Ashworth Emily, Baxter David, Gibb Iain, Wilson Mark, Bull Anthony M J
Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, United Kingdom.
Royal Centre for Defence Medicine, Birmingham, United Kingdom.
J Neurotrauma. 2023 Jan;40(1-2):141-147. doi: 10.1089/neu.2021.0400. Epub 2022 Sep 22.
Previous research has shown that injuries to the head and neck were prevalent in 73% of all mounted fatalities of underbody blast. The mechanisms that cause such injuries to the central nervous system (CNS) are not yet known. The aim of this study was to identify the head and spinal injuries in fatalities due to underbody blast (UBB) and then develop hypotheses on the causative mechanisms. All U.K. military fatalities from UBB with an associated head injury that occurred during 2007-2013 in the Iraq and Afghanistan conflicts were identified retrospectively. Computed tomography post-mortems (CTPMs) were interrogated for injuries to the head, neck, and spine. All injuries were documented and classified using a radiology classification. Pearson's chi-square and Fisher's exact tests were used to show a relationship between variables and form a hypothesis for injury mechanisms. There were 50 fatalities from UBB with an associated head injury. Of these, 46 had complete CTPMs available for analysis. Chi-square and Fisher's exact tests showed a relationship between lateral ventricle blood and injuries to the abdomen and thorax. Five partially overlapping injury constellations were identified: 1.multiple-level spinal injury with skull fracture and brainstem injury, 2.peri-mesencephalic hemorrhage, 3.spinal and brainstem injury, 4.parenchymal contusions with injury to C0-C1, and 5.an "eggshell" pattern of fractures from direct impact. These injury constellations can now be used to propose injury mechanisms to develop mitigation strategies or clinical treatments.
先前的研究表明，在所有车底爆炸致死的案例中，73%的死者头部和颈部有受伤情况。导致中枢神经系统（CNS）此类损伤的机制尚不清楚。本研究的目的是确定车底爆炸（UBB）致死案例中的头部和脊柱损伤，然后就致病机制提出假设。对2007年至2013年在伊拉克和阿富汗冲突期间因车底爆炸且伴有头部受伤的所有英国军人死亡案例进行了回顾性研究。对计算机断层扫描尸检（CTPMs）结果进行检查，以确定头部、颈部和脊柱的损伤情况。所有损伤均使用放射学分类进行记录和分类。使用Pearson卡方检验和Fisher精确检验来显示变量之间的关系，并形成损伤机制的假设。有50例因车底爆炸致死且伴有头部受伤的案例。其中，46例有完整的CTPMs可供分析。卡方检验和Fisher精确检验显示侧脑室出血与腹部和胸部损伤之间存在关联。确定了五个部分重叠的损伤组合：1. 伴有颅骨骨折和脑干损伤的多节段脊柱损伤；2. 中脑周围出血；3. 脊柱和脑干损伤；4. 伴有C0 - C1损伤的实质挫伤；5. 直接撞击造成的“蛋壳”样骨折。这些损伤组合现在可用于提出损伤机制，以制定缓解策略或临床治疗方法。
