Інформація призначена тільки для фахівців сфери охорони здоров'я, осіб,
які мають вищу або середню спеціальну медичну освіту.

Підтвердіть, що Ви є фахівцем у сфері охорони здоров'я.

Мобильная версия

Регистрация Забыли пароль?

Журнал «Травма» Том 27, №4, 2026

Вернуться к номеру

Черепно-мозкова травма в умовах сучасних викликів: епідеміологія, механізми ушкодження, гендерні відмінності та довгострокові наслідки (систематичний огляд)

Черепно-мозкова травма в умовах сучасних викликів: епідеміологія, механізми ушкодження, гендерні відмінності та довгострокові наслідки (систематичний огляд)

Авторы: V.V. Petrushenko (1), V.V. Chorna (1), N.M. Ordatii (1), А.V. Ordatii (2)
(1) - National Pirogov Memorial Medical University, Vinnytsia, Ukraine
(2) - Military Medical Clinical Center of the Central Region, Vinnytsia, Ukraine

Рубрики: Травматология и ортопедия

Разделы: Клинические исследования

Версия для печати


Резюме

Актуальність. Черепно-мозкова травма є однією з провідних причин інвалідності серед військовослужбовців, причому легкі форми становлять понад 80 % випадків і часто супроводжуються тривалими когнітивними, емоційними та поведінковими порушеннями. Мета: узагальнити сучасні дані щодо епідеміології, механізмів ушкодження, гендерних відмінностей і довгострокових наслідків черепно-мозкової травми у військовослужбовців в усьому світі на основі метааналізу зарубіжних та вітчизняних наукових досліджень. Матеріали та методи. Системний огляд виконаний шляхом метааналізу зарубіжних і віт-чизняних робіт, а також контент-аналізу публікацій у наукових базах Scopus, PubMed. Літературний пошук здійснювався за допомогою ключових слів (traumatic brain injury, military personnel, post-concussion syndrome, acubarotrauma, neurobehavioral and cognitive sequelae, suicidal behavior, epilepsy, dementia, disability, rehabilitation). До цього огляду ввійшла 51 стаття, опублікована у 2018–2026 рр. Результати. Вибухові й комбіновані травми призводять до дифузного аксонального ураження, мікросудинних змін і порушень мозкових мереж, що підвищує ризик судом, когнітивного дефіциту та деменції. Частими психічними наслідками є посттравматичний стресовий розлад, депресія, тривожні розлади й порушення сну, які погіршують соціальну адаптацію, особливо в поєднанні з нейроповедінковими змінами; жінки схильні до більш виражених когнітивних та емоційних симптомів. Висновки. Довгострокова реабілітація повинна базуватися на біопсихосоціальній моделі і включати мультидисциплінарну допомогу: медичну, когнітивну, фізичну, психотерапевтичну й соціальну підтримку. Наукова та практична значущість дослідження полягає у впровадженні доказових протоколів, національних реєстрів і програм профілактики для зниження інвалідності й покращення якості життя постраждалих.

Background. Traumatic brain injury is one of the leading causes of disability among military personnel, with mild forms accounting for over 80 % of cases and often accompanied by persistent cognitive, emotional, and behavioral impairments. The purpose was to summarize current evidence on the epidemiology, mechanisms of injury, gender differences, and long-term consequences of traumatic brain injury in military personnel worldwide, based on a meta-analysis of both international and domestic scientific studies. Materials and ­methods. A systematic review was conducted using meta-analysis of international and domestic studies, as well as content analysis of publications indexed in Scopus and PubMed. The literature search employed keywords: traumatic brain injury, military personnel, post-concussion syndrome, acubarotrauma, neurobehavioral and cognitive sequelae, suicidal behavior, epilepsy, dementia, disability, rehabilitation. A total of 51 articles published between 2018 and 2026 were included. Results. Blast and combined injuries lead to diffuse axonal da-mage, microvascular changes, and disruption of brain networks, increasing the risk of seizures, cognitive deficits, and dementia. Common psychiatric consequences include post-traumatic stress disorder, depression, anxiety disorders, and sleep disturbances, which worsen social adaptation, especially when combined with neurobehavioral chan­ges. Women are more prone to severe cognitive and emotional symptoms. Conclusions. Long-term rehabilitation should be based on a biopsychosocial model and include multidisciplinary interventions: medical, cognitive, physical, psychotherapeutic, and social support. The scientific and practical significance of this study lies in the implementation of evidence-based protocols, national registries, and prevention programs to reduce disability and improve the quality of life of affected individuals.


