中国平民穿透性脑损伤的临床管理:基于低速损伤特征的实践与展望OA

Objective To investigate the clinical characteristics,diagnosis,and treatment strategies for penetrating brain injury(PBI)in China based on single-center data.Methods The clinical data of 18 PBI patients treated in the Department of Neurosurgery,Huashan Hospital,Fudan University from January 2015 to November 2025 were analyzed retrospectively,including the types of penetrating objects and injury mechanisms.Integrating the latest international evidence,this study systematically elaborated on the diagnostic and therapeutic features and challenges of PBI in China,covering aspects such as epidemiology,imaging evaluation,surgical approach selection,management of cerebrovascular complications,intracranial pressure monitoring,and precise outcome prediction.Results Most patients were conscious,with Glasgow Coma Scale(GCS)scores ranging from 4 to 15(mean:13.6).Penetrating objects included metal fragments and nails(12 cases),metal bullets(4 cases),a metal handlebar(1 case),and a bamboo splinter(1 case).Of these,12 cases were skull base-type injuries,and 6 were calvarial-type injuries.One case was confirmed by digital subtraction angiography(DSA)to have a traumatic pseudoaneurysm in the distal middle cerebral artery.During follow-up,Glasgow Outcome Scale(GOS)scores were Grade Ⅳ in 1 case and GradeⅤin 16 cases.One patient died due to severe intracranial infection.Conclusions PBI in China is characterized predominantly by low-velocity,non-firearm-related injuries.The injury mechanisms,treatment strategies,and clinical outcomes significantly differ from the high-velocity firearm injury model commonly seen in Western countries.An individualized treatment approach under a multidisciplinary team is recommended,providing a theoretical basis for establishing localized clinical practice guidelines.