ObjectiveTo explore the value of maxillofacial osseous reconstruction in one-stage operation combined with craniotomy for moderate craniocerebral injury. MethodsA retrospective study was conducted by analyzing the clinical and radiographic results of 13 patients treated between January 2008 and February 2015. Among them, 7 patients admitted into the hospital between January 2008 and December 2009 were regarded as the control group. Among the 7 patients, 5 were males and 2 were females, aged between 22 and 66 years old, averaging (44.3±15.9) years old. The patients of the control group underwent craniotomy within 24 hours after admission, and accepted the second stage operation for maxillofacial reconstruction 3 to 5 weeks later. The other 6 patients including 4 males and 2 females aged between 27 and 57 years old, averaging (40.2±10.7) years old, admitted into the hospital between January 2010 and February 2015 were designated into the observation group. They underwent maxillofacial osseous reconstruction in one-stage operation combined with craniotomy within 24 hours after admission. The treatment effect, leakage of cerebrospinal fluid, intracranial infection and average length of stay were analyzed and compared. ResultsIn the control group, there were 5 cases of cerebrospinal rhinorrhea preoperatively, and all were cured after craniotomy. During the second stage operation for maxillofacial reconstruction, bone callus and scar tissue presented in all cases and poor reconstruction occurred to 3 cases. After reconstruction, cerebrospinal rhinorrhea recurred in 2 cases. The average length of stay was (43.4±4.5) days. For the observation group there were 3 cases of cerebrospinal rhinorrhea preoperatively, and one of them remained after the operation and cured 7 days later. The average length of stay was (22.7±2.7) days. None of the 13 patients suffered intracranial infection. ConclusionMaxillofacial osseous reconstruction should be considered in one-stage operation combined with craniotomy for moderate craniocerebral injury
ObjectiveTo investigate the mechanism of Semaphorin 3A (Sema3A) in fracture healing after nerve injury by observing the expression of Sema3A in the tibia fracture healing after traumatic brain injury (TBI). MethodsA total of 192 Wistar female rats, 8-10 weeks old and weighing 220-250 g, were randomly divided into tibia fracture group (group A, n=48), TBI group (group B, n=48), TBI with tibia fracture group (group C, n=48), and control group (group D, n=48). The tibia fracture model was established at the right side of group A; TBI model was made in group B by the improved Feeney method; the TBI and tibia fracture model was made in group C; no treatment was given in group D. The tissue samples were respectively collected at 3, 5, 7, 14, 21, and 28 days after operation; HE staining, immunohistochemistry staining, and Western blot method were used for the location and quantitative detection of Sema3A in callus tissue. ResultsHE staining showed that no obvious changes were observed at each time point in groups B and D. At 3 and 5 days, there was no obvious callus growth at fracture site with inflammatory cells and fibrous tissue filling in groups A and C. At 7 and 14 days, fibrous tissue grew from periosteum to fracture site in groups A and C; the proliferation of chondrocytes in exterior periosteum gradually formed osteoid callus at fracture site in groups A and C. The chondrocyte had bigger size, looser arrangement, and more osteoid in group C than group A. Group B had disorder periosteum, slight subperiosteal bone hyperplasia, and no obvious change of bone trabecula in group B when compared with group D. At 21 and 28 days, cartilage callus was gradually replaced by new bone trabecula in groups A and C. Group C had loose arrange, disorder structure, and low density of bone trabecula, big callus area and few chondrocyte and osteoid when compared with group A; group B was similar to Group D. Immunohistochemistry staining showed that Sema3A expression in chondrocytes in group C was higher than that in group A, particularly at 7, 14, and 21 day. Sema3A was significantly higher in osteoblasts of new bone trabecula in group A than group C, especially at 14 and 21 days (P<0.05). Western blot results showed that the Sema3A had the same expression trend during fracture healing in groups A and C. However, the expression of Sema3A protein was significantly higher in group C than group A (P<0.05) and in group B than group D (P<0.05) at 7, 14, 21, and 28 days. ConclusionAbnormal expression of Sema3A may play a role in fracture healing after nerve injury by promoting the chondrocytes proliferation and reducing the distribution of sensory nerve fibers and osteoblast differentiation.
Objective To analyze the influencing factors of prognosis of patients with traumatic brain injury (TBI), and explore the influence of hemoglobin (Hb) level combined with blood pressure variability (BPV) on the quality of prognosis of patients with TBI. Methods The data of 186 TBI patients who received systemic treatment in the Affiliated Zhangjiagang Hospital of Soochow University between January 2020 and December 2021 were retrospectively analyzed. According to the Glasgow Outcome Scale (GOS) 3 months after treatment, they were divided into group A (GOS 4-5, 159 cases) and group B (GOS 1-3, 27 cases). The general clinical data, BPV indexes and Hb levels of the two groups were analyzed by single factor analysis and multiple logistic regression analysis, and the predictive value of the logistic regression model was evaluated by receiver operating characteristic (ROC) curve, sensitivity, specificity and area under the curve (AUC). Results There was no statistical significance in gender, age, body mass index, blood urea nitrogen, prothrombin time, fasting blood glucose level, or smoking history (P>0.05); the patients’ Glasgow Coma Scale at admission in group A was higher than that in group B (P<0.05), and the constituent ratio with a history of hypertension of group A was significantly lower than that of group B (P<0.05). The between-group differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and Hb at admission, and SBP, DBP, and MAP 72 h after treatment were not statistically significant (P>0.05); the SBP-standard deviation (SD), DBP-SD, SPB-coefficient of variation (CV) and DBP-CV of group B 72 h after treatment were significantly higher than those of group A (P<0.05), and the level of Hb was significantly lower than that of group A (P<0.05). Hb [odds ratio (OR)=0.787, 95% confidence interval (CI) (0.633, 0.978), P=0.031], SBP-CV [OR=1.756, 95%CI (1.073, 2.880), P=0.023] and DBP-CV [OR=1.717, 95%CI (1.107, 2.665), P=0.016] were all independent prognostic factors of TBI patients. The ROC showed that the combined index of BPV and Hb was more valuable than that of single prediction, with an AUC of 0.896 [95%CI (0.825, 0.935), P<0.05]. Conclusions Both BPV and Hb are independent factors affecting the prognosis of TBI patients, and their combined application can more effectively predict the prognosis of TBI patients. Therefore, when treating and evaluating the prognosis of TBI patients, closely monitoring the changes in blood pressure and Hb levels can timely and effectively control the development of the disease, and provide scientific reference for subsequent treatment.
