Characterisation of retained energised fragments from explosive devices in military personnel
Characterisation of retained energised fragments from explosive devices in military personnel
复制标题
军事人员中爆炸装置残留带电碎片的表征
作者：
J. Breeze;C. Steel;A. Streit;K. Sarber
1.确定爆炸装置产生的碎片的形状、尺寸和总数对于确定个人装甲等可能的缓减方法十分重要。本研究的目的是比较切除碎片的质量与CT预测的质量，以确定使用这种方法单独使用CT测量多个身体区域的保留碎片的有效性。方法27个保留碎片切除连续患者在美国角色3医疗设施在阿富汗进行了检查。对每个碎片进行了三维测量，并获得了质量，以估计密度，从而估计可能的组成。这些相同的切除碎片进行放射学鉴定，计算其预测质量，并与已知质量进行配对t检验。通过X线片测定了20名伤员四个身体区域中每个区域的残留碎片总数，并估计了每个身体区域中最大碎片的质量。结果切除的碎片最常见的是金属碎片（17/27，63%），质量范围为0.008至37.6 g。CT预测的平均质量与测量值有显著差异（p=0.133），CT低估了真实质量5%-17%。889/958例（93%）残留碎片在成像上显示为金属，最常见的受累部位是躯干和上肢（占伤亡人数的45%）。结论通过CT预测金属碎片的质量是可能的，误差可达5%，但对于非金属碎片（如结石）则不太准确。只有3%的碎片通过清创或有目的的切除而被移除;这些碎片不仅是最大的或最表面的。这表明，在较小的误差范围内，未来对较大伤亡队列服役人员中残留碎片的尺寸和预测质量进行回顾性分析可能是可行的。
Introduction Characterising the shapes, dimensions and overall numbers of fragments produced by explosive devices is important for determining methods of potential mitigation, such as personal armour. The aim of this investigation was to compare the mass of excised fragments with that predicted from CT to ascertain the validity of using such an approach to measure retained fragments for multiple body areas using CT alone. Method 27 retained fragments excised from consecutive patients treated at a US Role 3 Medical Treatment Facility in Afghanistan were examined. Each fragment was measured in three dimensions and the mass was obtained to estimate the density and thereby probable composition. These same excised fragments were identified radiologically and their predicted masses calculated and compared with the known masses with a paired t-test. The total numbers of retained fragments in each of four body areas for 20 casualties were determined radiographically and the mass of the largest fragment in each body region estimated. Results Excised fragments were most commonly metallic (17/27, 63%), with masses ranging from 0.008 to 37.6 g. Mean mass predicted from CT was significantly different from than that measured (p=0.133), with CT underestimating true mass by 5%–17%. 889/958 (93%) retained fragments appeared metallic on imaging, with the most commonly affected body areas being the torso and upper extremity (45% of casualties). Conclusions Predicting the mass of metallic fragments from CT was possible with an error margin of up to 5%, but was less accurate for non-metallic fragments such as stone. Only 3% of fragments were removed through debridement or purposeful excision; these were not just the largest or most superficial. This suggests that future retrospective analysis of the dimensions and predicted masses of retained fragments in larger casualty cohorts of service personnel is potentially feasible within a small margin of error.