Division of Neurological Surgery, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Department of Aerospace and Mechanical Engineering, School of Science and Engineering, Saint Louis University, St. Louis, Missouri, USA.
World Neurosurg. 2022 Nov;167:176-183.e4. doi: 10.1016/j.wneu.2022.08.073. Epub 2022 Aug 24.
Blast-related traumatic brain injury (bTBI) is a significant cause of wartime morbidity and mortality. In recent decades, thermobaric explosives have emerged as particularly devastating weapons associated with bTBI. With recent documentation of the use of these weapons in the war in Ukraine, clinicians and laypersons alike could benefit from an improved understanding behind the dynamic interplay between explosive weaponry, its potential for bTBI, and the subsequent long-term consequences of these injuries. Therefore, we provide a general overview of the history and mechanism of action of thermobaric weapons and their potential to cause bTBI. In addition, we highlight the long-term cognitive and neuropsychiatric sequelae following bTBI and discuss diagnostic, therapeutic, and rehabilitation strategies, with the aim of helping to guide mitigation strategies and humanitarian relief in Ukraine. Thermobaric weapons produce a powerful blast wave capable of causing bTBIs, which can be further classified from primary to quaternary injuries. When modeling the hypothetical use of thermobaric weapons in Odessa, Ukraine, we estimate that the detonation of a salvo of thermobaric rockets has the potential to affect approximately 272 persons with bTBIs. In addition to the short-term damage, patients with bTBIs can present with long-term symptoms (e.g., post-traumatic stress disorder), which incur substantial financial costs and social consequences. Although these results are jarring, history has seen radical advancements in the understanding, diagnosis, and management of bTBI. Moving forward, a better understanding of the mechanism and long-term sequelae of bTBIs could help guide humanitarian relief to those affected by the war in Ukraine.
爆炸相关的创伤性脑损伤（bTBI）是战争时期发病率和死亡率的重要原因。近几十年来，温压弹已成为与 bTBI 相关的极具破坏性的武器。由于最近有记录显示在乌克兰战争中使用了这些武器，临床医生和非专业人士都可以从爆炸武器、其造成 bTBI 的潜力以及这些损伤的后续长期后果之间的动态相互作用方面得到更好的理解。因此，我们提供了温压武器的历史和作用机制以及它们造成 bTBI 的潜力的概述。此外，我们强调了 bTBI 后的长期认知和神经精神后遗症，并讨论了诊断、治疗和康复策略，旨在帮助指导乌克兰的缓解策略和人道主义救援。温压武器会产生强大的爆炸波，可能导致 bTBI，可以从原发性到继发性损伤进一步分类。在模拟温压武器在乌克兰敖德萨的假设使用时，我们估计，爆炸一组温压火箭弹有可能影响大约 272 名患有 bTBI 的人。除了短期损伤外，患有 bTBI 的患者还可能出现长期症状（例如，创伤后应激障碍），这会带来巨大的财务成本和社会后果。尽管这些结果令人震惊，但历史上已经在 bTBI 的理解、诊断和管理方面取得了重大进展。展望未来，更好地了解 bTBI 的机制和长期后遗症可能有助于指导对受乌克兰战争影响的人的人道主义救援。