Ключевые слова

черепно-мозкова травма; військовослужбовці; постконтузійний синдром; акубаротравма; нейроповедінкові та когнітивні наслідки; посттравматичний стресовий розлад; суїцидальна поведінка; епілептичні прояви; деменція; інвалідизація; реабілітація

traumatic brain injury; military personnel; post-concussion syndrome; acubarotrauma; neurobehavioral and cognitive sequelae; post-traumatic stress disorder; suicidal behavior; epilepsy; dementia; disability; rehabilitation

doi: http://dx.doi.org/616.831-001-036.22-06-055.2/.7

Для ознакомления с полным содержанием статьи необходимо оформить подписку на журнал.


Список литературы

1. Chorna VV, Zavodyak AY, Ivashkevych EM, Sivak VM, Slobodyan VV, Lunko O. Severity of injuries in mine-explosive trauma depending on the location of the person at the time of the explosion. Ukrainian Military Medical Journal. 2023;4(3):70-77. doi: 10.46847/ujmm.2023.3(4)-070.
2. Chorna VV, Zavodyak AY, Plakhotniuk IM, Lypkan VM, Tomashevskyi AV, Kolomiiets VV. Features of injuries from different types of weapons and the location of the person at the time of the explosion. Zdorovia Natsii. 2024;2(7):113-121. doi: 10.32782/2077-6594/2024.2/19.
3. Haarbauer-Krupa J, Pugh MJ, Prager EM, Harmon N, Wolfe J, Yaffe K. Epidemiology of Chronic Effects of Traumatic Brain Injury. Journal of Neurotrauma. 2021;38(23):3235-3247. doi: 10.1089/neu.2021.0062.
4. Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic Brain Injury: An Overview of Epidemiology, Pathophysiology, and Medical Management. The Medical Clinics of North Ame–rica. 2020;104(2):213-238. doi: 10.1016/j.mcna.2019.11.001.
5. Bouldin ED, Swan AA, Norman RS, Tate DF, Tumminello C, et al. Health Phenotypes and Neurobehavioral Symptom Severity Among Post-9/11 Veterans with Mild Traumatic Brain Injury: A Chronic Effects of Neurotrauma Consortium Study. The Journal of Head Trauma Rehabilitation. 2021;36(1):10-19. doi: 10.1097/HTR.0000000000000574.
6. Swan AA, Kennedy E, Cooper DB, Amuan ME, Mayo J, et al. Comorbidity and polypharmacy impact neurobeha–vioral symptoms and symptom validity failure among post-9/11 veterans with mild traumatic brain injury. Front Neurol. 2023;14:1228377. doi: 10.3389/fneur.2023.1228377.
7. Epstein EL, Martindale SL, Va Mid-Atlantic Mirecc Workgroup, Miskey HM. Posttraumatic stress disorder and traumatic brain Injury: Sex differences in veterans. Psychiatry Research. 2019;274:105-111. doi: 10.1016/j.psychres.2019.01.097.
8. Kong LZ, Zhang RL, Hu SH, Lai JB. Military traumatic brain injury: a challenge straddling neurology and psychiatry. Military Medical Research. 2022;9(1):2. doi: 10.1186/s40779-021-00363-y.
9. Denby E, Murphy D, Busuttil W, Sakel M, Wilkinson D. Neuropsychiatric Outcomes in UK Military Veterans with Mild Traumatic Brain Injury and Vestibular Dysfunction. The Journal of Head Trauma Rehabilitation. 2020;35(1):57-65. doi: 10.1097/HTR.0000000000000468.
10. Bryden DW, Tilghman JI, Hinds SR 2nd. Blast-Related Traumatic Brain Injury: Current Concepts and Research Consi–derations. J Exp Neurosci. 2019 Sep 12;13:1179069519872213. doi: 10.1177/1179069519872213.
11. Wang Z, Cheng F, Shi X, Dai J, Jin H, Liu Y. Advance on Blast-Induced Traumatic Brain Injury. World Neurosurgery. 2025;199:124115. doi: 10.1016/j.wneu.2025.124115.
