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颅脑外伤Traumatic Brain InjuryDefinition Traumatic Brain Injury: ( 外伤性脑损伤) Any external physical force traumatically injured the scalp, skull, or brain tissue Incidence of TBI Trauma can be classified by the affected area of the body (percentages of total incidence):Polytrauma (40%) ( 多发伤)Head injury (30%) Chest trauma (20%) （胸部外伤）Abdominal trauma (10%) （腹部外伤）Extremity trauma (2%) （四肢伤）severe head injuryDisability rate↑（致残率）Fatality rate ↑（致死率）Anatomy and physiology reviewClassifications of TBI Scalp injury （头皮损伤）Skull fracture （颅骨骨折）Brain injury （脑损伤） 头皮损伤头皮血肿头皮裂伤头皮撕脱伤颅骨骨折颅盖骨折颅底骨折脑 损 伤原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Type of Scalp InjuryScalp lacerationScalp hematomaScalp avulsion头皮血肿血肿类型血肿位置血肿质地血肿范围致伤原因皮下血肿皮下较硬，波动不明显局限在头皮挫伤中心局部挫伤、擦伤帽状腱膜下血肿帽状腱膜下层较软，有明显波动感可蔓延至全头儿童，牵拉头发后骨膜下血肿骨膜与颅骨之间张力大，有波动感血肿边缘不超过颅缝多见于产伤致颅骨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Type of Skull FractureLinear fracture （线性骨折）Depressed fracture （凹陷性骨折）Fracture of skull vault （颅骨骨折）Fracture of skull base （颅底骨折）Closed fracture （闭合性骨折）Open fracture ( 开放性骨折)线形骨折凹陷性骨折凹陷性骨折的手术治疗1 、开放性骨折（绝大部分尽早手术）2 、闭合（单纯）凹陷性骨折手术目的：皮肤边缘清创；复位骨片；修补硬膜撕裂；脑组织清创和恢复功能；颅骨重建；颅底骨折1 、多数颅底骨折是颅盖线性骨折的延续；2 、严重的颅底骨折可能导致假性动脉瘤；Fracture of Skull BaseLocationEcchymosis spotCSF leaks fromCranial nerve involvedAnterior cranial fo...