Friedl W, Karches C
Chirurgische Klinik II, Unfall- und Wiederherstellungschirurgie, Klinikum Aschaffenburg.
Chirurg. 1996 Nov;67(11):1107-13. doi: 10.1007/s001040050111.
Head traumas frequently occur in polytrauma patients but are also found as isolated injuries. In our hospital trauma center without a neurosurgical department, in a 21-month period, 489 patients with head/brain trauma were treated. This represents 6.5% of all patients treated in the trauma and reconstructive surgery clinic. In commotio cerebri (CC = 89.5% of the patients) constant conservative management and an uneventful course were observed; in 69 patients with contusio cerebri, 18 craniotomy operations had to be performed. In contrast, in only two cases was reoperation because of recurrent hematoma necessary. In four cases with complex and/or additional injuries, transfer to a neurosurgical center took place, and in two cases photophone consultation with that center was used. The mortality was 14.5%. The diagnostic and therapeutic regimens for the different types of injury and the requirements for the management of head/brain trauma in trauma centers without neurosurgical departments are presented: emergency service and medical staff, emergency room management, intensive care management, qualified neurological examination, X-ray imaging, including CT scan, OP-room equipment and trained surgeons. If these requirements are not available in a given hospital, early transfer of all patients for whom surgical management could be necessary to a neurosurgical department should be attempted. Only in patients with severe bleeding must immediate craniotomy be performed even in hospitals which do not have all the above mentioned facilities. In patients with intracerebral bleeding, bleeding in the dorsal fossa, injury of brain nerves, carotid artery or sinus cavernosus injuries, frontobasal injuries with liquor fistula or pneumonencephalon, transfer of the patients to specialized neurosurgical centers is indicated. With this selection, we obtained the same results in a trauma center without a neurosurgical department as reported in the literature. This avoids overloading neurosurgical centers with head/brain injury patients.
头部创伤在多发伤患者中经常发生，但也可作为单独损伤出现。在我院没有神经外科的创伤中心，在21个月的时间里，共治疗了489例头部/脑部创伤患者。这占创伤与重建外科门诊所有治疗患者的6.5%。在脑震荡患者中（占患者的89.5%），观察到持续的保守治疗且病程平稳；在69例脑挫伤患者中，不得不进行了18次开颅手术。相比之下，仅2例因复发性血肿需要再次手术。在4例伴有复杂和/或其他损伤的患者中，转至神经外科中心，2例与该中心进行了电话会诊。死亡率为14.5%。介绍了不同类型损伤的诊断和治疗方案以及没有神经外科的创伤中心对头部/脑部创伤管理的要求：急救服务和医务人员、急诊室管理、重症监护管理、合格的神经学检查、X线成像，包括CT扫描、手术室设备和训练有素的外科医生。如果某家医院不具备这些条件，应尝试将所有可能需要手术治疗的患者尽早转至神经外科。即使在没有上述所有设施的医院，只有在严重出血的患者中才必须立即进行开颅手术。对于脑内出血、后颅窝出血、脑神经损伤、颈动脉或海绵窦损伤、伴有脑脊液漏或气脑的额底损伤患者，应转至专业神经外科中心。通过这种筛选，我们在没有神经外科的创伤中心获得了与文献报道相同的结果。这避免了神经外科中心因头部/脑部损伤患者过多而不堪重负。
