Objective To explore the number variation trend of inpatients with traumatic brain injury (TBI) in high altitude and plain areas. Methods The first page information in medical records of TBI patients, who were admitted to military hospitals from 2001 to 2007, was searched and extracted from the Chinese Trauma Database. Two military hospitals in high altitude area and another two in the same hospital level in plain area were selected. Then, the number variation trend of TBI inpatients in those two areas was compared. Results In high altitude area, the proportion of male patients and their median inpatient days were higher, while the age, proportion of Han patients and surgery rate were lower than those in plain area (all Plt;0.001). During 2001-2007, there were 9 141 TBI patients discharged from the four hospitals, and the average annual growth rate was 13.15%. In high altitude area, the average annual growth rate of discharged inpatients was 24.00%, while in plain area, it was just 7.09%. The 4 common categories of TBI were intracranial injury, open wound of the head, neck and trunk, skull fracture, and other injuries. Conclusion Compared with the plain area, there are significant differences in the demographics, hospital stay and surgery of inpatients in high altitude area. The average annual growth rate of TBI inpatients discharged from hospitals in high altitude area is faster than that in plain area, to which should be paid attention by relevant departments.
摘要:目的:探讨5·12汶川8.0级地震中颅面部外伤的影像学表现特点。方法: 回顾性分析自2008年5月12~31日因地震颅面部外伤在我院行CT、MRI检查的伤员251例,其中CT检查248例,MRI检查16例。结果:放射检查阳性162例,阳性率为64.54%,以40～49岁年龄组最多,为53例,其中男性41例。在放射检查阳性中,多发伤112例(约69.13%),多类型颅面部外伤同时并存103例(约63.58%)。主要损伤发生率依次为软组织损伤(35.50%),骨折(22.94%),脑挫裂伤(21.21%),硬膜下及硬膜外血肿(10.40%),其它(共约9.92%)。结论: 地震造成颅面部外伤人群主要为40～49岁中年男性,多发伤、多类型颅面部外伤多见,并以软组织损伤、骨折、脑挫裂伤、硬膜下及硬膜外血肿较常见。Abstract: Objective: To describe the imaging features of head and face injured patients after the Wenchuan earthquake. Methods: The radiological information of 251 victims who were suspicious of head and face injury and underwent CT or MRI examinations from 12 May to 31 May 2008 was analysed retrospectively. There were 248 and 16 cases underwent CT or MRI examinations respectively. Results: One hundred and sixtytwo cases(64.54% )were positive. There were 53 cases in the 4049 years old age group, of which 41 were male. In patients with positive findings, 112 cases (about 63.58%) were comprised of several types of head and face injury. The incidence of the main injury type included: soft tissue injury (35.50%), fracture (22.94%), cerebral contusion (21.21%), subdural and epidural hematoma (12.40%), others (9.92%). Conclusions: The males with head and face injury in 4049 years old group were the major injured people in this earthquake. Head and face injury accompanied by multiple system injuries, the existence of several types of head and face injury at the same time were common. Among all the injury types, soft tissue injury, fracture, contusion, subdural and epidural hematoma were relatively commom.
Objective To investigate the changes in the expression level of PDGF in the bone callus of rats with femoral fracture and brain injury to explore the effect of brain injury on the fracture heal ing and the related mechanism. Methods Sixty-four 12-week-old SD rats weighing (356 ± 25) g were randomly divided into 8 groups with 8 rats in each. The rats in groups A1, B1, C1 and D1 had a femoral fracture and a brain injury for 1, 2, 3 and 4 weeks, respectively; the rats in groups A2, B2, C2 and D2 had a mere fracture without a brain injury for 1, 2, 3 and 4 weeks, respectively. After the CR films were taken, the bone callus was obtained 1, 2, 3 and 4 weeks after operation, respectively. Then, the bone callus and its histology were examined by HE staining, the expressions and changes in the level of PDGF were examined by the immunohistochemical staining, and the level of PDGF mRNA was measured by in situ hybridization. Results The CR films showed that the callus formation in the A1-D1 groups was earl ier and greater than that in the A2-D2 groups at the same time point. The HE staining indicated that more fibroblasts and early-stage chondrocytes were found in group A1; some fibroblasts in the fracture interspace and few early-stage chondrocytes were found in group A2; some newly-formed trabecular bones were found at the end of the fracture in group B1; but no trabecular bone formation was found in group B2; woven bone formation and a few chondrocytes between trabecular bones in the fracture interspace were found in group C1; only a few trabecular bones in the fracture interspace were found in group C2；woven bones turned to lamellar bones in group D1；and more immature trabecular bones in the fracture interspace were found in group D2. The positive expression of PDGF and PDGF mRNA was b in the cytoplasms of fibroblasts, mesenchymal cells, vascular endothel ial cells, early-stage chondrocytes, osteoblasts and osteoclasts. The percentage of the positive cells for PDGF and PDGF mRNA in the callus was significantly higher in groups A1-D1 than in groups A2-D2 at the same time point (P lt; 0.05). Conclusion Brain injury can promote the fracture heal ing process, which is probably related to an increase in the expression level of PDGF after the brain injury.
