Uraz spowodowany wybuchem miny jest obarczony wysoką śmiertelnością. Eksplozja miny przeciwpiechotnej rozrywa tkanki kończyny dolnej i powoduje złamania kości, co niejednokrotnie prowadzi do amputacji. Z kolei miny przeciwpancerne, które aktywują się na skutek bezpośredniego kontaktu z pojazdem, mogą wywołać wielonarządowe obrażenia, w tym oparzenia czy odłamkowe rany penetrujące, drążące do narządów.
Mina jest środkiem wybuchowym umieszczonym w ziemi, na ziemi lub w pobliżu ziemi albo innej powierzchni. Do wybuchu miny dochodzi wskutek obecności, bliskości lub zetknięcia się z nią osoby lub pojazdu. Obecnie istnieje około 350 typów min lądowych, które różnią się od siebie pod względem konstrukcji, wielkości i przeznaczenia. Należą do nich m.in. miny przeciwpiechotne (wybuchają na skutek obecności lub zbliżania się człowieka) i przeciwpancerne (wybuchają na skutek obecności lub zbliżania się pojazdu). Wskazane rodzaje min mogą spowodować różnego rodzaju obrażenia, które niejednokrotnie prowadzą do zgonu.
Mina przeciwpiechotna – rodzaje obrażeń
Przypadkowe odpalenie miny przez idącego człowieka może powodować bardzo zróżnicowane obrażenia. Dane przedstawione w literaturze pokazują, że u około 63-83 proc. ofiar dochodzi do całkowitej amputacji w obrębie kończyny dolnej, a w 6 proc. kończyny górnej. Amputacje obustronne dotyczą około 12,5 proc. przypadków. Inne obrażenia dotyczą utraty jednego lub obu oczu, miejscowego lub uogólnionego powikłania zapalnego i zakażenia, uszkodzenia podbrzusza i tułowia oraz głowy (wywołane przez odłamki).
W piśmiennictwie wyróżnia się dwa typy obrażeń minowych:
- typ A – urazy spowodowane przez małe miny przeciwpiechotne o średnicy około 10 cm i masie materiału wybuchowego do 100 g. Po nastąpieniu na minę dochodzi do rozerwania jednej stopy oraz niekiedy dalszej części podudzia. Czasem dochodzi do amputacji i odrzucenia fragmentu kończyny, rzadko uszkodzona jest druga kończyna i inne części ciała;
- typ B – urazy spowodowane większymi minami o średnicy powyżej 10 cm i zawierającymi 140-250 g materiału wybuchowego. Po nastąpieniu na minę prawie zawsze dochodzi do amputacji poniżej kolana i odrzucenia fragmentu kończyny. Niejednokrotnie amputacja jest wyższa – na poziomie kolana lub uda. Zwykle uszkodzona jest również druga kończyna ze złamaniami urazowymi lub amputacją. Obserwuje się również urazy pośladków i genitaliów, często stwierdza się także uszkodzenie penetrujące powłok brzucha i klatki piersiowej.
Wyróżnia się również urazy nietypowe głównie wywołane m.in. przez niewielkie rosyjskie miny kasetowe (narzutowe) PFM-1 i amerykańskie BLU-43. Wybuch powoduje ciężkie obrażenia kończyn górnych i twarzy. Ze względu na swój wygląd niejednokrotnie miny te przyciągają dzieci (tzw. miny-zabawki, miny-papugi).
W jaki sposób powstaje uraz minowy?
Głównym czynnikiem urazotwórczym przy eksplozji miny przeciwpiechotnej jest fala uderzeniowa, która działa na idące ciało od dołu ku górze. Energia jest na tyle duża, że może rozerwać tkanki ludzkie i spowodować złamanie kości. Wybuch odrzuca kończynę dolną w górę i w bok powodując przeprost w kolanie oraz wystąpienie znacznych naprężeń wzdłużnych, zginających się w podudziu i w jego kościach. Mina rozrywa więzadła stopy w 70 proc. powodując amputację w miejscu stawu poprzecznego śródstopia lub stępu. W 60 proc. przypadków dochodzi do otwartego złamania kości piętowej. Zespół tych obrażeń określa się w piśmiennictwie mianem „stopy minowej”. W wyniku wybuchu może dojść również do złamań na wyższym poziomie kończyny dolnej, m.in. na poziomie trzonu, goleni, kości piszczelowej, strzałkowej.
