Diagnosis and treatment of diffuse axonal injury in 169 patients

Diffuse axonal injury (DAI) following brain injuryhas acute and severe clinical manifestations andleads to a very high death rate. At presenttherapies for DAI do not have good effect. Weretrospectively analyzed 169 DAI patients treated in theSecond, Sixth…     

重型颅脑损伤中的弥漫性轴索损伤的救治

目的 探讨重型颅脑损伤中弥漫性轴索损伤的诊断与治疗。方法 总结本院近5年救治58例弥漫性轴索损伤患临床资料，并结合献，对重型颅脑损伤中的弥漫性轴索损伤的病因、诊断标准及治疗方法进行讨论。结果 58例弥漫性轴索损伤患诊治正确，31例抢救成功，27例死亡。结论 重型颅脑损伤中的弥漫性轴索损伤的死亡率较高，早期诊治是其抢救成功的关键。     

弥漫性轴索损伤后垂体功能不全的临床研究

目的 观察弥漫性轴索损伤(DAI)后垂体前叶主要激素的动态变化,为临床患者“激素替代治疗”提供理论依据. 方法 前瞻性收集经头颅MR证实的DAI患者85例和14例正常对照者,根据病灶发生部位将实验组分为轻、中、重3组.伤后3月和6月行GOSE评分评估预后,同期应用化学发光分析法检测患者血清泌乳素(PRL)、促肾上腺皮质激素(ACTH)、生长激素(GH)及促甲状腺素(TSH). 结果 实验组中,轻、中、重3组垂体激索水平下降的发生率伤后3个月分别为9.1％、29.0％、38.1％,伤后6个月为6.1％、10.0％、36.8％;对照组未见垂体激素水平低下现象.实验组根据GOSE评分,伤后6个月预后良好组51例、不良组34例,两组激素水平低下发生率分别为7.8％、25.8％.两组中ACTH、GH及TSH水平存在统计学差异(P＜0.05),PRL水平无统计学差异(P＞0.05). 结论 轻中型DAI患者慢性期可发生垂体前叶功能不全,但随康复时间延长大部分可恢复正常;重型患者垂体前叶功能不全发生率高且恢复率低.此外,部分垂体前叶激素水平的下降可影响患者的预后和康复.     

Ultrastructural observation of effect of moderate hypothermia on axonal damage in an animal model of diffuse axonal injury

OBJECTIVE: To investigate the effect of moderate hypothermia on responses of axonal cytoskeleton to axonal injury in the acute stage of injury. METHODS: Of fifteen adult guinea pigs, twelve animals were subjected to stretch injury to the right optic nerves and divided into the normothermic group (n = 6) in which the animal's core temperature was maintained at 36.0-37.5 degrees C and the hypothermia group (n = 6) in which the core temperature was reduced to 32.0-32.5 degrees C after stretch injury. Remaining three animals sustained no injury to the right optic nerves and served as control group. Half of injured animals (n = 3) of either normothermic group or hypothermic group were killed at either 2 hours or 4 hours after injury. The ultrastructural changes of axonal cytoskeleton of the right optic nerve fibers from the animals were examined under a transmission electron microscope and analyzed by quantitative analysis with a computer image analysis system. RESULTS: At 2 hours after stretch injury, there was a significant reduction in the mean number of microtubules (P < 0.001), and a significant increase in the mean intermicrotubule spacing (P < 0.05 or P < 0.01) in axons of all sizes in normothermic animals. The mean number of neurofilaments also decreased statistically (P < 0.01) in large and medium subgroups of axons in the same experimental group at 2 hours. By 4 hours, the large subgroup of axons in normothermic animals still demonstrated a significant decline in the mean number of microtubules (P < 0.01) and an increase in the mean intermicrotubule spacing (P < 0.05), while the medium and small subgroups of axons displayed a significant increase in the mean number of neurofilaments (P < 0.05) and reduction in the mean interneurofilament spacing (P < 0.05). On the contrary, either the mean number of microtubules and the mean intermicrotubule spacing, or the mean number of neurofilaments and interneurofilament spacing in axons of all sizes in hypothermic stretch-injured animals was not significant different from the mean values of sham-operated animals. CONCLUSIONS: Posttraumatic moderate hypothermia induced immediately after axonal injury results in substantial protection of axonal cytoskeleton and ameliorates axonal damage.     

