在装置距离20厘米时测量的最大穿透深度为46%,随着与田鼠陷阱距离的增加而减小(40厘米时穿透深度为37%,60厘米时为28%,80厘米时为19%)。为与人体眼进行对比,在约40厘米的距离测量到穿透深度为54%。在猪眼中,每厘米的异物数量随着与田鼠陷阱距离的增加而减少(平均值:20厘米距离时n = 174个异物,40厘米时n = 46个异物,60厘米时n = 23个异物,80厘米时n = 9个异物)。最大的穿透异物平均尺寸为383±43微米,最大为451微米。

结论

新型的气动机式田鼠陷阱会导致角膜、结膜和眼球筋膜出现更大的深深嵌入的蜡状异物,这些异物难以清除,只能通过手术处理。尽管触发时会发生剧烈爆炸,但患者和猪眼中均未发现异物导致穿透性眼外伤的证据。处理陷阱时应佩戴安全护目镜,以避免异物刺入眼睛。

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Primary blast injury to the eye and orbit: finite element modeling.眼部和眼眶原发性爆炸伤:有限元建模。
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