Cranial cerebral trauma associated with fractures of the tubular bones in children Diagnostic algorithm optimization
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StatusThe thesis was presented on the 20 June, 2007Approved by NCAA on the 20 September, 2007 Abstract – 0.91 Mb / in romanianThesisCZU [616.831+616.717+616.718]-001-07
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Keywords
transcranian ultrasonography, skeletar ultrasonography, diagnostic algorithms.Summary
CCT associated with fractures of the tubular bones in children is one of the severest type of childhood trauma. According to the official statistic data, the frequency of this trauma type is 25% to 40% of the total number.
In the same time, even in our days there is not a unique scientific research that would explain the major risks of complications appearance, regarding the isolated CCT or associated with other types of injuries.
The anatomic and physiologic features of the growing organism make the diagnosis and treatment of the cranial injuries more difficult, especially if they are associated with other types of injuries.
A lot of information has been collected in the world literature concerning the diagnosis and treatment of the CCT associated with fractures of the tubular bones in children. In spite of that a lot of aspects of this remain untreated. First of all this refers to the dominant injury, establishment of the optimal terms and the volume of the surgical intervention that depends on the relation between CCT gravity and the extracranial injuries.
The present research was made on 194 cases, hospitalized at the Scientifical-Practical National Center of Pediatric Surgery “Natalia Gheorghiu” of the Scientifical Research Institute of Mother’s and Child Health Care during 1995-2006. From the total number: 104 children presented with CCT associated with fractures of the tubular bones, 50 with isolated CCT and 40 with fractures of the tubular bones.
As a result of this research were established the optimal criteria of the diagnosis tactic used in patients with cranial cerebral trauma, associated with fractures of the tubular bones, based on their practical use, sufficiency and minimal invasively, paraclinical tests promptness and results collection, no special prepare of the patient for the investigations, minimal expanses and the presence of the “apparatus to the patient” principle.
The study of ultrasound possibilities regarding detection of the cranial and extracranial components of the trauma, also the comparative analyses of traditional and proposed diagnosis algorithm, shows that one of the way of this algorithm improvement concerning cranial cerebral trauma, associated with fractures of the tubular bones in children, is the use of ultrasound.
Ultrasound is being used for the diagnosis and monitoring of the traumatic intracranial changes, the associated non traumatic lesions and the structural changes of the traumatized tubular bones. Also it insures a qualitative intra and postoperatory monitoring.
The implementation of the proposed algorithm insures the possibility of an adequate monitoring of intracerebral changes and fractures of the tubular bones in children in case of associated trauma. The diagnose can be established by the clinical doctor during the patient’s visit.
The use of the presented algorithm in cranial cerebral trauma, associated with fractures of the tubular bones diagnose in children allows a decrease of the error number along with useless hospitalizations and a shortened period of the patient’s presence in the hospital, decrease use of CT and MRI, concerning the radiation load and a decreased index of mortality.
The practical value of this work are ultrasound images of different traumatic intracranial end extracranial changes, along with their description, collected as a result of the present research.
Oficial Reviewers
- Vasile Burunsus
doctor - Iurii Orlov
doctor habilitat în medicină, profesor, Kiev, Ucraina
Theses