Haemodynamic patterns in children with posttraumatic diffuse brain swelling. A preliminary study in 6 cases with neuroradiological features consistent with diffuse axonal injury

Summary Background. In the present report we describe the cerebral haemodynamics and the neuroradiological findings observed in six consecutive children, three males and three females aged 4–15.6 yrs (mean age 8.95) displaying a neuroradiological pattern consistent with diffuse axonal injury (DAI) along with slit ventricles. Methods. All the patients were admitted to the Paediatric Intensive Care Unit with GCS scores less than 8 after a severe brain injury. Serial head computed to mography (CT) and magnetic resonance (MR) scans demonstrated a radiological pattern of DAI. Transcranial Doppler Sonography (TCD) of the middle cerebral arteries was performed through the temporal bone window in all the patients. All patients but one underwent a continuous monitoring of intracranial pressure (ICP) and cerebral extraction of O₂ (CEO₂). Treatment with barbiturates and hyperventilation was necessary in all the cases. In one patient, a bilateral decompressive cran iectomy was performed in order to decrease severe in tracranial hypertension. Results. Hyperflow along with intracranial hyper tension, variably responsive to barbiturate medication, was observed in all the patients by means of TCD and CEO₂. Conclusions. Intracranial hypertension can be elevated in pediatric posttraumatic hyperflow syndromes associated with DAI. The observation of the time course of the parameters studied allowed us to modify the pharmacological treatment and/or perform surgical decompression (external cerebrospinal fluid (CSF) drainage in five cases; decompressive craniectomy in one case). Compartmental hyperflow TCD pattern was evident in only one patient. Although the limited number of pa tients in our series does not allow definite conclusions, we strongly believe that TCD, with ICP and CEO₂ monitoring, are useful tools in planning surgical strategy in children with neuroradiological signs of DAI.     

Diffusion tensor imaging fiber tractography for evaluating diffuse axonal injury

Patients with Diffuse axonal injury (DAI) frequently exhibit cognitive disorders chronically. Radiologic recognition of DAI can help understand the clinical syndrome and to make treatment decisions. However, CT and conventional MRI are often normal or demonstrate lesions that are poorly related to the cognitive disorders. Recently, diffusion tensor imaging (DTI) fiber tractography has been shown to be useful in detecting various types of white matter damage. The aim of this study was to evaluate the feasibility of using DTI fiber tractography to detect lesions in DAI patients, and to correlate the DAI lesions with the cognitive disorders. We investigated two patients with chronic DAI. Both had impaired intelligence, as well as attention and memory disorders that restricted their activities of daily living. In both patients, DTI fiber tractography revealed interruption of the white matter fibers in the corpus collosum and the fornix, while no lesions were found on conventional MRI. The interruption of the fornix which involves the circuit of Papez potentially correlates with the memory disorder. Therefore, DTI fiber tractography may be a useful technique for the evaluation of DAI patients with cognitive disorders.     

异丙酚对大鼠脑弥漫性轴索损伤后的脑保护作用

目的 评价异丙酚对损伤后脑组织的神经保护作用。方法 取健康Ｗｉｓｔａｒ大鼠７２只,采用Ｍａｒｍａｒｏｕ弥漫性颅脑损伤动物模型制备方法,造成大鼠重度颅脑损伤,异丙酚组（Ｐ组）给予１％异丙酚１ｍｇ．ｋｇ＾－１．ｍｉｎ＾－１持续静注３ｈ;对照组（Ｃ组）伤后不作处理;正常组（Ｎ组）不造成颅脑损伤,各组在伤后６、２４、４８和７２ｈ分别取脑组织做电镜观察和血生化指标测定。结果 （１）形态学：Ｃ组各时相显示了典型ＤＡＩ改变过程;Ｐ组在４８和７２ｈ轴索改变、微血管及胶质细胞损伤程度均明显轻于Ｃ组;（２）血生化指标：损伤后ＮＥＳ、ＥＴ和ＭＤＡ值Ｐ组和Ｃ组均较Ｎ组明显升高,但Ｐ组升高程度明显低于Ｃ组,并且随时间延长Ｐ组各值逐渐下降,而Ｃ组仍持续在较高水平。ＭＢＰ与ＮＯ高程度明显低于Ｃ组。并且随时间延长Ｐ组各值逐渐下降,而Ｃ组仍持续     

