23例头面部拳掌伤致脑干损伤致死病理学分析

Pathological changes in 23 cases died of brainstem injury caused by palm and fist attack on head

目的 观察头面部拳掌伤，及钝器打击伤致脑干损伤死的病理形态学特点，并探讨其成伤机理。方法 对23例拳击(A组)与30例钝器打击(B组)采用作者建立的脑干损伤取材方法，于脑干各颅神经根部作水平面切6块，HE染色光镜检查。结果 2组脑干损伤具有相同的病理形态学改变。A组水肿显著(71.6％)，B组以组织撕裂、挫碎为多(76.6％)；A组颅神经损伤多为单根(47.6％)，B组2根以上占53.7％，最多可达4根；A组单纯脑实质挫伤多(50％)，B组多伴发血肿或挫挤带。结论 拳、掌和钝器打击头面部致脑干损伤的病理形态学相同，但钝器打击比拳、掌致脑干损伤严重且广泛。提示脑干损伤致命与其受力部位、发病机理关系密切，而与受力强度关系不大。

Objective To observe the pathological changes of brain stem in sudden death caused by palm and fist attack or by blunt force attack on head. Methods Postmortem examination of 23 cases of fistattack (group A) and 30 cases of blunt force-attack (group B) sudden death were performed. Horizontal slices of the brain stem were taken at the root of cranial nerves, and tissue sections were stained by HE. Resuits 1. the pathological disorder type in group A is oedema and in group B, it is tear apart; 2, when the injury involved radices cranialis, single radices cranialis injury is predominant in group A, while in group B, multiple radices cranialis (2-4) injury is predominant; 3. brain contusion is simple in group A, and in group B brain contusion is mainly companied with hematoma. Conclusion The histological injury were more widely and severe in group B than in group A, which suggest that the fatal injury of brain stem is closely related to agressire site and pathological process, and is no obvious relationship with intension of attack.