Stacey Stephen, Forman Jason, Woods William, Arbogast Kristy, Kent Richard
Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia 22902, USA.
J Trauma. 2009 Dec;67(6):1278-83; discussion 1283. doi: 10.1097/TA.0b013e3181b57ab8.
Abdominal injuries can occur in children wearing adult seat belts during motor vehicle crashes. The particular anatomic structures injured may depend on the position of the seat belt, but this relationship has never been quantified in a controlled setting.
Thirty-four dynamic tests, designed to replicate crash loading, were performed on a validated porcine model of the 6-year-old human abdomen. The lap belt was positioned initially at either an "upper" or "lower" location on the abdomen. Detailed posttest necropsies identified all resulting injuries, which were then correlated to the initial position of the seat belt. The utility of using the presence or absence of an abdominal abrasion to predict internal abdominal injuries was also investigated.
The injury frequency distributions from upper and lower abdominal belt loading were found to be significantly different (p < 0.01). Upper abdominal loading most commonly produced splenic lacerations and rib fractures, whereas lower abdominal loading resulted primarily in injuries to the large and small intestines. The presence of an abdominal abrasion was found to be a fairly specific (Sp = 0.86) but not very sensitive (Sn = 0.33) predictor of internal injuries of moderate severity.
The relative frequency of each injury coupled with the presence or absence of an abdominal abrasion ("seat belt sign") should aid clinicians during their evaluations of children involved in motor vehicle crashes with possible occult abdominal trauma. In addition, the presence of a seat belt sign may have greater utility ruling in potentially occult abdominal injuries rather than excluding them.
在机动车碰撞事故中，佩戴成人安全带的儿童可能会发生腹部损伤。受伤的特定解剖结构可能取决于安全带的位置，但这种关系从未在可控环境中进行过量化。
在一个经过验证的6岁儿童腹部猪模型上进行了34次旨在模拟碰撞负荷的动态测试。安全带最初放置在腹部的“上部”或“下部”位置。详细的测试后尸检确定了所有由此产生的损伤，然后将这些损伤与安全带的初始位置相关联。还研究了利用腹部擦伤的有无来预测腹部内部损伤的效用。
发现上腹部和下腹部安全带负荷的损伤频率分布有显著差异（p < 0.01）。上腹部负荷最常见的是脾破裂和肋骨骨折，而下腹部负荷主要导致大肠和小肠损伤。发现腹部擦伤的存在是中度严重程度内部损伤的一个相当特异（Sp = 0.86）但不太敏感（Sn = 0.33）的预测指标。
每种损伤的相对频率以及腹部擦伤（“安全带征”）的有无，应有助于临床医生在评估涉及可能有隐匿性腹部创伤的机动车碰撞事故儿童时做出判断。此外，安全带征的存在可能在判定潜在隐匿性腹部损伤方面比排除这些损伤更有用。