复杂中足损伤的临床治疗

目的 回顾复杂中足损伤的临床治疗,评价其临床治疗的特点及要点.方法 2003年6月至2008年6月问收治22例复杂中足损伤患者,其中开放性骨折8例,伴有软组织缺损者5例.急诊收治患者13例,另9例为外院已处理的患者.急诊患者中仅1例行舟骨和中间、外侧楔骨的关节融合,其余均行复位和内固定.转诊患者:2例行距舟关节融合,3例行Lisfranc关节融合伴1例行趾近节截除,1例行舟楔火节融合,1例行跗横火节融合,1例行内侧柱截除,1例行外侧柱重建.5例伴软组织缺损的患者,4例行游离前锯肌移植,1例行腓肠神绛伴行血管逆行岛状皮瓣移植修复.结果 全部患者术后随访5～44个月,平均17.5个月.急诊患者随访时的主要后遗症状为长时问行走后疼痛,2例患者经应用局部封闭及非甾体类镇痛药治疗后症状缓解.转诊患者中,2例行走时易疲劳、酸痛;2例外侧第4、5跖骨头跖侧胼胝伴疼痛;1例前、中、后足僵硬,同时存在足内肌较广泛的萎缩,有较重的行走疼痛;内侧柱截除的患者有足弓塌陷、后足外翻的表现,使用特制鞋行走.急诊收治患者AOFAS评分为(80.3±8.7)分,转诊患者为(60.1±16.3)分.结论 复杂的中足损伤应在允分了解功能解剖、创伤病理的基础上早期手术,解剖复位和牢靠同定是获得良好疗效的关键.     

Content change of neurofilament protein subunits in experimental brain diffuse axonal injury by lateral head rotation

Objective:To explore the content change of neurofilament (NF) protein subunits in the experimental brain diffuse axonal injury(DAI) by lateral head rotation.Methods:Twenty-four Sprague Dawley (SD) rats were equally divided into three injury groups (2h,12h,and 24h post injury) and one control group.The models of DAI were made in the injury groups by lateral head rotation.western blotting technique was used to measure the contene of NF68(a kind of NF protein subunit) in the brainstem tissues among all the injured and control rats.The NF68 immunohistochemical staining was used in another six SD rats in order to observe the morphological changes in DAI.Results:The NF68 content in the brainstem tended to decrease at 2h post injury,decreased significantly at 12h and continued its decrease at 24h.NF56 and NF52,as the breakdown products of NF68,had a tendency to increase at 2-12h after the injury,and amounted to a significantly higher level at 24h.Microscopically,there were a lot of swelling neuronal axons in the ventral part of the medullar oblongate at 2h after the injury.some axons were disconnected,and axonal retraction balls formed on their proximal end.Conclusions:There is and occurrence of phosphorolysis within the brainstem in DAI by lateral head rotation.These reactions cause the breakdown of NF68,which results in the decrease of NF68 in content.It suggests that the breakdown of neurofilament protein subunits is an important reason for structural destroy of neurofilaments in DAI.     

腹腔镜技术诊治腹部损伤的应用体会(附102例报告)

目的:探讨腹腔镜技术诊治腹部损伤的价值及疗效.方法:回顾分析为102例腹部损伤患者施行腹腔镜探查的临床资料.结果:102例患者均经腹腔镜探查明确诊断,无漏诊、误诊.18例中转开腹,中转率17.65%,均为闭合性腹部损伤者(22.50%,18/80),开放性损伤者无一例中转开腹手术.29例(28.43%)为非治疗性.3例...     

