兔坠落式颅脑减速伤的实验研究

目的研究兔坠落式颅脑减速伤模型及探讨其损伤机制。方法用自行设计的减速伤致伤装置复制兔坠落式颅脑减速性损伤。致伤装置由滑动导轨、动物固定台车、基座、撞砧及支架等部分组成。55只家兔分为对照组（10只）和致伤组（45只）,致伤组又根据坠落的高度不同随机平均分为3组,I组2．5m,Ⅱ组3．5m,Ⅲ组7．0m。将兔仰卧固定于动物固定台车上从不同高度坠落,其颅顶部撞击基座上的撞砧,用高速摄像观察兔颅脑减速伤致伤过程。从动物伤后行为、CT影像、大体解剖观察和病理变化等四方面对兔颅脑损伤进行研究。结果I、Ⅱ组动物伤后4小时存活9只和6只,Ⅲ组动物致伤后即刻死亡。I组CT影像观察和解剖未见颅脑损伤;Ⅱ组致伤后出现颅骨骨折、脑挫伤、硬膜下出血、对冲伤和轻微脑实质出血;Ⅲ组均出现了颅骨骨折、脑挫伤、硬膜下出血、脑实质出血和对冲伤。颅脑减速伤的病理改变主要为出血性脑挫伤。结论坠落高度（减速度）对颅脑损伤的程度有影响,对冲伤在严重颅脑减速伤中尤为明显。     

严重胸部伤合并颅脑伤的特点与救治

报告１９６４年５月～１９９４年５月收治的资料完整的胸部和颅脑合并损伤４４例，按损伤严重度评分（ＩＳＳ）法，ＩＳＳ值≥２０，就损伤特点与救治原则进行讨论。临床资料一、一般资料本组４４例，男３５例，女９例，年龄１７～７６岁。汽车致伤３２例，摩托车致伤４例...     

合并多发伤的颅脑损伤诊治体会

分析219例合并多发伤的颅脑损伤临床资料,总结其救治体会。认为合并多发伤的颅脑损伤救治应先重后轻、先开放后闭合、优先处理致命伤,手术时机及方式宜结合受损器官的伤情和重要性而定。     

重型颅脑损伤合并多发伤的救治

目的 评估重型颅脑损伤合并多发伤的救治过程。方法 对我科收治的122例重型颅脑损伤合并多发伤病例的临床资料及伤后6个月GOS评分进行统计分析。结果 死亡29例,植物生存3例,重残6例,轻残12例,治愈72例。结论 重型颅脑损伤合并多发伤以青壮年车祸伤为多见,应早期诊断、及时抢救,避免漏诊和误诊,首先处理危及生命的损伤等是抢救成功的关键。骨折早期手术内固定和ICU监护对成功救治有着重要作用。     

颅脑损伤合并伤的诊治体会

目的 探讨基层医院对颅脑损伤合并伤的救治。方法 本院收治85例颅脑损伤合并伤,入院时GCS≤9分,颅脑手术治疗50例,去骨瓣减压血肿清除术33例,钻孔血肿清除术9例,颞肌下减压术5例,微创血肿清除术3例。其它包括气管切开、胸腔闭式引流、骨折切开复位内固定术、椎管减压、剖腹探查等。结果 死亡18例,存活67例（平均随访2昕）,其中重残12例,轻残18例,37例恢复满意。结论 对颅及损伤合并伤的救治,各科应通力合作,重点诊治危及生命的损伤,最大程度地降低死亡率及伤残率。     

468例颅脑摩托车交通伤特点分析

随着经济的发展 ,城市车辆急剧增多 ,私人购车尤其是购置两轮摩托车 (以下简称摩托车 )的居民人数迅速上升。在广东珠江三角洲经济相对发达的地区 ,平均每户居民至少有 1辆以上摩托车 ,摩托车交通事故逐年增多 ,成为交通事故致伤、致残的主要原因之一[1 ,2 ] 。笔者就我院 1997年 3月～ 2 0 0 0年 3月救治的 46 8例摩托车交通事故所致的急性颅脑创伤 (以下简称颅脑摩托车交通伤 )的事故资料、临床和ＣＴ影像特点进行综合分析 ,为有效防止和救治颅脑摩托车交通伤提供借鉴与参考。资料与方法1.伤员及伤情资料 :1997年 3月～2 0 0 0年 3月我院…     

