Yavuz M Sunay, Asirdizer Mahmut, Cetin Gursel, Günay Balci Yasemin, Altinkok Muzaffer
Section of Forensic Medicine of the Medical Faculty of Suleyman Demirel University, Isparta, Turkey.
Am J Forensic Med Pathol. 2003 Dec;24(4):339-45. doi: 10.1097/01.paf.0000103011.14578.c3.
In this study, it was aimed to investigate the relationship between skull fractures and intracranial lesions following head injury. For this purpose, 500 cases, which were referred to the Third Committee of Council of Forensic Medicine in Istanbul due to traffic accidents by the courts of laws between 1998 and 2000, were examined retrospectively. They were categorized in 3 groups based on findings of their cranium x-rays and brain tomographies. 1- The cases who have fractures in skull bones with brain lesions 2- The cases who have fractures in skull bones with no brain lesions 3- The cases who have brain lesions with no skull fractures. They were examined in detail according to age, sex, localization of skull fractures and brain lesions, and if surgery was applied or not. Of the cases, 152 (30.4%) had only linear fractures, 69 (13.8%) had depressed fractures, 92 (18.4%) had linear fractures plus intracranial lesions, 49 (9.8%) had depressed fractures plus intracranial lesions and 138 (27.6%) had only intracranial lesions. The rate of intracranial lesion among the cases with the skull fracture was 38.9% (141/362), while the rate of skull fracture among the cases with the intracranial lesion was 50.3% (141/279) (P < 0.001). Male to female ratios were 2.4/1 for linear fractures, 5.2/1 for depressed fractures, and 3.5/1 for intracranial lesions. Linear fractures were more frequent among females whereas depressed fractures were often among males (chi2: 9.68, df: 4, p: 0.046). The mean age was 26.3. The rate of depressed fractures was higher the age groups of 0-30 years. (chi2: 16.28, df: 4, p: 0.003). Depressed fractures in the regions of frontal and parietal and, linear fracture in the regions of temporal and occipital were found at higher rates (P < 0.001). In conclusion, we reviewed skull fractures and/or intracranial lesions due to traffic accidents, and found depressed fractures to be more common among males whereas linear fractures to be more common among females and young males. In the male, the skull architecture is thicker and stronger than females and young males. We can state that presence of skull fractures lowers the incidence of intracranial lesions by lowering the intracranial pressure.
本研究旨在探讨头部受伤后颅骨骨折与颅内病变之间的关系。为此，对1998年至2000年间因交通事故被法院转至伊斯坦布尔法医委员会第三委员会的500例病例进行了回顾性研究。根据颅骨X光片和脑部断层扫描结果，将他们分为3组。1-颅骨骨折且伴有脑部病变的病例；2-颅骨骨折但无脑部病变的病例；3-有脑部病变但无颅骨骨折的病例。根据年龄、性别、颅骨骨折和脑部病变的部位以及是否进行了手术，对这些病例进行了详细检查。其中，152例（30.4%）仅有线性骨折，69例（13.8%）有凹陷性骨折，92例（18.4%）有线性骨折加颅内病变，49例（9.8%）有凹陷性骨折加颅内病变，138例（27.6%）仅有颅内病变。颅骨骨折病例中颅内病变的发生率为38.9%（141/362），而颅内病变病例中颅骨骨折的发生率为50.3%（141/279）（P<0.001）。线性骨折的男女比例为2.4/1，凹陷性骨折为5.2/1，颅内病变为3.5/1。线性骨折在女性中更为常见，而凹陷性骨折在男性中更为常见（卡方值：9.68，自由度：4，p值：0.046）。平均年龄为26.3岁。0至30岁年龄组的凹陷性骨折发生率较高（卡方值：16.28，自由度：4，p值：0.003）。额叶和顶叶区域的凹陷性骨折以及颞叶和枕叶区域的线性骨折发生率较高（P<0.001）。总之，我们回顾了因交通事故导致的颅骨骨折和/或颅内病变，发现凹陷性骨折在男性中更为常见，而线性骨折在女性和年轻男性中更为常见。在男性中，颅骨结构比女性和年轻男性更厚更强。我们可以说颅骨骨折的存在通过降低颅内压降低了颅内病变的发生率。