氢质子磁共振波谱成像联合磁敏感成像评价弥漫性轴索损伤

目的探讨评价氢质子磁共振波谱（^1H—MRS）和磁敏感成像技术（susceptibility weighted imaging,SWI）在弥漫性轴索损伤（diffuse axonal injury,DAI）的早期诊断治疗中的价值。方法选择2009年9月至2010年8月收治DAI患者24例,分别在伤后1周、1个月行^1H—MRS和SWI检查,再随机选择20例健康成年人作为对照组。比较各组胼胝体压部和基底节N一乙酰天冬氨酸（N—acetylaspartate,NAA）／肌酸和磷酸肌酸（creatine compound,Cr）、胆碱复合物（choline—containing compounds,Cho）／Cr、肌醇（mlNs）／Cr以及谷氨酸和谷氨酰胺（Glx）／Cr等指标的差异。观察T：序列对DAI组病例的检出率;SWI序列观察微出血像素数目及微出血灶检出数。结果与对照组相比,DAI伤后1周、1个月组胼胝体压部NAA／Cr、Cho／Cr、mlNs／Cr、GLx／Cr、基底节区NAA／Cr、Cho／Cr的差异有统计学意义。T2及SWI对轴索病灶的检测率明显提高。24例DAI患者均有微出血。SWI序列及T2序列在微出血像素数及微出血灶数比较差异有统计学意义。结论磁共振波谱技术可反映弥漫性轴索损伤不同时间段局部组织代谢变化,SWI则可检测到微小出血灶,两者结合可更早明确弥漫性轴素损伤的诊断。     

Effect of arousal methods for 175 cases of prolonged coma after severe traumatic brain injury and its related factors

ersistentcomaofover 1monthhasbeenconsideredprolongedcoma .1 3Theexactnumberofpersistentvegetativestatus (PVS)isnotclear ,however,about 10 %ofseveretraumaticbraininjuryhasbecometobePVSandevenhigherinheavyseveretraumaticbraininjuriesaccordingtoepidemiology .TwentythousandsofPVSintheUnitedStatesandovertwohundredthousandsofPVSinChinahavebeenestimated ,whichcauseshugetragedytopatients ,familyandthenations .1 3ArousalproceduresforPVShasnotbeenprovedbecauseoflackofrandomizedprospectivecontroll…     

Effect of arousal methods for 175 cases of prolonged coma and its factors after severe traumatic brain injury

Objective: To determine the effect methods for prolonged coma of 175 patients traumatic brain injury and related factors.of arousalwith severe Methods: There were 175 cases with persistent coma longer than 1 month after severe traumatic brain injury. Coma lasted 1-12 months. Arousal procedures included hyperbaric oxygen, physical therapy and arousal drugs. Results: In the 175 prolonged coma patients 110 got recovery of consciousness; in 118 cases with coma of 1-3 months, 86 cases recovered consciousness ( 72.9%) ; in 42 cases with coma of 4-6 months, 20 cases recovered consciousness (47.6) ; and in 15 cases with coma of longer than 6 months, only 4 cases recovered consciousness (26.7%). The recovery of consciousness depended on patient‘s primary brain stem damage, cerebral hernia, GCS score, and age. Conclusions: Application of appropriate arousal procedures improves recovery of consciousness in patients with prolonged coma.     

利用废弃指与股前外侧皮瓣串联急诊修复小儿手部鞭炮爆炸伤

目的 探讨小儿手部严重鞭炮炸伤急诊修复方法。方法 临床应用股前外侧皮瓣与废弃指串联急诊一期修复虎口和手部创面及再造拇指。结果 皮瓣及再造的拇指均顺利成活，经2年随访，手部外形及生长发育正常，再造拇指感觉均已恢复，两点辨别觉6mm-10mm，对掌对指功能良好。结论 在手部严重爆炸伤时应用股前外侧皮瓣与废弃指串联急诊一期修复虎口和手部创面及再造拇指，疗程短、疗效好。     

