目的：研究外伤性脑梗死患者血小板P选择素动态变化的临床意义。方法：用流式细胞仪测定42例外伤性脑梗死患者，50例无脑梗死外伤患者及40例正常对照者外周血血小板P选择素。结果：急性期(1周内)外伤性脑梗死患者P选择素明显高于无梗死脑外伤患者和健康对照组(Plt;0.01)。14 d时，外伤性脑梗死患者血小板P选择素表达，与无梗死脑外伤患者和健康对照组无显著差异(Pgt;0.005)。结论：P选择素参与外伤性脑梗死的病理过程，测定它们有利于外伤性脑梗死的早期诊治，改善预后。
Objective To review the current status and advances of the correlation between traumatic brain injury (TBI) and fracture healing. Methods The related domestic and abroad literature about the correlation between TBI and fracture healing was extensively reviewed and analyzed. Results There are a variety of studies on the correlation between TBI and fracture healing, which can be divided into two major aspects: revascularization and osteogenesis; the local and systemic changes of the neuropeptide and hormone after TBI. Conclusion TBI facilitates callus formation, the further research is needed to clarify the exact mechanism.
目的：分析地震灾害中颅脑外伤合并眼伤的临床特点和诊治难点，为制定合理的对策提供参考。方法：统计分析2008年5月12日汶川地震中绵阳地区颅脑外伤合并眼伤96例的疾病资料，以及早期处理方案和效果。结果：颅脑外伤合并的眼伤中钝挫伤比例高(99.5%)，昏迷患者容易忽视眼部损伤。结论：在生命抢救后的功能抢救阶段及时检查眼部情况有利于早期发现和挽救视功能；根据灾情整合眼科医疗资源，利用原有团队建制，有利于提高医院对大规模灾情的紧急应对效率。
ObjectiveTo build core items of database for traumatic brain injury (TBI) in rehabilitation medical database.MethodsRelevant factors in TBI database were summarized through database search in combination of acknowledged relevant items of TBI in rehabilitation medical database. Delphi method was used for experts to determine which items should be included by two rounds of questionnaires.ResultsThe average authority coefficient of experts was 0.94. After two rounds of questionnaires, 73 were included. Its contents include: general conditions, brain damage and disposal, relevant rehabilitation assessment scales, previous rehabilitation treatment, treatment expenses, and contents that require attention during re-evaluation.ConclusionsAfter two rounds of Delphi evaluation, the core items of database for TBI are identified with high recognition and consistency from experts.
摘要:目的:探讨5·12汶川8.0级地震中颅面部外伤的影像学表现特点。方法: 回顾性分析自2008年5月12~31日因地震颅面部外伤在我院行CT、MRI检查的伤员251例,其中CT检查248例,MRI检查16例。结果:放射检查阳性162例,阳性率为64.54%,以40～49岁年龄组最多,为53例,其中男性41例。在放射检查阳性中,多发伤112例(约69.13%),多类型颅面部外伤同时并存103例(约63.58%)。主要损伤发生率依次为软组织损伤(35.50%),骨折(22.94%),脑挫裂伤(21.21%),硬膜下及硬膜外血肿(10.40%),其它(共约9.92%)。结论: 地震造成颅面部外伤人群主要为40～49岁中年男性,多发伤、多类型颅面部外伤多见,并以软组织损伤、骨折、脑挫裂伤、硬膜下及硬膜外血肿较常见。Abstract: Objective: To describe the imaging features of head and face injured patients after the Wenchuan earthquake. Methods: The radiological information of 251 victims who were suspicious of head and face injury and underwent CT or MRI examinations from 12 May to 31 May 2008 was analysed retrospectively. There were 248 and 16 cases underwent CT or MRI examinations respectively. Results: One hundred and sixtytwo cases(64.54% )were positive. There were 53 cases in the 4049 years old age group, of which 41 were male. In patients with positive findings, 112 cases (about 63.58%) were comprised of several types of head and face injury. The incidence of the main injury type included: soft tissue injury (35.50%), fracture (22.94%), cerebral contusion (21.21%), subdural and epidural hematoma (12.40%), others (9.92%). Conclusions: The males with head and face injury in 4049 years old group were the major injured people in this earthquake. Head and face injury accompanied by multiple system injuries, the existence of several types of head and face injury at the same time were common. Among all the injury types, soft tissue injury, fracture, contusion, subdural and epidural hematoma were relatively commom.
Objective To investigate the changes in the expression level of PDGF in the bone callus of rats with femoral fracture and brain injury to explore the effect of brain injury on the fracture heal ing and the related mechanism. Methods Sixty-four 12-week-old SD rats weighing (356 ± 25) g were randomly divided into 8 groups with 8 rats in each. The rats in groups A1, B1, C1 and D1 had a femoral fracture and a brain injury for 1, 2, 3 and 4 weeks, respectively; the rats in groups A2, B2, C2 and D2 had a mere fracture without a brain injury for 1, 2, 3 and 4 weeks, respectively. After the CR films were taken, the bone callus was obtained 1, 2, 3 and 4 weeks after operation, respectively. Then, the bone callus and its histology were examined by HE staining, the expressions and changes in the level of PDGF were examined by the immunohistochemical staining, and the level of PDGF mRNA was measured by in situ hybridization. Results The CR films showed that the callus formation in the A1-D1 groups was earl ier and greater than that in the A2-D2 groups at the same time point. The HE staining indicated that more fibroblasts and early-stage chondrocytes were found in group A1; some fibroblasts in the fracture interspace and few early-stage chondrocytes were found in group A2; some newly-formed trabecular bones were found at the end of the fracture in group B1; but no trabecular bone formation was found in group B2; woven bone formation and a few chondrocytes between trabecular bones in the fracture interspace were found in group C1; only a few trabecular bones in the fracture interspace were found in group C2；woven bones turned to lamellar bones in group D1；and more immature trabecular bones in the fracture interspace were found in group D2. The positive expression of PDGF and PDGF mRNA was b in the cytoplasms of fibroblasts, mesenchymal cells, vascular endothel ial cells, early-stage chondrocytes, osteoblasts and osteoclasts. The percentage of the positive cells for PDGF and PDGF mRNA in the callus was significantly higher in groups A1-D1 than in groups A2-D2 at the same time point (P lt; 0.05). Conclusion Brain injury can promote the fracture heal ing process, which is probably related to an increase in the expression level of PDGF after the brain injury.
Patients with severe traumatic brain injury (TBI) have a higher mortality rate, often dying within a few hours after injury. The management of trauma site, transportation, and early hospital stay is closely related to the outcome of TBI patients. The final success rate of TBI patients varies after different prehospital treatments, and the quality of prehospital treatment for TBI needs to be further improved. Therefore, the TBI prehospital management guideline emerged, and the third version of the guideline was released in April 2023. In order to provide better advice and guidance on the treatment of prehospital TBI, this article interprets the key points of updating the third edition of the prehospital TBI management guideline.