Gurdjian E S
Surg Gynecol Obstet. 1975 Jun;140(6):845-50.
With blunt impacts, there may be bruising or tearing of scalp, elastic deformation of the skull with or without linear fracture, mass motions or relative movements of the brain mass--inertial stress propagation--as well as pressure gradients. Mass motions of the brain may cause concussion, vascular tears with extravasation and contusions of the cerebral surface as well as lesions in the deeper portions of the cerebral mass. Coup contusion is caused by the inbending bone at the impact site striking the immobile head. Contrecoup contusiions result from injury to the brain surface in the frontotemporal area as the moving brain impacts the rough and irregular bony interior. In the experimental laboratory, a contusion is easily produced by a moving object striking the relatively immobile head. During impact if the head is on a solid stand, such as the metal table, a contrecoup lesion is seen at the opposite end from the impact site. This contrecoup lesion is produced by the brain impacting the skull, as well as the flattening of the skull against the brain at the antipole, from the presence of the solid table. Intermediate contusions develop between the impact site and the antipole in the brain interior as a result of inertial stress propagation.
钝器撞击时，可能会出现头皮瘀伤或撕裂、颅骨弹性变形（伴有或不伴有线性骨折）、脑块的质量运动或相对运动——惯性应力传播——以及压力梯度。脑块的质量运动可能导致脑震荡、血管撕裂伴外渗和脑表面挫伤以及脑块深部的损伤。冲击伤是由撞击部位的内弯骨撞击固定的头部所致。对冲伤是由于移动的大脑撞击粗糙不规则的颅骨内部，导致额颞区脑表面受伤。在实验室内，一个移动的物体撞击相对固定的头部很容易造成挫伤。撞击过程中，如果头部放在坚实的支撑物上，如金属桌上，在撞击部位的另一端会出现对冲性损伤。这种对冲性损伤是由大脑撞击颅骨以及由于坚实桌子的存在，颅骨在对侧极处压向大脑所致。由于惯性应力传播，在脑内部的撞击部位和对侧极之间会出现中间性挫伤。
