Hein P M, Schulz E
Institute for Forensic Medicine, University of Würzburg, Federal Republic of Germany.
Acta Neurochir (Wien). 1990;105(1-2):24-9. doi: 10.1007/BF01664853.
Contrecoup fractures of the base of the skull are regarded as rare in the clinical literature. In our material (n = 171 falls on the same level and on or from stairs), the overall frequency of contrecoup fractures of the anterior cranial fossa in fatal cranio-cerebral trauma due to falls was 12%, as compared to 24% with occipital point of impact of the head. The relationships between the impact site on the head, form of fracture at the point of impact with involvement of the skull cap and/or the base of the skull, coup and contrecoup injuries of the brain, localization of contrecoup fractures in the anterior cranial fossa and the occurrence of monocle and spectacle haematomas display a major variability. Fractures occur in the form of simple fractures and as impression fractures (fracture fragments or fracture boundaries displaced to the inside). Clinical diagnosis is difficult because of the concealed position of the anterior skull base. Contrecoup fractures become of forensic medical significance when symptoms of a frontobasal injury occur for the first time after trauma which has occurred some time in the past and when the question arises as to the causal connection with the original trauma. In investigation of living persons, it may be difficult to decide whether haemorrhages in the region of the orbit and its vicinity result from a direct blunt force or derive from fractures of the base of the skull, especially contrecoup fractures.
颅骨底部的对冲性骨折在临床文献中被认为较为罕见。在我们的资料中（171例同一水平以及在楼梯上或从楼梯上跌落的病例），因跌落导致的致命性颅脑创伤中，前颅窝对冲性骨折的总体发生率为12%，而头部枕部撞击时这一比例为24%。头部撞击部位、累及颅骨穹窿和/或颅底的撞击点骨折形式、脑的冲击伤和对冲伤、前颅窝对冲性骨折的定位以及单眼和眼镜状血肿的发生之间存在很大差异。骨折表现为单纯骨折和凹陷性骨折（骨折碎片或骨折边界向内移位）。由于前颅底位置隐蔽，临床诊断困难。当过去曾有过一段时间的创伤后首次出现额底部损伤症状，且出现与原始创伤因果关系的问题时，对冲性骨折就具有法医医学意义。在对活体进行调查时，可能难以确定眼眶及其附近区域的出血是由直接钝性外力所致还是源于颅底骨折，尤其是对冲性骨折。
