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Schädel-Hirn-Trauma (SHT)

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Orthopädie und Unfallchirurgie

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Zusammenfassung

Das Schädel-Hirn-Trauma (SHT) ist eines der häufigsten Traumata mit einem heterogenen Verletzungsmuster und hoher sozioökonomischer Bedeutung. Das epidurale Hämatom entsteht meistens traumatisch. Rasche Diagnostik und Therapie sind wichtig für eine gute Prognose des Patienten. Das akute Subduralhämatom („Polytrauma des Gehirns“) ist oftmals von anderen intrakraniellen Verletzungen begleitet, und trotz rascher Therapie resultiert in vielen Fällen nicht die vollständige Erholung. Das chronisch subdurale Hämatom ist sehr verbreitet. Nicht selten benötigt der Patient eine operative Therapie. Traumatische intrazerebrale Blutungen entstehen durch heftige Gewalteinwirkung. Bei großen Kontusionen mit entsprechenden Symptomen wird eine operative Therapie bevorzugt. Insbesondere von der Lokalisation der Hirnkontusionen und dem Schweregrad der Begleitverletzungen hängt die Prognose ab. Diffuse axonale Verletzungen treten an typischen Lokalisationen im Gehirn auf und entstehen durch primäre und sekundäre Axotomie. Es existiert keine spezifische Therapie. Die primären Schädigungen bei SHT können nicht beeinflusst werden. Das Therapieziel liegt in der frühen Erkennung und der nachfolgenden Verhinderung von sekundären Schäden. Die präklinische Phase und eine interdisziplinäre Zusammenarbeit in der Klinik spielen hierbei eine bedeutende Rolle. Neben der raschen Durchführung von diagnostischen und operativen Maßnahmen ist meist auch eine spezialisierte neurointensivmedizinische Versorgung notwendig.

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  1. Klinik für Neurochirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland

    Hussam Aldin Hamou & Hans Clusmann

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  1. Klinik für Orthopädie, Klinikum Osnabrück GmbH Klinik für Orthopädie, Osnabrück, Niedersachsen, Germany

    Martin Engelhardt

  2. Unfallchirurgie, Universitätsklinikum Münster Unfallchirurgie, Münster, Nordrhein-Westfalen, Germany

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Hamou, H.A., Clusmann, H. (2019). Schädel-Hirn-Trauma (SHT). In: Engelhardt, M., Raschke, M. (eds) Orthopädie und Unfallchirurgie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54673-0_47-1

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