Injury biomechanics, neuropathology, and simplified physics of explosive blast and impact mild traumatic brain injury.
Injury biomechanics, neuropathology, and simplified physics of explosive blast and impact mild traumatic brain injury.
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DOI：
10.1016/b978-0-444-52892-6.00006-4
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发表时间：
2015-01-01
影响因子：
--
通讯作者：
De Lanerolle, N C
中科院分区：
文献类型：
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作者：
Bandak, F A;Ling, G;De Lanerolle, N C
爆炸冲击波和钝性撞击头部是导致轻度创伤性脑损伤(MTBI)的两种负荷类型。虽然这两种原因引起的mTBI在行为学上有一些共同的特征，但潜在的损伤机制在病理生理学上有明显的不同。文献中已经提供了各种解释来解释由两种类型的负荷引起的与mTBI相关的器官损害。目前对这一领域的认识受到对爆炸性冲击波和钝性撞击头部影响的物理和生物力学认识程度的限制，这导致了对手术脑损伤损伤机制的各种研究方法。在这一章中，我们提供了与爆炸冲击波和钝器撞击对头部的力相关的术语的简化描述，以帮助该领域的读者评估对脑损伤“伤害”过程的解释。值得注意的是，任何一种负荷造成的mTBI通常只会导致少量神经元损失，海马神经元似乎特别容易受到爆炸性冲击波的影响。在大型动物模型上的爆炸冲击波研究显示了一种独特的脑室周围损伤模式，这与经典的弥漫性轴索损伤不同。星形胶质细胞和小胶质细胞的激活在爆炸冲击伤和撞击伤中也可见，但这可能是一种一般性的继发性脑损伤反应，对爆炸冲击波或钝挫伤没有特异性。此外，虽然中到重度冲击性闭合性头部损伤有时会导致点状出血或血肿，但即使反复暴露于爆炸伤中，它们似乎也与爆炸伤无关。
Explosive blast shock waves and blunt impact to the head are two types of loading shown to result in mild traumatic brain injury (mTBI). While mTBI from these two causes shares some common features behaviorally, there are distinct differences in the pathophysiology of the underlying injury mechanisms. Various elucidations have been offered in the literature to explain the organic damage associated with mTBI resulting from both types of loading. The current state of understanding in this field is somewhat limited by the degree of appreciation of the physics and biomechanics governing the effects of explosive blast shock waves and blunt impact on the head, which has resulted in the various approaches to the investigation of the operative brain injury "wounding mechanisms". In this chapter we provide a simplified description of terminology associated with forces on the head from explosive blast shock waves and blunt impact, to assist readers in the field in evaluating interpretations of brain injury "wounding" processes. Remarkably, mTBI from either loading is shown generally to result in only a small loss of neurons, with hippocampal neurons appearing to be particularly vulnerable to explosive blast shock waves. Explosive blast studies in large animal models show a unique pattern of periventricular injury, which is different from the classic diffuse axonal injury. Both astrocyte and microglial activation are also seen in explosive blast as well as impact trauma, but this may be a general secondary brain injury response, nonspecific to explosive blast or blunt trauma. Additionally, while moderate to severe impact closed head injuries sometimes result in petechial hemorrhages or hematomas, they do not appear to be associated with explosive blast mTBI even with repeated exposure to blasts.