Anatomical features of cerebral contusion caused by occipital deceleration injury
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5=SimSun occipital deceleration injury caused by cerebral contusion of cerebral contusion Wang Qian Zhu Qingfeng Yang Ting Tian Yalei Cranial brain injury regardless of the foot injury or as part of the same body complex injury, its incidence has become higher and higher, from the injury mechanism Analysis, because of the spatial cushioning of the craniocerebral injury, the main cause of the injury is the hitting site, and its prognosis is relatively good. Craniocerebral deceleration is not the case, in addition to the direct damage of the force part, the hemorrhage can also appear more serious damage, which has a close relationship with the local anatomy, combined with clinical, 87 cases of occipital deceleration The following 1 clinical data 1.1 data of this group of 87 cases, 72 cases of the blade, 15 women, 10 years old, 8 months, 72 years old, an average of 36 years old; injury caused by training 58 cases of reconnaissance soldiers after the inverted training fall. There were 26 cases of car accident injuries, and the other 3 cases of 1.2 cases of clinical dysfunction disorders in 36 cases within 30 minutes within 21 minutes, 15 cases over 30 minutes, the most conscious disturbance was 2 weeks, 013, 135, 3 coma scores 38 points and 12 cases; 912 points 29 cases; 1315 points and 46 cases; 51 cases with occipital scalp hematoma, 46 cases of periorbital tissue skin downstream, 6 cases of cerebrospinal fluid rhinorrhea, 3 cases of rhinorrhea and single ear leak, 6 cases of unilateral ear leak, 2 cases of intracranial product There were 15 cases of traumatic subarachnoid hemorrhage, 28 cases of occipital bone fracture, 18 cases of occipital lobe contusion, 39 cases of frontal lobe injury, 8 cases of double frontal cerebral contusion, 31 cases of unilateral frontal contusion, 21 cases of psychiatric symptoms. Including apathy, excitement, proverbs, temper, temperament, strangeness, loss of scent in 3 cases, and urine stagnation in 2 cases. 1.3 treatment methods usually use comprehensive treatment to prevent infection and dehydration and reduction of intracranial pressure. Continuous lumbar puncture and drainage of traumatic subarachnoid hemorrhage with severe headache, hematoma evacuation in 9 cases with large hematoma and large cerebral edema and high intracranial pressure. The recovery period was treated with high helium oxygen chamber. .
2 Treatment results 2 cases continued to coma after injury, 1 case died of cerebral palsy in subdural hematoma of brain contusion; another case died of asphyxia, and the amount of occipital bone fracture of Dafan æ³¢ that affected the rock bone was confirmed by autopsy. Brain contusion. 3 Discussion The occipital deceleration injury is the more common type of craniocerebral injury, which accounts for about a small amount of craniocerebral injury. In addition to the occipital brain tissue damage caused by direct violence in the factory, the more major damage occurs in the amount. The underside of the leaf is also the heel of the injured part.
3.1 Injury mechanism The occipital deceleration of the occipital part of the occipital occipital part of the occipital part of the occipital part of the occipital part of the occipital body is still in a static state. The brain tissue that floats in the cranium still moves at the original speed. The part is displaced, so reciprocating until it is still. In this way, the cerebral palsy damage direction and the brain tissue in the opposite direction may be injured by repeated repeated impacts. 3.2 Applied anatomy The anterior cranial fossa has a bony bulge compared with the middle 5 cranial fossa, such as The sharp cockscomb bulge is obvious. The anterior bed sacral sphenoid ridge and the deep olfactory sulcus 2 frontal lobe 5 skull base structure have relatively few connected tissues, so the frontotemporal mobility is relatively large, 4 is more closely related. The olfactory nerve and the corpus callosum may be pulled and injured by a wide range of movements. The dura mater of the forehead is tightly bound at the site of the sieve plate. 4 The skull fracture occurs. Although the crack is extremely small, there are 4 cerebrospinal fluid nasal or intracranial hernias. In this group, there were 6 cases of simple rhinorrhea and 3 cases of ear nose leakage. Due to the overlapping of the anterior cranial fossa structure, it is difficult to see the signs of skull base fracture. It can only be inferred from cerebrospinal fluid leakage or intracranial gas accumulation. fracture.
3.3 Characteristics of occipital deceleration In the craniocerebral injury, the occipital part is often collided. The reason is that the human body has a protection against the upper limb defense when it falls down. When the brain injury is often compared with the forehead or lateral force When the sacral sacral deceleration occurred, 1 the local injury was lighter, and the rushed part was more sturdy. The original flash was after the corpse impact, and the brain was moving backwards. The 4 flat structures at the base of the cranial fossa, such as the anterior bed of the sacral sphenoid ridge, cause friction, forming a contusion and laceration of the cerebral cortex in the frontal part of the cerebral cortex. This local brain tissue displacement easily tears the blood vessels between the brain surface and the hard dislocation bridge. Subdural hematoma 3. Accompanied by brain shift 1 In the presence of a pituitary stalk traction caused by a urine collapse and loss of olfactory nerves due to rupture of the olfactory nerve 4, soft tissue damage can occur at the point of direct violent occipital Scalp hematoma or skull fracture, but the damage of the occipital lobe and cerebellum is not serious, because the occipital bone and the cerebellar surface are smoother, and the cerebellum is a membranous structure with a cushioning effect; The sinus has fewer bridge veins and thus This site also rarely occurred in 8 cases due to fracture of the bridge vein. If there is no occipital hematoma, the occipital point of the occipital part is like the side, then the contralateral part of the hemorrhoid is easily damaged, that is, the left occipital part is stressed, and the right frontal lobe may be injured. The ipsilateral hedging injury may occur but rarely . The closer the injured part is to the middle of the occiput, the greater the chance of bilateral injury. In this group, only 8 cases of double frontal lobe injury occurred, and the remaining 31 cases were unilateral frontal lobe injury.