【摘要】 目的 探讨颅脑损伤(BI)死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法 从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月-2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例(402%),继发性脑干损伤死亡61例(480%),并发症死亡15例(118%),其中伤后12 h内死亡者直接死因均为严重原发性脑损伤,存活12 h～1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论 在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.
ObjectiveTo investigate the effects of large trauma craniotomy on severe traumatic brain injury. MethodsA total of 132 cases of severe traumatic brain injury adopted large trauma craniotomy between July 2008 and August 2013, and the clinical data were retrospectively analyzed. ResultsAccording to the results of GOS assessment at discharge, 67 patients (50.75%) were satisfied, 26 (19.70%) were mildly disable, 10 (7.58%) were severely disable, 12 (9.09%) were in vegetative state, and 17 (12.88%) were dead. ConclusionCorrect use of large trauma craniotomy on severe brain injury cases will help to improve the treatment outcome, reduce complications and improve quality of survival.
ObjectiveTo investigate the value of adaptive support ventilation (ASV) plus lung recruitment maneuvers (LRM) for patients with traumatic brain injuries combined with ARDS. MethodsThirty trauatic brain injuried patients combined with ARDS including 18 males and 12 females at age of 15-76 years were mechanically ventilated by SIMV+PSV or ASV+LRM.The patient was initially ventilated with SIMV for 8 hours,with tidal volume(VT)of 8 mL/kg,PEEP=0,oxygen inhalation concentration of 60%.Then,one of ASV+LRM and SIMV modes was randomly selected for continual ventilation.The positive end-expiratory pressure were set at three levels (PEEP 0,5 and 10 cm H2O).Each level of PEEP was maintained for 60 minutes.During the use of ASV+LRM,pressure controlled ventilation (PCV) was at 40 cm H2O and breath holding continued for 30 seconds.Then,the mode was turned to ASV.Respiratory mechanics,hemodynamics,blood gas,oxygen delivery,intracranial pressure and other indicators were measured when each level of PEEP was ventilated for 50 minutes. ResultsCompared with SIMV mode in the same level of PEEP,ASV+LRM mode had lower peak inflating pressure (PIP),airway plate pressure(Pplat) and intrapulmonary shunt(Qs/Qt),central venous pressure(CVP),intracranial pressure(ICP),but higher oxygenation index (PaO2/FiO2) and partial pressure of oxygen (PaO2)(all P<0.05).There was no statistical difference in MAP between two modes (P>0.05). ConclusionASV+LRM mode is better than SIMV in ventilation for traumatic brain injuried patients combined with ARDS.
Objective To compare the incidence of social function disorders in head injury patients with and without craniocerebral injury and to explore the value for mental identification. Methods SDSS (Social Disability Screening Schedule), GAF (Global Assessment Function) and GAS (Global Assessment Scale) instruments were used to test the social function of 56 patients without craniocerebral injury and 55 patients with craniocerebral injury. Results One hundred and eleven patients with head injury were included and identified as head injury with or without craniocerebral injury by CT or MRI. The incidence of social function deficit, tested by using SDSS instrument, was 33.9% (19/56) in patients without craniocerebral injury and 45.5% (25/55) in patients with craniocerebral injury respectively. There was no statistically significant difference between the two groups (χ2=1.544, P=0.214). This was also no statitical difference in both GAS group (t=0.021, P=0.983) and GAF group (t=0.391, P=0.697). Conclusions The limited evidence showed that the incidence of social function deficit of the head injury patients combined with craniocerebral injury is higher than those who without craniocerebral injury, but the difference between the two groups has no statistically significant difference.We could not detect a difference in the incidence of social deficit between those head injury patients with or without craniocerebral injury ones.
In recent years, although the mortality rate caused by traumatic brain injury has declined, the disability rate has remained high, which has a serious impact on patients and their families. Therefore, solving the complications and sequelae caused by traumatic brain injury is the focus and difficulty of current clinical research. Integration of traditional and western medicine rehabilitation is an effective method for the treatment of the central nervous system at home and abroad, and it also fully reflects its therapeutic advantages in the application of traumatic brain injury. Based on this, this paper will mainly introduce the clinical characteristics of patients with traumatic brain injury, and systematically expound the commonly used clinical rehabilitation treatment methods of integration of traditional and western medicine, aiming to provide a certain guidance for the rehabilitation treatment of traumatic brain injury.