儿童与成人急性颅脑外伤类型在CT检出率中的差异性初步分析

Preliminary analysis of the differences of the children and adult patients with acute craniocerebral trauma types in CT detection rate

目的分析儿童与成人急性颅脑外伤类型在CT检出率中的差异性及其原因。方法回顾性分析2011年4月至2012年5月到川医学院附属医院就诊且有完整资料的儿童（儿童组）和成人（成人组）急性颅脑外伤患者285例，分析颅骨骨折、颅内脑外血肿、蛛网膜下腔出血、脑室系统出血、脑内血肿、脑挫裂伤及合并两种（含两种）以上征象的病例数，对两组间各征象的例数比较采用，检验，其中当频率〈1时用Fisher精确概率法检验。结果儿童组的颅骨骨折检出率83．6％（92／110）明显高于成人组的72．6％（127／175），且组间差异有统计学意义（χ^2=4．647，P〈0．05）；儿童组的颅内脑外血肿、蛛网膜下腔出血、脑内血肿、脑挫裂伤及合并两种（含两种）以上损伤的检出率分别为40．9％（45／110）、15．5％（17／110）、5．5％（6／110）、40．9％（45／110）及57．3％（63／110）明显低于成人组的53．7％（94／175）、42．9％（75／175）、13．1％（23／175）、54．3％（95／175）及70．3％（123／175），且组间差异均有统计学意义（χ^2=4．433—23．201，P〈0．05）；儿童组的脑室系统出血检出率0（0／110）低于成人组的3．4％（6／175），但组间差异无统计学意义（χ^2=4．368，P〉0．05）。结论儿童以其自身特有的解剖学、生理病理、受伤方式及受力大小等因素，使得其在急性颅脑外伤时的脑外伤类型的CT检出率与成人比较具有一定差异性。

Objective To analyze the difference of CT detection rate between children and adults with different types of acute cranioeerebral trauma,and explore the reasons of the difference. Methods Data of 285 patients of hospitalized children（ children group） and adults （adult group） with acute cranio-cerebral trauma during April 2011 to May 2012 in the Affiliated Hospital of North Sichuan Medical College were retrospectively analyzed. The cases of the skull fracture, intracranial and outside the brain hematoma （subdural hematoma, Epidural hematoma and Mixed hematoma）, subaraehnoid hemorrhage, intraventrieular hemorrhage,intracerebral hematoma, cerebral contusion and the cases with more than two （including two） symptoms above were analyzed, and the cases with different types of symptoms between groups were compared statistically by chi-square test or Fisher exact probability method test. Results The skull fracture detection rate of children group （83.6%, 92/110 ）was higher than that of adult group （72. 6%, 127/175 ）, and there was statistically significant difference between the two groups （χ^2 = 4.467, P 〈 0. 05 ）. The detection rate of intracranial hematoma, subarachnoid hemorrhage, intracerebral hematoma, cerebral contusion and the cases with more than two （including two）symptoms above in children group [ 40. 9 % （45/110 ）, 15. 5 % （17/110 ）, 5.5% （6/110） ,40. 9% （45/110） and 57. 3% （63/110） ] was less than that of the adult group[53.7% （94/ 175）, 42. 9% （75/175）, 13.1% （23/175）, 54. 3% （ 95/175 ） and 70. 3% （ 123/175 ） ], and there was statistically significant difference between the two groups （χ^2 = 4.433-23. 201, all P 〈 0. 05 ）. The detection rate of intraventricular hemorrhage in children group （0,0/110） was less than that of adult group （3.4% ,6/ 175 ）, but there was no statistically significant difference between the two groups （P 〉 0. 05 ）. Conclusion There are certain differences in the CT detection rate between children and adult with acute cranio-cerebral trauma for children＇s unique anatomy, physiology and pathology, injured way and stress factors such as size.