澳门镜湖医院救治道路交通伤3648例分析

目的 探讨澳门地区道路交通伤的一些流行病学特点。方法 回顾性统计分析澳门镜湖医院１９９４年１月～１９９８年１２月救治３６４８例道路交通伤病案。结果 道路交通意外致伤３６４２例，死亡６例；轿车和摩托车是造成人员伤亡的主要车型，分别占机动车所致交通伤的４９．８％和３９．１％；机动车与行人碰撞是道路交通伤的主要类型，占５１．８％，儿童组占爱伤行人的４６．４％；大部分交通伤造成的人员损伤较轻微，擦伤、挫裂     

颅脑损伤的诊断和治疗

颅脑损伤在战时和平时都很常见，约占全身各部位伤的14％～17％，其发生率仅次于四肢伤，占第二位，但伤死率和致残率占各部位伤的首位。诊治是否及时和得当，关系到伤员的生命，因此必须提高颅脑伤的诊治水平，最大限度地降低死亡率和伤残率。颅脑损伤包括头皮、颅骨和脑组织损伤。头皮、颅骨和硬脑膜3层同时破损，脑组织和外界沟通者，称为开放性颅脑损伤；头皮、颅骨和硬脑膜的任何1层保持完整，脑组织不与外界相通者，称为闭合性颅脑损伤。1颅脑损伤的发生机制颅脑损伤可分为原发性颅脑损伤和继发性颅脑损伤两大类，脑震荡及脑挫裂伤为…     

颅脑火器伤损伤机制与病理

火器性颅脑损伤的致伤物主要是弹片和枪弹，其伤情与伤员距炸（射）点的距离及致伤物的性质、速度、大小和形状等有密切关系。致伤物为近炸（射）点、速度快、体积小时，易造成贯通伤；若为远炸（射）点、速度慢、体积大则多造成盲管伤或反跳伤。体积小、形状规整、表面光滑的致伤物对脑组织损伤小，而体积大、形状不规整、表面粗糙的致伤物对脑组织损伤大。1原发病理变化1．1颅骨损伤飞射物穿透颅骨，多造成洞形骨折，特点是内板损伤较外板重，如为贯通伤则出口处颅骨破坏较入口处重。如果飞射物垂直于颅板方向射入，造成的洞形骨折为圆形…     

外伤性气颅的CT诊断

外伤性颅内积气又称外伤性气颅，因颅底骨折、颅骨开放性骨折或火器脑穿通伤，骨折线波及副鼻窦、乳突气房或颅脑其它部位损伤导致硬脑膜破裂而引起，是颅脑损伤疾病较常见的并发症，其发生率约为颅脑损伤的9．7％。笔者收集70例外伤性气颅患者的CT资料并结合文献进行回顾性分析。     

颅脑损伤的因素及院前急救

发生颅脑损伤的因素：（1）钝器伤。如棍棒、砖石和锤等钝器，爆炸落石，高处落下重物，工程事故、塌方及机械力等导致的头部创伤、挤压伤，交通事故中的车辆碰撞等造成的损伤。这类损伤的致伤区域头皮软组织多有较大面积挫裂伤，创口形态不规则，创缘不整，挫伤严重。损伤部位多为粉碎性骨折，骨折片错位、凹陷，移位的骨折片可进人脑实质内，硬脑膜撕裂，     

道路交通伤骨折临床特点分析

目的分析道路交通伤骨折临床特点,提出相应的处理原则。方法2002年1月-2007年12月我院收治了526例交通伤骨折患者,男391例,女135例,平均38．7岁。对其受伤方式、损伤机制、损伤类型、人群分布、骨折临床特点及处理原则进行统计分析。结果本组526例,死亡11例,分别死于颅脑伤5例,失血性休克4例,颈髓损伤2例。骨折内固定364例,外固定架固定88例,骨牵引和石膏固定63例。骨折愈合494例,骨不连7例,骨髓炎5例,截肢9例。结论道路交通伤骨折,损伤机制复杂,创伤严重,多发性骨折和下肢骨折常见,多为开放性损伤。早期救治的重点：及时有效防治休克,防止漏诊误诊,早期行骨折内固定。     

交通事故伤与碰撞类型的关系

对５１１例交通事故伤住院病人的损伤模式和碰撞类型进行了流行病学分析。伤员构成为：摩托车人员占３６．０％、行人占３４．２％、自行车人员占１８．２％和汽车内人员占１１．６％。不同碰撞类型颅脑损伤发生率明显不同（Ｐ＜０．０１）：行人被摩托车撞颅脑损伤发生率高于行人被汽车撞；摩托车人员自身事故颅脑损伤发生率高于骑摩托车被汽车撞者；德国人员颅脑损伤发生率高于摩托车人员。笔者指出各种碰撞类型的交通事故伤原因及     

