گزارش يك مورد تروماي نافذ جمجمه با دستگاه ميخكوب بادي

The Case Report of a Penetrating Brain Injury after in-Driven Nail Shot from a ‘Pneumatic Nailer’

زﻣﯿﻨﻪ و ﻫﺪف: آﺳﯿﺐﻫﺎي ﻧﺎﻓﺬ ﻣﻐـﺰي در دو ﮔـﺮوه ﮐﻠﯽ ﺳﺮﻋﺖ ﭘﺎﯾﯿﻦ و ﺳﺮﻋﺖ ﺑﺎﻻ ﻗﺎﺑﻞ دﺳﺘﻪﺑﻨﺪي ﻫﺴﺘﻨﺪ. ﮔﺮوه اول ﺑﻪ ﻃﻮر ﻣﻌﻤـﻮل ﺷﺎﻣﻞ آﺳﯿﺐﻫﺎي ﻧﺎﻓﺬ اﯾﺠﺎد ﺷﺪه ﺗﻮﺳـﻂ ﺳﻼحﻫﺎي ﺳﺮد ﻫﺴﺘﻨﺪ. در اﯾﻦ ﻣﯿﺎن اﺑـﺰارﻫﺎﯾﯽ وﺟـﻮد دارﻧﺪ ﮐﻪ در ﻣﺤﯿـﻂ ﮐﺎر ﻏﯿﺮ اﯾﻤﻦ ﻣﯽﺗﻮاﻧﻨﺪ آﺳﯿﺐﻫﺎي ﺑﺎﻟﻘﻮه اﯾﺠﺎد ﮐﻨﻨﺪ. ﻫﺪف از اﯾﻦ ﮔﺰارش ﻣﻌﺮﻓﯽ ﯾﮏ ﻣﻮرد ﻧﺎدر از آﺳﯿﺐﻫﺎي ﻧﺎﻓﺬ ﺟﻤﺠﻤﻪ ﺑﺎ ﺳﺮﻋﺖ ﭘﺎﯾﯿﻦ، ﺑﺮرﺳﯽ ﻧﺤﻮة درﻣﺎن آن و ﻣﻘﺎﯾﺴﻪ ﺑﺎ ﺳﺎﯾﺮ ﻣﻮارد ﻣﺸﺎﺑﻪ ﻣﯽﺑﺎﺷﺪ. ﻣﻌﺮﻓﯽ ﻣﻮرد: ﺑﯿﻤﺎر ﻣﺮد 19 ﺳﺎﻟﻪاي اﺳﺖ ﮐﻪ ﺑﻪ دﻧﺒﺎل ﺷﻠﯿﮏ ﻣﯿﺦ از ﻣﯿﺨﮑﻮب ﺑﺎدي ﺣﯿﻦ ﮐﺎر ﺳﺎﺧﺘﻤﺎﻧﯽ دﭼﺎر ﺗﺮوﻣﺎي ﻧﺎﻓﺬ ﺟﻤﺠﻤﻪ و ﻣﻐﺰ ﺷﺪه ﺑﻮد. ﭘﺲ از اﻧﺠﺎم ﺑﺮرﺳﯽﻫﺎي ﺗﺼﻮﯾﺮﺑﺮداري و ﺳﺮﺑﺮوواﺳﮑﻮﻟﺮ، ﺑﯿﻤﺎر ﺗﺤﺖ ﺟﺮاﺣﯽ ﻗﺮار ﮔﺮﻓﺖ و ﻣﯿﺦ ﺧﺎرج ﮔﺮدﯾﺪ. ﺳﯿﺮ ﺑﺴﺘﺮي ﺑﯿﻤﺎر ﭘﺲ از ﺟﺮاﺣﯽ ﺑﺪون ﻣﺸﮑﻞ ﺳﭙﺮي ﺷﺪ. ﭘﯿﮕﯿﺮي ﺑﯿﻤﺎر 14 روز ﺑﻌﺪ از ﺳﺎﻧﺤﻪ ﺗﻮﺳﻂ آﻧﮋﯾﻮﮔﺮاﻓﯽ ﻋﺮوق ﻣﻐﺰي ﺻﻮرت ﮔﺮﻓﺖ ﮐﻪ از ﻧﻈﺮ آﻧﻮرﯾﺴﻢ ﺗﺮوﻣﺎﺗﯿﮏ ﻣﻨﻔﯽ ﺑﻮد. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﺷﻨﺎﺧﺖ آﺳﯿﺐﻫﺎي ﺑﺎﻟﻘﻮه ﻧﺎﺷﯽ از اﺑﺰارﻫﺎي ﺧﺎص در ارﺗﻘﺎي ﺗﺪاﺑﯿﺮ اﯾﻤﻨﯽ ﻋﻠﯽاﻟﺨﺼﻮص در ﺷﺎﺧﻪ ﻃﺐ، ﮐﺎر و ﻓﻬﻢ راﻫﺒـﺮدﻫﺎي درﻣﺎﻧﯽ ﭘﺲ از ﭼﻨﯿﻦ ﺳﻮاﻧﺤﯽ، ﮐﻤﮏﮐﻨﻨﺪه اﺳﺖ.

Introduction & Objective: Penetrating head wound are classified according to the velocity of the in-driven missile into; low velocity and high velocity missiles. The low velocity missiles are usually nonbullets, so called ‘cold weapons’. These are the instruments formally used in the work stations not critically controlled for safety. Case report: A 19 year old man suffering from penetrating brain injury (PBI) with a nail in-driven by a pneumatic nailer was referred to the emergency room. His neurological examination was normal. Regular radiological exams and angiograms were done before the operation. The postoperative course was uneventful and the control of cerebral angiogram was also normal. Conclusions: Awareness of the potential harms of the instruments used in the working areas is necessary to prevent possible mortal damages. Even though different studies have tried to elucidate different aspects of PBIs, but there are still poorly defined questions regarding the duration of antibiotherapy, anti-epileptic therapy and the probable duration needed for development of traumatic aneurysms.