The root cause of the forehead impact injury is the tissue structure of the frontal floor and the pathogenesis of occipital deceleration injury. Recognizing this point, in clinical diagnosis, consider the call; can only consider the local lesions of the focus point, should consider the corresponding The hedging damage of the part, especially the damage of the frontal surface of the frontal lobe, during the exploration, if the position of the hole is too high, it may cause the omission of the hematoma at the bottom of the brain.
1 Tu Tong today editor. Emergency neurosurgery. The first edition. Beijing People's Army Medical 12 Chinese People's Liberation Army General 1 owed to the hospital, the chief editor of the Military Medical University. Practical rushing surgery. The first edition. Beijing Warrior Press, 1978390393.
3 Lu Juduo, Wang Yonglin, Wu Jiaqing. The significance of the cerebral cortical bridge blood vessels. Anatomy and; 4 Shi Yuquan editor. Encyclopedia of Chinese Medicine. Neurosurgery. The first edition.
Shanghai Sea Science and Technology Press, 9843839.
Supporting laryngoscope in the treatment of laryngeal diseases Zhang Junguang 1 Bai Lijun = Our department has been on the laryngeal benign lesions since May 1997, such as papilloma vocal cord polyp keratosis, etc. Massectomy.
Get better efficacy, report as follows 1 Information and methods 1.1 Clinical data This group of 18 patients were examined by fiber laryngoscopy before surgery. Broadly understand the extent of the lesion. Preliminary estimates of the nature of the lesion. There were 2 males and 6 females, aged 3,068 years, with an average of 47.5 years; 12 cases of left ligament lesions, 10 cases of right ligament lesions, and 4 cases of bilateral vocal cord lesions. The course of the disease is months, years, and average months. Postoperatively, pathologically confirmed papilloma in 2 cases, larynx keratosis in 3 cases, and vocal cord polyps in 3 cases.
1.2 surgical methods using tracheal intubation combined with static anesthesia. The patient was lying flat, the mask was given oxygen for 5 minutes, and the anesthesia was induced. The succinylcholine was intravenously dripped to relax the muscles and then inserted into the instrument. The 8th tube was used and the trachea was intubated through the oral cavity. The tracheal intubation is located in the posterior part of the glottis, ie in the respiratory or vocal cord cartilage, without affecting the surgical procedure. After the general anesthesia is satisfied, the shoulder pad is high, the head is stretched back, the surgeon holds the laryngoscope left, enters the epiglottis before the anesthesia cannula, picks up the epiglottis, exposes the front of the glottis, and fixes the laryngoscope to the installed On the chest plate, tighten the screw and adjust the laryngoscope at any time. Do not make it too deep or too shallow. 1 to Lumen and the former commissure is completely exposed. For patients with short neck and thick, if the anterior commissure is not well exposed, the assistant gently presses the thyroid cartilage plate back, and the anterior commissure can be exposed. According to the difference in the lesion. The operator holds the suction tube to the left, the right hand, and the laryngoscope. Special knife and scissors, Xie and other equipment operations, completely remove the changes, to avoid damage to normal tissue. For patients with broad-based polyps and larynx keratosis, they can be cut with a knife along the edge of the vocal cords, and then clamped, and the laryngeal papilloma is removed with a thin knife. After the operation, the calf cavity was coated with 1 cain to prevent the throat, and the laryngoscope was removed. After the anesthesia was awake, the tracheal intubation was pulled out. Postoperative banned sound week, but should take more deep breathing to prevent anterior commissure adhesion; intravenous dexamethasone mg to prevent laryngeal edema.
2 results regularly followed by six months. Up to a month. Three patients with larynx keratosis returned to normal after surgery; 13 patients with vocal cord polyps improved their pronunciation after surgery, and the pronunciation returned to normal after half a month. During the follow-up of half a year, there was no recurrence; 1 patient with laryngeal papilloma returned to normal after operation; 1 patient with laryngeal papilloma had preoperative adhesion before the week, and the pronunciation was poor. The patient refused to undergo surgery again. , effective 94.4.
3 Discussion The support laryngoscope was applied to the clinic in the decade. In the mid-1990s, we began to summarize the treatment experience of 18 patients in this group. We believe that wood surgery is satisfactory for the treatment of broad-based meat of the vocal cord of the steep keratosis of the larynx, and that the disease is under indirect laryngoscopy. It is difficult to cure. The vision is not good, the disease is not well matched, and the laryngeal reflex is fast. The operator is in a hurry, and the patient who is injured in the normal tissue is more painful. Recovery, long period of time; tracheotomy before surgery, to postoperative care to bring a few cases of postoperative neck cut 1 scar effect Ge Guan, and surgery 6 pronunciation underpass.
Therefore, 18 cases of this group were excluded from the loyalty. In addition to a case of flash laryngeal papilloma involving bilateral vocal cords, the post-operative commissure adhesion was poor, and the remaining pronunciations returned to normal. Therefore, the lesions corresponding to the bilateral lesions should be operated in several stages, and the vocal cord adhesion can be avoided. We conclude that the technique has advantages and bright light. Clear vision.
Strong stereoscopic effect, using mechanical instead of human fixed laryngoscope. The operator can operate with both hands, the operation accuracy is high, the damage is small; the throat is opened, the pain of the patient is reduced, the cost is reduced, and the application can be combined with the microscope and the laser, and the glottic glottic type early throat malignancy is used. The lesions were completely removed.