颅脑损伤合并多发伤的临床分析

颅脑损伤合并伤在诊断时往往会掩盖和影响合并伤的诊断，特别在昏迷和休克情况下更易造成漏诊，延误治疗。因此不能只注重本专业范围内的检查，而忽略其他部位的检查，对待颅脑伤，必须及时做出诊断，尽快合理地处理合并伤，以取得更好的疗效。     

颅脑弹片伤的伤情特点与处理

弹片所致颅脑损伤在致伤特性、创伤弹道学特点和损伤范围上有其特殊性。结合本组病例就该伤特点和处理原则作一讨论。临床资料１．一般资料：本组２２例，均为男性。年龄６～４８岁，平均２７．３岁。临床主要表现：昏迷８例，偏瘫４例，双瞳散大１例，病理征阳性５例，脑...     

颅脑枪弹伤特点及手术治疗

探讨颅脑枪弹伤的救治。认为保持呼吸道通畅,行CT或X线检查、尽早施行手术、术后加强抗感染及营养支持等是救治成功的关键。     

39例颅脑损伤合并颌面伤的紧急处理

１９８７年４月～１９９３年４月，我科收治颅脑损伤合并颌面伤３９例。笔者就其紧急处理的有关问题讨论如下。临床资料本组男３１例，女８例，年龄８～７０岁，平均年龄２７．５岁。受伤原因：车祸１５例，暴炸伤５例，打击伤４例，坠落伤３例，刀伤２例。临床表现：闭合...     

Is contrast-enhanced CT indicated in acute head injury?

Summary The authors discuss the value of intravenous contrast enhancement in CT scanning in acute head injury. In a series of seventy consecutive patients they conclude that no incremental information was obtained by performing contrast-enhanced CT scans in the acute phase of the head injury.     

脑弥漫性轴索损伤的临床表现及CT诊断

目的探讨脑弥漫性轴索损伤(DAI)的临床表现、CT诊断。方法分析32例脑弥漫性轴索损伤的临床资料及cT图像资料。同时对所有病例进行GCS评分。结果DAI的CT征象主要为：a)弥漫性双侧脑白质水肿、脑肿胀、灰白质界限不清；b)脑室、脑池、脑沟及蛛网膜下腔变窄、消失，无中线移位；c)脑弥漫性肿胀，白质内点、片状出血，但未形成血肿，无占位效应；d)脑弥漫性肿胀伴硬脑膜下薄层出血。患者伤后昏迷时间越长，临床表现越重，GCS评分越低，cT显示脑室系统受压程度越重则预后越差。结论DAI根据临床表现及影像学检查可作出临床诊断?但DAI病情与CT表现不一致时需行CT薄层扫描或MRI检查。     

儿童头颈部横纹肌肉瘤的CT及MR影像学特点

 目的 探讨儿童头颈部横纹肌肉瘤(rhabdomyosarcoma,RMS)的CT及MR影像学特点。方法 回顾性分析29例病理证实的儿童头颈部RMS的影像学资料,其中23例行MRI检查,18例行CT检查。结果 10例发病部位位于鼻咽部,4例位于鼻腔及鼻窦,5例位于鼻翼部,3例位于颌面部,6例位于耳部,1例位于左侧颞下窝。肿瘤形态不规则,呈浸润性生长,多侵蚀破坏邻近骨质。CT图像病灶密度不均匀,瘤体内均无钙化。MR检查T₁WI呈等或稍低信号,T₂WI呈稍高信号,信号不均匀,增强后瘤灶明显不均匀强化。8例侵犯眼眶,13例进入并侵犯鼻腔,14例侵犯副鼻窦,15例侵犯颞骨乳突,12例侵犯颞骨岩部,14例突破颅底,累及硬脑膜,同时4例侵犯邻近脑组织,2例发生脑脊液转移。结论 儿童头颈部RMS好发于脑膜旁区。CT能够很好地显示肿瘤对周围骨质结构的破坏,而MR能更清楚显示肿瘤软组织受累范围,两者结合可提供更全面的影像信息。     

Edema in the retropharyngeal space associated with head and neck tumors: CT imaging characteristics

To determine computed tomographic (CT) imaging characteristics of retropharygeal edema, we reviewed CT images in 18 patients with head and neck tumors. Retropharyngeal edema spread craniocaudally between soft palate and upper half of thyroid cartilage in all patients. No edema fluid extended above soft palate and below thyroid cartilage. Horizontally, it spread symmetrically in ten and asymmetrically in eight patients. Predominance in asymmetrical retropharyngeal edema was found on the same side as that of unilateral predominance both in lymph nodes enlargement and jugular vein stenosis/occlusion. All patients had edema also in other cervical spaces. Edema of retropharyngeal and other spaces fluctuated synchronously. In 14 patients, as primary lesion and/or cervical lymph nodes regressed, retropharyngeal edema disappeared or decreased. Retropharyngeal edema had some imaging characteristics. With knowledge of that, we could avoid diagnostic confusion when evaluating head and neck CT images.     