12. Pashkovskyi SM, Ordatiy NM, Angelska VYu, She-met VS, Humeniuk NI. Sleep disturbances as a therapeutic target in comprehensive rehabilitation of servicemen. Zhurnal Suchasnoi Psykholohii. 2026;1(40):59-67. doi: 10.26661/2786-7471/2026-1-7.
13. Pashkovskyi SM, Ordatiy NM, Angelska VYu, She–met VS, Humeniuk NI, Smaglo DV. Medico-psychological aspects of rehabilitation of servicemen with combined somatic and neurological disorders. Naukovi Perspektyvy. 2025;6(60):1472-1484. doi: 10.52058/2708-7530-2025-6(60)-1472-1484.
14. LaValle CR, Carr WS, Egnoto MJ, Misistia AC, Sa–lib JE, et al. Neurocognitive Performance Deficits Related to Immediate and Acute Blast Overpressure Exposure. Frontiers in Neurology. 2019;10:949. doi: 10.3389/fneur.2019.00949.
15. Belding JN, Khokhar B, Englert RM, Fitzmaurice S, Thomsen CJ. The Persistence of Blast- Versus Impact-Induced Concussion Symptomology Following Deployment. The Journal of Head Trauma Rehabilitation. 2021;36(6): E397-E405. doi: 10.1097/HTR.0000000000000715.
16. Vasterling JJ, Jacob SN, Rasmusson A. Traumatic Brain Injury and Posttraumatic Stress Disorder: Conceptual, Diagnostic, and Therapeutic Considerations in the Context of Co-Occurrence. J Neuropsychiatry Clin Neurosci. 2018 Spring;30(2):91-100. doi: 10.1176/appi.neuropsych.17090180.
17. Chang BL, Walker MC, Kullmann DM, Schorge S. Deciphering temporal gene expression dynamics during epilepsy development using a rat model of focal neocortical epilepsy. Epilepsia. 2025 Jan;66(1):288-302. doi: 10.1111/epi.18169.
18. Li J, Seidlitz J, Suckling J, Fan F, Ji GJ, et al. Cortical structural differences in major depressive disorder correlate with cell type-specific transcriptional signatures. Nat Commun. 2021 Mar 12;12(1):1647. doi: 10.1038/s41467-021-21943-5.
19. Nordberg J, Schaper FLWVJ, Bucci M, Nummenmaa L, Joutsa J. Brain lesion locations associated with secondary seizure generalization in tumors and strokes. Hum Brain Mapp. 2023 Jun 1;44(8):3136-3146. doi: 10.1002/hbm.26268.
20. Sun Y, Hu H, Qin L, Chen Z, Su S, et al. Brain connectivity regions of lesions causing focal to bilateral tonic-clonic seizures correlates with gene expression. Neurobiol Dis. 2025 Oct 1;214:107031. doi: 10.1016/j.nbd.2025.107031.
21. Mac Donald CL, Barber J, Hunt D, Andre JB, Fann JR, et al. Long-Term Postdeployment Clinical Subtypes of Risk and Resiliency in Brain Injury and Neurodegeneration. JAMA Netw Open. 2025 Dec 1;8(12):e2547954. doi: 10.1001/jamanetworkopen.2025.47954.
22. Agimi Y, Hai T, Gano A, Stuessi K, Gold J, et al. Clinical Trajectories of Comorbidity Associated with Military-Sustained Mild Traumatic Brain Injury: Pre- and Post-Injury. J Head Trauma Rehabil. 2024 Nov-Dec 1;39(6):E564-E575. doi: 10.1097/HTR.0000000000000934.
23. Lototska-Dudyk UB, Krupka NO, Breydak OA, Chorna VV, Podolyan VM, Ivashkevych EM. Kharchuvannya viy–skovosluzhbovtsiv Zbroynykh Syl Ukrayiny. Vinnytsia: FOP Korzun DY; 2023. 76 p. (in Ukrainian).
24. Lototska-Dudyk UB, Krupka NO, Chorna VV. The current state and organization of military nutrition of Ukrainian Armed Forces in the conditions of Russian aggression against Ukraine. Naukovyy visnyk Uzhhorodskoho universytetu. Seriia “Medytsyna”. 2023;1(67):89-94. doi: 10.32782/2415-8127.2023.67.16 (in Ukrainian).