Amputacja dokonuje się zazwyczaj w wyniku dużych naprężeń przełamujących kość, a także rozerwania tkanek miękkich, rozdymanych przez gazy wybuchowe i powietrzne. Fala uderzeniowa odrzuca pozostałości kończyny, pozostawiając kikut z charakterystycznie wystającą kością piszczelową i kalafiorowo rozdętymi strzępami skóry i mięśni. Strzępy skóry kikuta i pasma mięśni zapadają się i obkurczają, zakrywając rozległość obszaru uszkodzenia.
Miny przeciwpancerne – rodzaje obrażeń
Mina przeciwpancerna wybucha na skutek bezpośredniego kontaktu z pojazdem. Obrażenia u ofiar tych wybuchów są znacznie cięższe i obarczone większą śmiertelnością niż wybuchy min przeciwpiechotnych. Na ogół uraz dotyczy kilku narządów i ma różnoraki charakter. W piśmiennictwie, w skutek wybuchu miny przeciwpancernej, wyróżnia się następujące obrażenia:
- złamania zamknięte kończyn, miednicy, złamania kompresyjne kręgosłupa – na skutek uniesienia się podłogi pojazdu, ściskania przez siedziska tułowia i kończyn pasażerów, uderzenia o kabinę pojazdu;
- pęknięcie błony bębenkowej i uszkodzenie narządów brzucha – na skutek fali uderzeniowej;
- oparzenia i zatrucia wziewne – na skutek wybuchu pożaru. Oparzenia obserwuje się u około 33 proc. ofiar wybuchu miny przeciwpancernej. Najczęściej lokalizują się na odkrytych częściach ciała, czyli na twarzy, przedramionach, szyi i rękach. Zwykle są to oparzenia I stopnia, jednak nierzadko dochodzi do oparzeń IV stopnia;
- rany odłamkowe penetrujące – mnogie, wielokierunkowe rany penetrujące z dużymi ubytkami skóry, drążące do narządów;
- urazy tępe i uszkodzenia narządów wewnętrznych – na skutek tych urazów często dochodzi do krwotoków wewnętrznych, a w konsekwencji do zgonów.
Następstwa urazu minowego
Urazy minowe charakteryzują się ryzykiem występowania wielu powikłań. Do najczęściej obserwowanych następstw zalicza się zanieczyszczenie i zainfekowanie rany bakteriami Clostridium tetani i Clostridium perfringens, a także Pseudomonas aeruginosa. Leczenie wymaga wdrożenia wczesnej, intensywnej antybiotykoterapii i seroterapii zapobiegającej tężcowi, zgorzeli gazowej, posocznicy i ropnemu zapaleniu kości. Ponadto w miejscach przerwania nerwów często powstają nerwiaki poamputacyjne, powodujące bóle fantomowe – dotyczy to nawet 60 proc. ofiar wybuchu miny. W kikutach po amputacji urazowej, które spowodowane są działaniem fali uderzeniowej, po kilku miesiącach od urazu obserwuje się również ogniska kostnienia tkanek miękkich, które w 1/5 przypadków wymagają reparacji. Za przyczynę ich występowania podaje się prawdopodobieństwo pozostawienia w kikucie ognisk martwiczej i nie w pełni odkażonej tkanki.
Ofiary wybuchu minowego wymagają ponadto skomplikowanego protezowania uszkodzonej kończyny, a także długotrwałej opieki rehabilitacyjnej i psychologicznej.
Źródło: K. W. Zieliński i wsp., „Patologia obrażeń i schorzeń wywołanych współczesną bronią w działaniach wojennych i terrorystycznych, Ministerstwo Obrony Narodowej, Warszawa, 2010
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