Direct sagittal (positional) computed tomography of the head

Summary A new method for positioning the head of the patient in the gantry of a fast wholebody scanner is reported, whereby reproducible direct sagittal scans of the head can be obtained and all the disadvantages of mathematically reconstructed views can be avoided. There are also the marked advantages that the midline and parasagittal structures can be evaluated without artifacts, and that rapid sequence CT or computed angiotomography of an intracranial lesion can be performed with the same density and spatial resolution comparable to the lateral plane of conventional carotid and vertebral angiography.Figures 2–4 have been taken from: Dtsch Med Wochenschr (1981) 106 (43): 1416–1417 with the permission of Thieme-Verlag, Stuttgart, FRG.     

Neuroimaging in non-accidental head injury: if, when, why and how

Non-accidental head injury (NAHI) in infants is an important but difficult topic. To miss or misdiagnose NAHI potentially has important consequences. The evidence base upon which to base decisions is limited but growing. This article aims to summarise current literature and thinking in this difficult area.     

高原复合冲击伤伤情特点的研究

目的探讨猪高原复合冲击伤的伤情特点。方法将30只猪分为5组,每组各6只,于海拔3 500m处分别复制单纯冲击伤、15%体表面积Ⅱ°烧伤、一侧后肢高速弹片伤、烧冲复合伤和弹冲复合伤模型。用PCB公司生产的压力传感器测定冲击波的物理参数,观察伤后28小时动物活存情况和大体形态学改变。结果单纯烧伤组和单纯弹片伤组动物全部活存,均未见明显形态学改变。单纯冲击伤组可见中度肺出血和轻度肠道浆膜下出血,且动物均全部存活。烧冲复合伤组和弹冲复合伤组肺出血加重,半数动物(3/6)为重度肺出血,同时伴中度肺水肿,肠道未见加重效应。烧冲复合伤组2只动物分别于伤后16、10小时死亡,弹冲复合伤组1只动物于伤后3小时死亡。结论高原复合冲击伤与单纯冲击伤相比,具有伤情更重,死亡率更高的特点,加重效应的器官主要为肺脏,加重的程度大致为一个等级。     

成人股骨头无菌性坏死的CT诊断

<正> 成人股骨头无菌性坏死是临床上一种常见致残性骨病,随着影像技术发展,近年来其发病率及检出率有增加趋势。其早期诊断对患者的治疗及关节功能的维持具有重要价值。现就我院近年来收治的30例经CT诊断资料完整的股骨头无菌性坏死的病例进行分析总结,以提高对该病的认识和诊断水平。     

Imaging findings in diffuse axonal injury after closed head trauma

Even in patients with closed head trauma, brain parenchyma can be severely injured due to disruption of axonal fibers by shearing forces during acceleration, deceleration, and rotation of the head. In this article we review the spectrum of imaging findings in patients with diffuse axonal injuries (DAI) after closed head trauma. Knowledge of the location and imaging characteristics of DAI is important to radiologists for detection and diagnosis. Common locations of DAI include: cerebral hemispheric gray-white matter interface and subcortical white matter, body and splenium of corpus callosum, basal ganglia, dorsolateral aspect of brainstem, and cerebellum. In the acute phase, CT may show punctate hemorrhages. The true extent of brain involvement is better appreciated with MR imaging, because both hemorrhagic and non-hemorrhagic lesions (gliotic scars) can be detected. The MR appearance of DAI lesions depends on several factors, including age of injury, presence of hemorrhage or blood-breakdown products (e. g., hemosiderin), and type of sequence used. Technical aspects in MR imaging of these patients are discussed. Non-hemorrhagic lesions can be detected with fluid attenuated inversion recovery (FLAIR), proton-density-, or T2-weighted images, whereas gradient echo sequences with long TE increase the visibility of old hemorrhagic lesions. Received 17 September 1997; Revision received 2 December 1997; Accepted 15 December 1997