Oeur R Anna, Karton Clara, Post Andrew, Rousseau Philippe, Hoshizaki T Blaine, Marshall Shawn, Brien Susan E, Smith Aynsley, Cusimano Michael D, Gilchrist Michael D
School of Human Kinetics, University of Ottawa;
Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario;
J Neurosurg. 2015 Aug;123(2):415-22. doi: 10.3171/2014.10.JNS14440. Epub 2015 Apr 24.
Concussions typically resolve within several days, but in a few cases the symptoms last for a month or longer and are termed persistent postconcussive symptoms (PPCS). These persisting symptoms may also be associated with more serious brain trauma similar to subdural hematoma (SDH). The objective of this study was to investigate the head dynamic and brain tissue responses of injury reconstructions resulting in concussion, PPCS, and SDH.
Reconstruction cases were obtained from sports medicine clinics and hospitals. All subjects received a direct blow to the head resulting in symptoms. Those symptoms that resolved in 9 days or fewer were defined as concussions (n = 3). Those with symptoms lasting longer than 18 months were defined as PPCS (n = 3), and 3 patients presented with SDHs (n = 3). A Hybrid III headform was used in reconstruction to obtain linear and rotational accelerations of the head. These dynamic response data were then input into the University College Dublin Brain Trauma Model to calculate maximum principal strain and von Mises stress. A Kruskal-Wallis test followed by Tukey post hoc tests were used to compare head dynamic and brain tissue responses between injury groups. Statistical significance was set at p < 0.05.
A significant difference was identified for peak resultant linear and rotational acceleration between injury groups. Post hoc analyses revealed the SDH group had higher linear and rotational acceleration responses (316 g and 23,181 rad/sec(2), respectively) than the concussion group (149 g and 8111 rad/sec(2), respectively; p < 0.05). No significant differences were found between groups for either brain tissue measures of maximum principal strain or von Mises stress.
The reconstruction of accidents resulting in a concussion with transient symptoms (low severity) and SDHs revealed a positive relationship between an increase in head dynamic response and the risk for more serious brain injury. This type of relationship was not found for brain tissue stress and strain results derived by finite element analysis. Future research should be undertaken using a larger sample size to confirm these initial findings. Understanding the relationship between the head dynamic and brain tissue response and the nature of the injury provides important information for developing strategies for injury prevention.
脑震荡通常在数天内恢复，但在少数情况下，症状会持续一个月或更长时间，被称为持续性脑震荡后症状（PPCS）。这些持续的症状也可能与更严重的脑损伤有关，类似于硬膜下血肿（SDH）。本研究的目的是调查导致脑震荡、PPCS和SDH的损伤重建的头部动力学和脑组织反应。
从运动医学诊所和医院获取重建病例。所有受试者头部均受到直接撞击并出现症状。那些在9天或更短时间内症状消失的被定义为脑震荡（n = 3）。症状持续超过18个月的被定义为PPCS（n = 3），3例患者出现硬膜下血肿（n = 3）。在重建过程中使用了Hybrid III头模以获取头部的线性和旋转加速度。然后将这些动态响应数据输入都柏林大学脑创伤模型，以计算最大主应变和冯·米塞斯应力。使用Kruskal-Wallis检验，随后进行Tukey事后检验，以比较损伤组之间的头部动力学和脑组织反应。统计学显著性设定为p < 0.05。
损伤组之间在峰值合成线性和旋转加速度方面存在显著差异。事后分析显示，硬膜下血肿组的线性和旋转加速度反应（分别为316 g和23,181 rad/sec²）高于脑震荡组（分别为149 g和8111 rad/sec²；p < 0.05）。在最大主应变或冯·米塞斯应力的脑组织测量方面，各组之间未发现显著差异。
对导致短暂症状（低严重程度）脑震荡和硬膜下血肿的事故进行重建显示，头部动态反应的增加与更严重脑损伤的风险之间存在正相关关系。有限元分析得出的脑组织应力和应变结果未发现这种关系。未来的研究应使用更大的样本量来证实这些初步发现。了解头部动力学与脑组织反应之间的关系以及损伤的性质，为制定损伤预防策略提供了重要信息。
