颅脑外伤颅脑外伤TraumaticBrainInjury张明铭中南大学湘雅二院神经外科DefinitionTraumaticBrainInjury:(外伤性脑损伤)Anyexternalphysicalforcetraumaticallyinjuredthescalp,skull,orbraintissueIncidenceofTBITraumacanbeclassifiedbytheaffectedareaofthebody(percentagesoftotalincidence):Polytrauma(40%)(多发伤)Headinjury(30%)Chesttrauma(20%)(胸部外伤)Abdominaltrauma(10%)(腹部外伤)Extremitytrauma(2%)(四肢伤)severeheadinjuryDisabilityrate↑(致残率)Fatalityrate↑(致死率)AnatomyandphysiologyreviewClassificationsofTBIScalpinjuryScalpinjury(头皮损伤)(头皮损伤)SkullfractureSkullfracture(颅骨骨折)(颅骨骨折)BraininjuryBraininjury(脑损伤)(脑损伤)头皮损伤头皮损伤头皮血肿头皮血肿头皮裂伤头皮裂伤头皮撕脱伤头皮撕脱伤颅骨骨折颅骨骨折颅盖骨折颅盖骨折颅底骨折颅底骨折脑损伤脑损伤原发性脑损伤原发性脑损伤继发性脑损伤继发性脑损伤原发性脑损伤脑震荡皮层挫伤原发性脑干损伤弥漫性轴索损伤骨折撕裂伤原发性脑外伤无法人为干预脑血肿脑水肿脑缺血血管痉挛导致的损伤继发性脑损伤TypeofScalpInjuryScalplacerationScalphematomaScalpavulsion头皮血肿血肿类型血肿类型血肿位置血肿位置血肿质地血肿质地血肿范围血肿范围致伤原因致伤原因皮下血肿皮下血肿皮下皮下较硬,波较硬,波动不明显动不明显局限在头局限在头皮挫伤中皮挫伤中心心局部挫伤、局部挫伤、擦伤擦伤帽状腱膜帽状腱膜下血肿下血肿帽状腱膜帽状腱膜下层下层较软,有较软,有明显波动明显波动感感可蔓延至可蔓延至全头全头儿童,牵儿童,牵拉头发后拉头发后骨膜下血骨膜下血肿肿骨膜与颅骨膜与颅骨之间骨之间张力大,张力大,有波动感有波动感血肿边缘血肿边缘不超过颅不超过颅缝缝多见于产多见于产伤致颅骨伤致颅骨受损受损头皮撕脱伤的处理处理原则:压迫止血、止痛、防治休克、清创、抗感染。手术方法:1.头皮瓣复位再植2.清创后自体植皮3.晚期创面植皮TypeofSkullFractureTypeofSkullFractureLinearfractureLinearfracture(线性骨折)(线性骨折)DepressedfractureDepressedfracture(凹陷性骨折)(凹陷性骨折)FractureofskullvaultFractureofskullvault(颅骨骨折)(颅骨骨折)FractureofskullbaseFractureofskullbase(颅底骨折)(颅底骨折)ClosedfractureClosedfracture(闭合性骨折)(闭合性骨...