25. Scott BR, Uomoto JM, Barry ES. Impact of Pre-Existing Migraine and Other Co-Morbid or Co-Occurring Conditions on Presentation and Clinical Course Following Deployment-Related Concussion. Headache. 2020 Mar;60(3):526-541. doi: 10.1111/head.13709.
26. Harrison EM, Chung SY, Englert RM, Belding JN. The Effect of Concussion Mechanism of Injury on Sleep Problems in Active Duty Service Members Following Deployment. Mil Med. 2024 Jan 23;189(1–2):e141-e147. doi: 10.1093/milmed/usad197.
27. Belding JN, Fitzmaurice S, Englert RM, Lee I, Kowitz B, et al. Blast Exposure and Risk of Recurrent Occupational Overpressure Exposure Predict Deployment TBIs. Mil Med. 2020 Jun 8;185(5–6):e538-e544. doi: 10.1093/milmed/usz289.
28. Englert RM, Belding JN, Thomsen CJ. Self-Reported Symptoms in U.S. Marines Following Blast- and Impact-Rela–ted Concussion. Mil Med. 2023 Jul 22;188(7–8):e2118-e2125. doi: 10.1093/milmed/usad026.
29. Chung SY, Harrison EM, Englert RM, Belding JN. Effects of Blast- and Impact-Related Concussion on Persistent Sleep Problems. J Head Trauma Rehabil. 2025 Jan-Feb 01;40(1):E66-E74. doi: 10.1097/HTR.0000000000000974.
30. Rowland JA, Martindale SL. Considerations for the assessment of blast exposure in service members and vete–rans. Front Neurol. 2024 Apr 15;15:1383710. doi: 10.3389/fneur.2024.1383710.
31. Martindale SL, Kolaja CA, Belding JN, Liu L, Rull RP, et al. Blast exposure and long-term diagnoses among veterans: a millennium cohort study investigation of high-level blast and low-level blast. Front Neurol. 2025 Jul 31;16:1599351. doi: 10.3389/fneur.2025.1599351.
32. Belding JN, Englert R, Bonkowski J, Thomsen CJ. Occupational Risk of Low-Level Blast Exposure and TBI-Related Medical Diagnoses: A Population-Based Epidemiological Investigation (2005–2015). Int J Environ Res Public Health. 2021 Dec 8;18(24):12925. doi: 10.3390/ijerph182412925.
33. Brenner LA, Forster JE, Gradus JL, Hostetter TA, Hoffmire CA, et al. Associations of Military-Related Traumatic Brain Injury with New-Onset Mental Health Conditions and Suicide Risk. JAMA Netw Open. 2023 Jul 3;6(7):e2326296. doi: 10.1001/jamanetworkopen.2023.26296.
34. Zafonte RD, Daneshvar DH, Fisher L. Detangling the Association Between Traumatic Brain Injury, Mental Health, and Suicide in Active Duty Service Members. JAMA Netw Open. 2023 Jul 3;6(7):e2327644. doi: 10.1001/jamanetworkopen.2023.27644.
35. Chin DL, Zeber JE. Mental Health Outcomes Among Military Service Members After Severe Injury in Combat and TBI. Mil Med. 2020 Jun 8;185(5–6):e711-e718. doi: 10.1093/milmed/usz440.
36. Moore MJ, Shawler E, Jordan CH, Jackson CA. Ve–teran and Military Mental Health Issues. 2023 Aug 17. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. NBK572092.
37. Jurick SM, Crocker LD, Merritt VC, Sanderson-Cimino ME, Keller AV, et al. Independent and Synergistic Associations Between TBI Characteristics and PTSD Symptom Clusters on Cognitive Performance and Postconcussive Symptoms in Iraq and Afghanistan Veterans. J Neuropsychiatry Clin Neurosci. 2021 Spring;33(2):98-108. doi: 10.1176/appi.neuropsych.20050128.
38. Stika MM, Riordan P, Aaronson A, Herrold AA, Ellison RL, et al. Cognition and Other Predictors of Functional Disability Among Veterans with Mild Traumatic Brain Injury and Posttraumatic Stress Disorder. J Head Trauma Rehabil. 2021 Jan-Feb 01;36(1):44-55. doi: 10.1097/HTR.0000000000000611.