颞骨骨折及其并发症的临床研究

为探讨颞骨骨折及其并发症的特点及救治方法，作者对1989年1月－1999年11月收治的48例颞骨骨折临床资料进行了回顾性分析。结果显示，48例颞骨骨折患者中交通事故所致的占66．7％，存活43例（89．6％），死亡5例（10．4％）；中、内耳或颅脑损伤占77．1％，听力下降或耳鸣占48％；纵行骨折的脑脊液耳漏占36．7％，面瘫占3％；横行骨折的面瘫占37．5％，脑脊液耳漏则占25％。研究结果表明，交通事故伤是造成颞骨骨折的首要高危因素，其严重并发症为颅脑损伤，合并多脏器伤常是致死性并发症；其常用并发症为听力下降或耳鸣等中、内耳损伤；纵行骨折以脑脊液耳漏多见，横行骨折易造成面瘫。     

道路交通伤机动车碰撞类型比较研究

目的：研究道路交通伤的临床流行病学特点与机动车碰撞类型的关系。方法；将14779例由机动车碰撞所致的道路交通伤患者按其碰撞类型分组，对致伤方式、受伤部位、创伤严重程度、生理改变以及预测预后等方面进行比较和统计学分析。结果：机动车与行人和机动车碰撞为道路交通伤机动车主要碰撞类型，机动车与行人和摩托车碰撞致伤者损伤严重程度评分（ISS）分值较高，生存概率（Ps )预测值较低，且死亡所占比例较大（51．98％，92／177）；2个部位损伤为各种碰撞类型的主要受伤形式，其中头部及四肢骨骼伤较为常见，胸及腹部简明损伤定级（AIS）高会值伤较多；车外人员伤后生理紊乱较车内人员更为显著（P＜0．0）。结论：机动车所致的道路交通临床特点根据碰撞类型不同而有明显区别，高危伤情、高发部位及高危区为非对称性分布，机动车外交通伤比车内交通伤更为严重。     

颅底骨折的CT

颅底骨折有极其严重的后果。在进行头颅CT扫描之前应进行普通X 线检查,以阐明颅底骨折作为考虑颅内损伤的诊断标准。自从颅底骨折采用CT 诊断以来,X 线证实颅骨损伤就失去意义,因为与之相比,软组织损伤就仅有次要的意义。可是随着CT 的进展,也能检查颅骨的复杂结构,因此颅脑CT 在快速诊断颅脑损伤方面,亦能诊断颅底骨折。作者采用CT 检查了214例颅脑损伤患者,其中36例诊断为颅内损伤伴颅底骨折,比常规放射学发现骨折高2倍。为检查颅骨结构,扫描层厚度为2毫米,扫描时间为10秒,为了显示非常细小的骨折,使用高分辨计算程序(H—R 型)是必要的。骨折部位如下:前颅凹底18例、中颅凹底20     

2. An unusual death due to the impalement of a gear stick into the brain stem through the nasal cavity: a case report

A 59-year-old male was driving a car on the road and was involved in a traffic accident, colliding with a tanker and a big lorry. When an ambulance arrived at the scene, he was in a state of cardiopulmonary arrest and was bleeding profusely from his right nostril. He was confirmed dead at hospital. The autopsy showed a laceration of the right upper lip extending to the right nostril. In the basal skull there was a notable perforation at the ethmoid bone together with the central part of the sphenoid bone including the sella turcica. In accordance with the basal skull bone fractures, there were pronounced contusion injuries at the brain stem and a contusion injury was also observed in the right part of the cerebellum. After careful investigation of a causative stick-like item that was present inside the car, it was concluded that a severe movement of the man's body, as a result of the traffic collision, caused the gear stick which was fixed to the steering wheel to become impaled in the man's right nostril. The gear stick passed through the nasal cavity and into the basal skull bones, resulting in fatal brain stem injuries.     