Maisonneuve骨折的临床诊治特点及15例手术疗效分析

目的 :探讨Maisonneuve骨折(maisonneuve fractures of the fibula,MFF)的诊断和治疗特点,并评估其手术治疗的临床疗效。方法:自2017年3月至2018年6月,采用手术治疗15例MFF患者,其中男9例,女6例;年龄27～54(35.00±7.46)岁;受伤至手术时间5～8(6.33±1.04) d。所有骨折为新鲜闭合性损伤。观察患者术后骨性愈合时间及术后并发症情况,并于术后12个月采用美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)评分评价患者术后踝关节功能恢复程度。结果:15例患者获得随访,时间12～28(17.00±3.79)个月。4例发生漏诊。所有骨折获得骨性愈合,时间4～6(4.80±0.94)个月。术后未出现切口感染、骨折延迟愈合或不愈合等并发症。术后12个月AOFAS评分为(90.23±7.27)分;其中优9例,良3例,可3例。结论:MFF是一类严重的不稳定的踝关节损伤类型,容易忽视腓骨高位骨折及下胫腓的分离而造成漏诊误诊,手术治疗可恢复下胫腓联合以及踝穴的...     

新型弥漫性轴索损伤动物模型的建立

了大鼠DAI模型,且具良好的稳定性和重复性.     

弥漫性脑肿胀临床分析(附46例报告)

目的　分析弥漫性脑肿胀 (DBS)的机理并探讨其诊断和治疗。方法　按Zimmerman的CT诊断标准对急诊 46例弥漫性脑肿胀 (DBS)患者临床资料进行研究 ,并对其诊断和鉴别诊断、治疗和预后进行分析。结果　DBS多发生于交通肇事 ,后即刻意识障碍 ,呈持续性昏迷 ,CT表现双侧大脑弥漫性肿胀 ,中线附近散在点状高密度灶。结论　DBS损伤机制与病理诊断的弥漫性轴索损伤 (DAI)是一致的 ,其致死、致残率高。     

上肢神经电损伤早期松解修复术后的临床疗效观察

目的:探讨上肢神经电损伤早期显微外科松解修复的临床疗效和肌电图评估结果。方法:自2013年4月至2019年12月,我们对8例肢体Ⅲ～Ⅳ度电击伤即上肢神经电损伤患者在伤后3个月内进行神经探查松解术。术前及术后2周、3个月行肌电图检查,术后6个月随访患肢感觉及运动功能恢复情况。结果:术后2周本组患者行肌电图检查,结果显示受...     

All roads lead to disconnection? – Traumatic axonal injury revisited

Summary Traumatic brain injury (TBI) evokes widespread/diffuse axonal injury (TAI) significantly contributing to its morbidity and mortality. While classic theories suggest that traumatically injured axons are mechanically torn at the moment of injury, studies in the last two decades have not supported this premise in the majority of injured axons. Rather, current thought considers TAI a progressive process evoked by the tensile forces of injury, gradually evolving from focal axonal alteration to ultimate disconnection. Recent observations have demonstrated that traumatically induced focal axolemmal permeability leads to local influx of Ca²⁺ with the subsequent activation of the cysteine proteases, calpain and caspase, that then play a pivotal role in the ensuing pathogenesis of TAI via proteolytic digestion of brain spectrin, a major constituent of the subaxolemmal cytoskeletal network, the “membrane skeleton”. In this pathological progression this local Ca²⁺ overloading with the activation of calpains also initiates mitochondrial injury that results in the release of cytochrome-c, with the activation of caspase. Both the activated calpain and caspases then participate in the degradation of the local axonal cytoskeleton causing local axonal failure and disconnection. In this review, we summarize contemporary thought on the pathogenesis of TAI, while discussing the potential diversity of pathological processes observed within various injured fiber types. The anterograde and retrograde consequences of TAI are also considered together with a discussion of various experimental therapeutic approaches capable of attenuating TAI.     

外伤性弥漫性脑萎缩的临床特征

目的探讨外伤性弥漫性脑萎缩的临床特征和形成机制。方法回顾性分析根据头部CT检查诊断的外伤性弥漫性脑萎缩18例,并和同期无脑萎缩的脑外伤病人100例进行比较。结果18例弥漫性脑萎缩病人的入院时GCS和脑萎缩发生时的GOS分别为6.3±2.9和3.39±0.70,明显低于对照组的10.5±3.4和4.67±0.59(P<0.01);手术治疗、去骨瓣减压、术后脑水肿的比率均明显高于对照组(P<0.01)。结论重度脑外伤可导致外伤性弥漫性脑萎缩,其发生机理可能为原发的神经元和轴突损伤以及继发的外伤后脑缺血性损害。