Contemporary biomechanical theory of traumatic brain injury has its foundation in Holbourn’s thesis on shear strain and Ommaya’s primate experimentation demonstrating the role of rotation in a variety of lesions inc...Contemporary biomechanical theory of traumatic brain injury has its foundation in Holbourn’s thesis on shear strain and Ommaya’s primate experimentation demonstrating the role of rotation in a variety of lesions including subdural hematoma(SDH)and diffuse axonal injury.Empirical human observations have since confirmed,for the most part,the early concepts.Ethical concerns regarding primate research,however,have prompted in vitro models,which in turn has led to challenges with respect to the correlation between in vitro observations and the clinical data.Despite these challenges,medicolegal proceedings may call upon biomechanical engineers to reconstruct complex injury scenarios and offer opinions on the scientific plausibility of clinical disease states,such as SDH,hemorrhagic retinopathy,and cerebral edema,associated with hypothetical or proffered action sequences during the course of an unwitnessed homicide.It is important to note,however,that in vitro models by their nature are low‑evidence quality studies that attempt to advance hypotheses but do not address cause and effect.As a whole,biomechanical models,as they pertain specifically to the brain and spine,are mathematically imprecise.Often,endpoints of limited relevance are relied upon(e.g.,skull fracture thresholds),which predictably overestimate the in vivo risk of significant injury.Given the increasing role of biomechanical engineering in the interpretation of fatal pediatric head trauma,a heightened awareness of the limitations warranted.展开更多
目的分析影响外伤性重型颅脑损伤并发迟发性颅内血肿患者预后的相关因素,为改善患者预后提供参考依据。方法回顾性分析本院2013年7月至2016年7月收治的161例外伤性重型颅脑损伤并发迟发性颅内血肿患者的临床资料,按照预后质量,将恢复良...目的分析影响外伤性重型颅脑损伤并发迟发性颅内血肿患者预后的相关因素,为改善患者预后提供参考依据。方法回顾性分析本院2013年7月至2016年7月收治的161例外伤性重型颅脑损伤并发迟发性颅内血肿患者的临床资料,按照预后质量,将恢复良好/中度残疾者纳入预后良好组,将重度残疾/植物生存/死亡者纳入预后不良组,计算患者预后不良率并比较两组患者基线资料,将存在统计学差异的因素纳入多因素Logistic回归分析,分析影响外伤性重型颅脑损伤并发迟发性颅内血肿患者预后的危险因素。结果 161例患者中,47例预后不良(29.19%)。多因素Logistic回归分析显示,年龄≥60岁、减速伤、有合并伤、有并发症、多发性血肿、外伤性重型颅脑损伤发病后格拉斯哥昏迷评分(Glasgow coma score,GCS)≥13分、迟发性颅内血肿发病后GCS≥13分及迟发性颅内血肿出血量>60 ml是影响外伤性重型颅脑损伤并发迟发性颅内血肿患者预后的独立危险因素(P<0.05)。结论年龄、颅脑损伤严重程度、受伤性质及血肿类型均可影响外伤性重型颅脑损伤并发迟发性颅内血肿患者的预后,明确患者病情程度并注重并发症的处理,对降低患者病死率和病残率具有重要意义。展开更多
文摘Contemporary biomechanical theory of traumatic brain injury has its foundation in Holbourn’s thesis on shear strain and Ommaya’s primate experimentation demonstrating the role of rotation in a variety of lesions including subdural hematoma(SDH)and diffuse axonal injury.Empirical human observations have since confirmed,for the most part,the early concepts.Ethical concerns regarding primate research,however,have prompted in vitro models,which in turn has led to challenges with respect to the correlation between in vitro observations and the clinical data.Despite these challenges,medicolegal proceedings may call upon biomechanical engineers to reconstruct complex injury scenarios and offer opinions on the scientific plausibility of clinical disease states,such as SDH,hemorrhagic retinopathy,and cerebral edema,associated with hypothetical or proffered action sequences during the course of an unwitnessed homicide.It is important to note,however,that in vitro models by their nature are low‑evidence quality studies that attempt to advance hypotheses but do not address cause and effect.As a whole,biomechanical models,as they pertain specifically to the brain and spine,are mathematically imprecise.Often,endpoints of limited relevance are relied upon(e.g.,skull fracture thresholds),which predictably overestimate the in vivo risk of significant injury.Given the increasing role of biomechanical engineering in the interpretation of fatal pediatric head trauma,a heightened awareness of the limitations warranted.
文摘目的分析影响外伤性重型颅脑损伤并发迟发性颅内血肿患者预后的相关因素,为改善患者预后提供参考依据。方法回顾性分析本院2013年7月至2016年7月收治的161例外伤性重型颅脑损伤并发迟发性颅内血肿患者的临床资料,按照预后质量,将恢复良好/中度残疾者纳入预后良好组,将重度残疾/植物生存/死亡者纳入预后不良组,计算患者预后不良率并比较两组患者基线资料,将存在统计学差异的因素纳入多因素Logistic回归分析,分析影响外伤性重型颅脑损伤并发迟发性颅内血肿患者预后的危险因素。结果 161例患者中,47例预后不良(29.19%)。多因素Logistic回归分析显示,年龄≥60岁、减速伤、有合并伤、有并发症、多发性血肿、外伤性重型颅脑损伤发病后格拉斯哥昏迷评分(Glasgow coma score,GCS)≥13分、迟发性颅内血肿发病后GCS≥13分及迟发性颅内血肿出血量>60 ml是影响外伤性重型颅脑损伤并发迟发性颅内血肿患者预后的独立危险因素(P<0.05)。结论年龄、颅脑损伤严重程度、受伤性质及血肿类型均可影响外伤性重型颅脑损伤并发迟发性颅内血肿患者的预后,明确患者病情程度并注重并发症的处理,对降低患者病死率和病残率具有重要意义。