39. Gardner RC, Bahorik A, Kornblith ES, Allen IE, Plassman BL, Yaffe K. Systematic Review, Meta-Analysis, and Popu–lation Attributable Risk of Dementia Associated with Trauma–tic Brain Injury in Civilians and Veterans. J Neurotrauma. 2023 Apr;40(7–8):620-634. doi: 10.1089/neu.2022.0041.
40. Coppel D, Barber J, Temkin NR, Mac Donald CL. Combat Deployed Service Members by Blast TBI and Service Separation Status 5-years Post-deployment: Comparison of Cognitive, Neurobehavioral, and Psychological Profiles of Those Who Left vs. Those Still Serving. Mil Med. 2024 Feb 27;189(3–4):e795-e801. doi: 10.1093/milmed/usad378.
41. Raza Z, Hussain SF, Ftouni S, Spitz G, Caplin N, et al. Dementia in military and veteran populations: a review of risk factors-traumatic brain injury, post-traumatic stress disorder, deployment, and sleep. Mil Med Res. 2021 Oct 13;8(1):55. doi: 10.1186/s40779-021-00346-z.
42. Coppel D, Barber J, Temkin NR, Mac Donald CL. Longitudinal Assessment of Selective Motor Dysfunction in Service Members with Combat-Related Mild TBI. Mil Med. 2025 Jun 30;190(7–8):e1534-e1542. doi: 10.1093/milmed/usae400.
43. Caciagli L, Allen LA, He X, Trimmel K, Vos SB, et al. Thalamus and focal to bilateral seizures: A multiscale cognitive imaging study. Neurology. 2020 Oct 27;95(17):e2427-e2441. doi: 10.1212/WNL.0000000000010645.
44. He X, Chaitanya G, Asma B, Caciagli L, Bassett DS, et al. Disrupted basal ganglia-thalamocortical loops in focal to bilateral tonic-clonic seizures. Brain. 2020 Jan 1;143(1):175-190. doi: 10.1093/brain/awz361.
45. Sheppard J, Wynford-Thomas R, Robertson NP. “Navigating the network”: localising the lesion with the advent of lesion network mapping. J Neurol. 2023 Dec;270(12):6207-6209. doi: 10.1007/s00415-023-12059-5.
46. Shvets AV, Podolyan YV, Holinko MI. Features of functional state restoration among military personnel after traumatic brain injury combined with acubarotrauma. Zaporozhye Medical Journal. 2020;22(3):329-337. doi: 10.14739/2310-1210.2020.3.204905 (in Ukrainian).
47. Babov KD, Zabolotna IB, Plakida AL, Volyanska VS, Babova IK, et al. The effectiveness of high-tone therapy in the complex rehabilitation of servicemen with post-traumatic stress disorder complicated by traumatic brain injury. Neurol Sci. 2023 Mar;44(3):1039-1048. doi: 10.1007/s10072-022-06510-0.
48. Law of Ukraine “On Rehabilitation in the Healthcare Sector” No. 1053-IX, as amended on 01 Jan 2026. Available from: https://zakon.rada.gov.ua/laws/show/1053-20#Text.
49. Babakhanyan I, Sedigh R, Remigio-Baker R, Hungerford L, Bailie JM. Traumatic brain injury rehabilitation for warfighters with post-traumatic stress. NeuroRehabilitation. 2024;55(3):295-302. doi: 10.3233/NRE-230274.
50. Shvets AV, Horishna OV, Deputat YM, Rychka OV, Zhaldak AY, Kikh AY. Prognostic assessment of medical rehabilitation needs among Armed Forces of Ukraine servicemen based on the structure of their combat injuries. Ukr J Milit Med. 2022;3(3):110-7. doi: 10.46847/ujmm.2022.3(3)-110.
51. Mykhailenko YV. Psychological rehabilitation and social adaptation of servicemen with post-traumatic stress disorder (PTSD) in post-war society. Qualification work for the degree of Bachelor, spec. C4 “Psychology”. Mykolaiv: Petro Mohyla Black Sea National University; 2025. 96 p. (in Ukrainian).

Вернуться к номеру