Iskhakov O S, Shipilevskiĭ V M, Aliab'ev V N, Shipuleva I V
Zh Vopr Neirokhir Im N N Burdenko. 2005 Jul-Sep(3):8-13; discussion 13.
Clinical and computed tomographic comparisons were made in 590 children with mild brain injury (BI). The children admitted for BI of 13-15 scores assessed by the Glasgow coma scale (GCS) in the first hour after injury were examined. They all underwent brain computed tomography (CT), skull X-ray study, and neurological studies. Their history data were analyzed. 73% of the children were admitted within the first 12 hours following injury. Falling from the growth height was mainly responsible for BI (45.2%). The frequency of the CT signs of BI was 36.3%. Surgical treatment was required in 5.8% of the children; among them 4.4% and 1.4% were operated on for depressed fractures and intracranial hematomas, respectively. A relationship was found between the presence of the CT signs of BI and the GCS scores on admission. With 15 and 13 GCS scores, the positive CT pattern was detected in 16 and 70% of cases. Well-defined focal neurological symptoms and multiple vomiting (38 and 57%, respectively) are predictors of acute pathology on a CT scan. X-ray skull fracture increases the likelihood of CT pathology up to 62%. Consciousness disturbance of as high as 13-14 GCS score concurrent with noticeable neurological symptoms and skull fracture increases the probability of the positive CT pattern up to 93%. X-ray and CT studies did not reveal acute traumatic injuries when there were traces of skull injury in the presence of clear consciousness and in the absence of vomiting.
对590名轻度脑损伤(BI)儿童进行了临床和计算机断层扫描比较。对受伤后第一小时内根据格拉斯哥昏迷量表(GCS)评分为13 - 15分的BI患儿进行了检查。他们均接受了脑部计算机断层扫描(CT)、颅骨X线检查和神经学检查。对他们的病史数据进行了分析。73%的儿童在受伤后的前12小时内入院。从生长高度跌落是导致BI的主要原因(45.2%)。BI的CT征象出现频率为36.3%。5.8%的儿童需要手术治疗;其中分别有4.4%和1.4%因凹陷性骨折和颅内血肿接受手术。发现BI的CT征象与入院时的GCS评分之间存在关联。GCS评分为15分和13分时,CT阳性表现分别在16%和70%的病例中被检测到。明确的局灶性神经症状和多次呕吐(分别为38%和57%)是CT扫描显示急性病变的预测指标。颅骨X线骨折使CT显示病变的可能性增加至62%。GCS评分为13 - 14分的意识障碍,同时伴有明显神经症状和颅骨骨折,使CT阳性表现的概率增加至93%。当意识清醒且无呕吐但存在颅骨损伤痕迹时,X线和CT检查未发现急性创伤性损伤。