Objective To investigate the changes in the expression level of bone morphogenetic protein 2 (BMP2) in the bone callus of rats with femoral fracture and brain injury to explore the effect of the brain injury on the fracture healing and to explore the related mechanism. Methods Thirty-two 12 week old SD rats weighing 368±25 g were randomly divided into 4 groups of 8 rats in each. The rats in Group A had a femoral fracture and a brain injury for 1 week; the rats in Group B had a femoral fracture but without brain injury for 1 week; the rats in Group C had a fracture and a brain injury for 2 weeks; and the rats in Group D had a fracture but without brain injury for 2 weeks. Thus, Groups A and C were used as the femoral fracture and brain injury models, and Groups B and D as the pure femoral fracture models for the controlled study. After the X-ray films were taken, the bone callus was obtained 1 week and 2 weeks after operation, respectively. Then, the bone callus growth and its histology were examined with theHE staining, the expression and changes in the level of BMP-2 were examined with the immunohistochemical staining, and the level of BMP-2 mRNA was measured with the RT-PCR. Results The X-ray films showed that less bone callus formation was found in Group A, and the fracture line in Group B was clearer than that in Group A. There was a greater amount of callus in Group C, and the fracture line was blurred. Only a little bone callus formation was found in Group D. The HE staining indicated that more fibroblasts and early-stage chondrocytes were found in Group A; some fibroblasts in the fracture interspace and fewer early-stage chondrocytes in Group B; some newly-formed trabecular bone at the end of the fracture in Group C; but no trabecular bone formation in Group D. The immunohistochemical staining indicated that the positive expression of BMP2 was b in the cytoplasms of the fibroblasts, the mesenchymal cells, the vascular endothelial cells, the early-stage chondrocytes, and the osteoblasts. The number of the positive cells was greater in Group A than in Group B, with a higher color intensity. The number of the positive cells was greater in Group C than in Group D, with a higher color intensity. The percentages of the cells positive for BMP-2 in the callus were greater in Groups A and C (0.762%±0.052%，0.756%±0.079%)than in Groups B and D (0.702%±0.052%，0.672%±0.044%) at the same time point, ith a statistically significant difference (Plt;0.05). The RT-PCR analysis showed that the expression of BMP-2 mRNA in the callus in Groups A-D was decreased in sequence. There was a significantly higher level of the expression in Groups A and C(1.07±0.13，0.78±0.11) than in Groups B and D(0.91±0.12，0.61±0.08) at the same time point (Plt;0.05). Conclusion The brain injury can promote the fracture healing process, which is probably related to an increase in the expression level of BMP-2 after the brain injury.
目的 探讨二级医院神经内外科整合的可行性及优越性，观察组织化医疗模式的临床效果。 方法 将神经内、外科整合为一个一级临床科室——脑系科，建立完善的多学科一体化治疗的组织化医疗网络体系。入选重型颅脑外伤和脑出血患者共289例，其中2004年8月-2008年12月在脑系科住院的重型颅脑外伤、脑出血患者共147例接受组织化医疗模式治疗，作为治疗组；2001年1月-2004年8月分散在我院内科、外科住院的重型颅脑外伤、脑出血患者共142例接受传统常规治疗，作为对照组。比较观察两组患者的治疗效果。 结果 治疗组神经功能缺损评分、日常生活活动能力评分和GCS分别为7.47±5.24、59.74±15.56和13.72±1.06；对照组分别为16.18±9.89、34.00±10.54和10.84±1.58。两组比较，差异有统计学意义(Plt;0.05)。治疗组与对照组比较，临床治愈率提高55.64%，平均住院日缩短10.34 d，病死率降低21.26%，并发症降低20.15%，致残率降低20.24%。 结论 采用组织化医疗模式能明显改善患者预后，缩短住院时间，提高患者的生活质量，是适合我国基层医院神经内、外科危急重症的治疗模式，具有其可行性及优越性。
目的：研究外伤性脑梗死患者血小板P选择素动态变化的临床意义。方法：用流式细胞仪测定42例外伤性脑梗死患者，50例无脑梗死外伤患者及40例正常对照者外周血血小板P选择素。结果：急性期(1周内)外伤性脑梗死患者P选择素明显高于无梗死脑外伤患者和健康对照组(Plt;0.01)。14 d时，外伤性脑梗死患者血小板P选择素表达，与无梗死脑外伤患者和健康对照组无显著差异(Pgt;0.005)。结论：P选择素参与外伤性脑梗死的病理过程，测定它们有利于外伤性脑梗死的早期诊治，改善预后。
目的：分析地震灾害中颅脑外伤合并眼伤的临床特点和诊治难点，为制定合理的对策提供参考。方法：统计分析2008年5月12日汶川地震中绵阳地区颅脑外伤合并眼伤96例的疾病资料，以及早期处理方案和效果。结果：颅脑外伤合并的眼伤中钝挫伤比例高(99.5%)，昏迷患者容易忽视眼部损伤。结论：在生命抢救后的功能抢救阶段及时检查眼部情况有利于早期发现和挽救视功能；根据灾情整合眼科医疗资源，利用原有团队建制，有利于提高医院对大规模灾情的紧急应对效率。