Pattern of craniofacial injuries in patients admitted to Tanta University Hospital – Egypt

The goal of this work was to determine the craniofacial injury patterns in hospitalized patients to facilitate the awareness, by identifying, describing and quantifying trauma for use in planning and evaluation of preventive programs. Two-hundred and fifty five patients with craniofacial injuries were registered at the department of neurosurgery in Tanta University Hospital. Data were collected including age, gender, medical history, cause of injury and type of injury, location and frequency of soft tissue injuries, skull fractures, facial bone fractures, brain injuries and concomitant injuries, patient symptoms, clinical signs and the radiological findings. The most common causes of craniofacial injuries were road traffic accidents, followed by activity of daily life and assaults. Gender distribution showed that, males were at higher risk than females with a ratio of 5.5/1. In total of skull fractures, 47.84% were fissure fracture and 24.31% were depressed fractures. In total of brain injuries, 7.06% for concussion, 4.71% for contusion, 10.98% for brain laceration, 14.12% for pneumocephalus and 36.47% for brain edema. Regression analysis revealed increased risk for skull fractures and brain injuries in traffic accidents were 84.78%, 94.20%, respectively, and 59.14%, 50.54% in activity of daily life, but the probability of soft tissue injuries increase in traffic accident and violence.     

Finite element analysis to determine the cause of ring fractures in a motorcyclist’s head

The finite element (FE) method can potentially help in reconstructing skull fracture biomechanisms, enabling differentiation of the injury patterns caused by traffic accidents. This study aims to (1) reconstruct a motorcycle driver–car accident case using the total human model for safety and FE simulations; and (2) analyze the biomechanisms of fatal ring fractures in the motorcyclist’s skull base to determine if the fatal craniocerebral injuries were caused by a fall onto the highway after hitting a pedestrian or by the subsequent impact of a car. We simulated a series of loading scenarios of falls onto the road and impacts by a car, with and without a helmet being used. We reconstructed the injury processes and compared the biomechanics results to the skull tolerance limit. For the scenario of falling with a helmet, the Von-Mises stress around the foramen magnum indicated ring fractures with a slight fracture at the impact site, consistent with that detected in a traditional forensic pathology autopsy. Moreover, we found that a helmet can significantly protect the skull by controlling the increase in stress around the impact site. However, it has very little effect on the skull base, neck, or cervical spine. We determined that the characteristic ring fracture was most probably caused by the fall onto the highway. Thus, the subsequent car accident did not contribute to the motorcyclist’s death. Our study demonstrates that the FE model and method can explore injury biomechanisms, assisting in the identification of injury patterns in forensic practices.     

259例北京市道路交通事故死亡分析

目的了解北京市交通伤害死亡的流行病学特点,为有关部门制定预防和控制交通伤害措施提供科学依据。方法按照死者性别、年龄、职业、事故发生时间、道路行为方式、肇事车型、死亡原因等相关参数,对2004～2009年北京市急救中心收集的道路交通致死事故进行回顾性分析。结果共收集道路交通致死事故259例,死者男女性别比为2.45:1,21～50岁为高发人群(69.11%)。以23:00～1:00时段致死车祸发生频率最高(15.08%);7～8月和10～11月致死事故高发,分别为20.85%、23.17%;从一周分布上来看,星期三发生率最低(11.97%),最常发生于星期六(17.37%)、星期日(16.22%)。死者的职业前两位为工人(39.00%)、农民(15.83%);受伤部位以颅脑损伤为主(81.85%)。死者主要道路行为方式为步行(47.49%)、骑自行车(21.24%);肇事车辆多见于小型汽车(65.64%)。2005年后致死事故总体呈现下降趋势。结论需要加强对行人和驾驶人员的交通安全教育,提高交通安全意识。交管部门应严格执法,尤其应加强夜间及周末的执法力度,加强对电动自行车的管理,重视轨道交通安全设施建设。     

The spectrum of facial fractures in motor vehicle accidents: an MDCT study of 374 patients

Road traffic accidents are a major health problem worldwide resulting frequently in maxillofacial injuries. The purpose of the study was to assess the incidence and spectrum of facial fractures in patients involved in a motor vehicle accident (MVA). Using picture archiving and communication system, all requests for suspected facial trauma were retrieved during a 62-month period; 374 met the inclusion criteria. Two researchers interpreted the multidetector computed tomography images by consensus. The motor vehicles involved were divided into two groups: those involving a passenger car or a larger vehicle and those involving a motorized two-wheeler. Furthermore, the motor vehicle accidents were divided into collisions and run-off-road accidents. Of the 374 patients (aged 15–80, mean 34), 271 (72 %) were male and 103 (28 %) female. Of all patients, 262 (70 %) had a facial or skull base fracture; of these, multiple separate fractures were present in 56 %. Nasal fractures were the most common fractures followed by orbital, skull base, and maxillary fractures. Frontal bone, LeFort, and zygomatic arch fractures were always accompanied by other fractures. Fractures were more frequent in the group of collisions compared with run-off-road accidents. In the two-wheeled group, only 15 % did not have facial or skull base fractures. Fractures often occur in multitudes as 39 % of all patients have multiple facial or skull bone fractures, and thus, emergency radiologists should be familiar with the complexity of the injuries. Negative clear sinus sign and low-energy sentinel injuries should be trusted as indications of undetected injuries in MVA victims.     

