Russian Journal of Pediatric Surgery

Детская хирургия

1560-95102412-0677

Eco-Vector

745

10.55308/1560-9510-2023-27-4-245-253

Original Study Articles

Оригинальные исследования

Computed tomography of intracranial hemorrhages in injured infants and little children aged from 0 months till 3 years

Компьютерная томография внутричерепных кровоизлияний при травме у младенцев и детей младшего возраста

https://orcid.org/0000-0002-6949-3072

Zaytseva

E. S.

Зайцева

Е. С.

Russian Federation

Moscow, 119180

119180, г. Москва

https://orcid.org/0000-0002-3235-8854

Akhadov

T. A.

Ахадов

Т. А.

Russian Federation

Moscow, 119180

119180, г. Москва

https://orcid.org/0000-0002-4709-9461

Bozhko

O. V.

Божко

О. В.

Russian Federation

Moscow, 119180

119180, г. Москва

https://orcid.org/0000-0002-6349-5739

Mamatkulov

A. D.

Маматкулов

А. Д.

Russian Federation

Moscow, 119180

119180, г. Москва

https://orcid.org/0000-0002-4627-9874

Ublinskiy

M. V.

Ублинский

М. В.

Russian Federation

Maxim V. Ublinskiy, MD, PhD, senior researcher

Moscow, 119180

Максим Вадимович Ублинский, кандидат биол. наук, научный сотрудник

119180, г. Москва

maxublinsk@mail.ru

https://orcid.org/0000-0002-1610-2672

Semenova

Zh. B.

Семёнова

Ж. Б.

Russian Federation

Moscow, 119180

119180, г. Москва

https://orcid.org/0000-0001-5022-9952

Manzhurtsev

A. V.

Манжурцев

А. В.

Russian Federation

Moscow, 119180

119180, г. Москва

https://orcid.org/0000-0002-1698-0547

Khusainova

D. N.

Хусаинова

Д. Н.

Russian Federation

Moscow, 119180

119180, г. Москва

Clinical and Research Institute of Emergency Pediatric Surgery and TraumaГБУЗ г. Москвы «Научно-исследовательский институт неотложной детской хирургии и травматологии» Департамента здравоохранения города Москвы

24102023

274

2452530111202220102023

2023

Russian Journal of Pediatric Surgery

Детская хирургия. Журнал им. Ю.Ф. Исакова

https://jps-nmp.ru/jour/article/view/745

Introduction. The most common reason for young children to seek medical aid in hospitals is head injuries caused by falls from a small height. Currently, computed tomography (CT) of the head is a preferred method for rapid detection of bone fractures and brain injuries in children.Purpose. To investigate specific features of CT signs of intracranial hemorrhages in children with TBI under three years of age.Material and methods. 1334 children aged less than one month to 3 years with isolated TBI were examined at CT scanning. 128-slice scanner "Ingenuity CT" (Philips) was used for the examination. Scanning of the area of interest (head + cervical spine) was performed at the lowest possible values to reduce radiation exposure, including the O-MAR program, with step 0.75 mm at slice thickness 0.75 mm; reconstruction interval was 2 mm. The voltage applied to an X-ray tube during scanning (kV), current strength and time (mAS) were selected depending on patient's weight and age. The effective dose range was from 1.27 mSv to 1.91 mSv.Results. In 510 out of 1334 injured children (38.2%), there were traumatic injuries of various degree, from uncomplicated cephalohematomas and linear fractures to massive intracranial hematomas and total cerebral edema; the rest 61.8% (n=824) had concussion. The performed CT scanning revealed that 87.84% (448/510) children had skull fractures, of which only 18.3% (82/448) had “isolated skull fractures”; the others (366 = 81.7%) had accompanying intracranial injuries.Discussion. Pathological changes in children, aged 0 mon-3 years, after TBI are significantly different of those in children of other age groups. CT is the basic primary diagnostic instrument and should be used in all children with TBI no later than the first three hours. Radiation diagnostics play a key role in putting a correct diagnosis, if physicians use the information obtained at CT and know TBI mechanism in infants and little children.Conclusion. CT is an imaging method of choice for acute TBI in little children to accurately identify and therefore treat intracranial lesions. In addition, CT is an effective diagnostic tool in detecting secondary traumatic injuries.

Введение. Причиной обращения детей раннего возраста за медицинской помощью чаще всего являются травмы головы в результате падения с небольшой высоты. Компьютерная томография (КТ) головы в настоящее время является предпочтительным методом для быстрого обнаружения переломов костей и повреждений головного мозга у детей.Цель – исследовать особенность КТ-симптоматики внутричерепных кровоизлияний при черепно-мозговой травме (ЧМТ) у детей младше трёх лет.Материал и методы. КТ проведена у 1334 детей в возрасте от нескольких недель до 3 лет с изолированной ЧМТ. Исследование выполнено на 128-срезовом томографе "Ingenuity CT" (Philips, Нидерланды). Сканирование зоны интереса (голова+шейный отдел позвоночника) проводилось с максимально возможными низкими значениями для уменьшения лучевой нагрузки, включая программу О-MAR, с шагом 0,75 мм при толщине среза 0,75 мм, а интервал реконструкции составлял 2 мм. Напряжение во время снимка на рентегновской трубке (KV), силу тока и временя (mAS) подбирали в зависимости от массы тела и возраста пациента. Диапазон эффективной дозы был от 1,27 до 1,91 мЗв.Результаты. Из 1334 травмированных детей у 510 (38,2%) выявлены различной степени травматические повреждения от неосложнённых кефалогематом и линейных переломов до массивных внутричерепных гематом и тотального отёка мозга, у остальных 824 (61,8%) было сотрясение головного мозга. В результате выполненной КТ у 448 (87,84%) из 510 детей выявлены переломы костей черепа, из которых только у 82 (18,3%) из 448 были изолированные переломы костей черепа, а у остальных 366 (81,7%) они сопровождались внутричерепными повреждениями.Заключение. У детей 0–3 лет патологические изменения в результате ЧМТ значительно отличаются по сравнению с детьми другого возраста. КТ является главным первичным инструментом исследования и должна проводиться всем детям с ЧМТ не позднее первых трёх часов с момента травмы. Исходя из информации, полученной при КТ, зная механизм ЧМТ у младенцев и детей раннего возраста, лучевые методы диагностики играют ключевую роль при установлении точного диагноза.

computed tomographyskull fracturesintracranial injurieschildrentraumatic brain injury

компьютерная томографияпереломы костей черепавнутричерепные повреждениядетичерепно-мозговая травма

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