64层螺旋CT在道路交通事故尸体检验中的初步应用

目的 探讨64层螺旋CT在道路交通事故全身尸体检验中的应用价值.方法 根据事故现场监控录像、现场勘查照片等获得本例行人道路交通事故的发生过程.由专业的法医于事故当天对遇难者尸体进行尸表检验,得出尸体检验报告.采用64层螺旋CT对遇难者尸体进行全身扫描,并在后处理工作站对CT断面图像进行多平面重建和三维重建.将CT图像所见与尸体检验报告进行比较.结果 尸表检验发现遇难者全身多处软组织损伤、蛛网膜下腔出血、血胸、多发肋骨骨折、鼻骨骨折.认为遇难者系交通事故致颅脑损伤、胸腔脏器损伤死亡.64层螺旋CT扫描结果显示遇难者颅脑、胸部、腹部、骨盆及脊柱多器官、多脏器发生严重的损伤.结论 64层螺旋CT可获得比尸表检验更多、更重要的组织器官和脏器损伤信息,两者联合应用,可为道路交通事故伤情鉴定提供更充分、可靠的依据.     

深圳市532例道路交通事故四肢伤流行病学分析

目的 通过记录分析医院急诊患者情况,探讨深圳市道路交通伤中四肢损伤的伤情特点.方法 设计调查问卷,对2007年1月～2007年12月深圳市6个行政区的6家综合性医院的急诊外科四肢道路交通伤患者进行记录,并对相关数据进行分析; 伤后4个月通过电话方式对患者创伤康复分级、工作恢复情况进行随访,了解患者伤后恢复情况.结果 道...     

中国高速公路2007-2009年交通伤害的流行病学研究

目的 分析中国高速公路交通伤害的流行病学特点,为高速公路交通伤害的预防与控制提供科学依据.方法 分析1994-2009年中国高速公路交通伤害的长期趋势和流行特征,以里程事故率、里程死亡率、事故致死率等指标评价中国高速公路交通伤害的严重性,通过聚类分析比较地区间里程死亡率和事故致死率的差别.结果 1994-2009年中国高速公路交通伤害的长期趋势除事故致死率逐年上升,里程事故率和死亡率波动下降外,其他指标均先上升后下降,下降后的各指标仍高于1994年水平.在交通伤害的四项基本指标中除事故起数外,其他三项指标(受伤人数、死亡人数和直接财产损失)在路网交通伤害中所占的比重逐年递增,以直接财产损失最明显,2006年以来占的比重均在30％以上.2007-2009年高速公路交通伤害的资料显示,4∶00和16∶00前后为事故高发时段,事故中驾驶员因素占93.02％,其中驾龄＜5年的驾驶员引起的事故占40.92％,行人和乘车人是高速公路的弱势人群,其事故致死率高达72.75％;尾随相撞(44.17％)和撞向固定物(16.35％)是主要的事故形态,路面干燥和晴天时事故比例高,分别为77.60％和65.93％.结论 中国高速公路交通伤害的严重性与日俱增,应根据该类伤害的流行病学特点,有针对性地采取加强道路管理、道路使用者的宣传教育和提高急救医疗服务水平等措施.     

车祸所致的颅脑损伤（附426例分析）

本文报告由车祸引起的颅脑损伤426例，并与同期非车祸所致的496例进行对比分析。分析表明，车祸所致颅脑损伤多较严重。且多为合并份，并发症亦多。随着交通事业的发展其发生率有逐渐增高的趋势，文章对其损伤的机理，临床特点以及诊断处理等问题进行了讨论。     

A degloving foot injury in a traffic accident

An unusual human remain found on a road became one key to reconstruct the traffic accident. A woman was found dead on a snow-covered road. Her left foot showed a large deficit of skin and underlying fat tissue. The detached skin and tissue were found into her left sock and shoe lying at a distance of 23 m from the body. There were multiple fractures on her back and occipital cranial bone. Severe injuries revealed in heart, liver, and brain. The neck remained intact. These findings suggested that her back has been strongly hit by the object with the flat surface, for example, the front side of a cab-over or truck, from behind at a high speed. Furthermore, the degloving injury in her left foot suggested that a vehicle ran over the foot which faced the vehicle. We reconstructed the accident as follows. Firstly the wheel of the vehicle ran over the victim's foot, and then, the victim turned away from the vehicle. Finally, the front side hit her twisted body from behind, resulting in a traumatic degloving injury.