medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-930medvis-930Research ArticleДЕТСКАЯ РЕНТГЕНОЛОГИЯPEDIATRIC RADIOLOGYКомпьютерная томография при переломах таза у детейComputer and magnetic resonance imaging for pelvic fractures in childrenhttps://orcid.org/0000-0002-2527-2956СероваН. Ю.SerovaN. Yu.

Серова Наталья Юрьевна – кандидат медицинских наук, научный сотрудник НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Natalya Yu. Serova – Cand. of Sci. (Med.), researcher, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

serova_tu@yahoo.comhttps://orcid.org/0000-0002-3235-8854АхадовТ. А.AkhadovT. A.

Ахадов Толибджон Абдуллаевич – доктор медицинских наук, профессор, руководитель отдела лучевых методов диагностики НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Tolibdzhon A. Akhadov –Doct. of Sci. (Med.), Professor, Head of radiology department, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

akhadov@mail.ruhttps://orcid.org/0000-0001-9418-4418КарасеваО. В.KarasevaO. V.

Карасева Ольга Витальевна – доктор медицинских наук, заместитель директора по научной работе, руководитель отдела сочетанной травмы, анестезиологии-реанимации НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Olga V. Karaseva – Doct. of Sci. (Med.), deputy director for research, Head of the Department of Combined Trauma, Anesthesiology and Resuscitation, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

karaseva.o@list.ruhttps://orcid.org/0000-0002-2910-3711МельниковИ. А.Mel'nikovI. A.

Мельников Илья Андреевич – кандидат медицинских наук, врач-рентгенолог НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Ilya A. Mel'nikov – Cand. of Sci. (Med.), radiologist, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

ilyamed@mail.ruhttps://orcid.org/0000-0002-4709-9461БожкоО. В.BozhkoO. V.

Божко Ольга Васильевна – кандидат медицинских наук, ведущий научный сотрудник НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Ol'ga V. Bozhko – Cand. of Sci. (Med.), radiologist, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

bozhko_olga@mail.ruhttps://orcid.org/0000-0001-7407-2515НикишовС. О.NikishovS. O.

Никишов Сергей Олегович – кандидат медицинских наук, заведующий отделением травматологии НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Sergey O. Nikishov – Cand. of Sci. (Med.), Head of Traumatology Department, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

nso.doc@yandex.ruhttps://orcid.org/0000-0003-1260-4509ДмитренкоД. М.DmitrenkoD. M.

Дмитренко Дмитрий Михайлович – заведующий отделением рентгенодиагностики НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Dmitriy M. Dmitrenko – Head of X-ray Department, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

dmitrenich@mail.ruhttps://orcid.org/0000-0001-5022-9952МанжурцевА. В.ManzhurtsevA. V.

Манжурцев Андрей Валерьевич – кандидат физико-математических наук, научный сотрудник НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Andrei V. Manzhurtsev – Cand. of Sci. (Phys.-Math.), researcher, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

andrey.man.93@gmail.comhttps://orcid.org/0000-0001-9862-3609АхлебининаМ. И.AkhlebininaM. I.

Ахлебинина Мария Игоревна – врач-рентгенолог НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Maria I. Akhlebinina – radiologist, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

akhlebinina.m.i@gmail.comhttps://orcid.org/0000-0002-9103-9191КостиковаТ. Д.KostikovaT. D.

Костикова Татьяна Дмитриевна – врач-рентгенолог НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Tatyana D. Kostikova – radiologist, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

kostikovatd@gmail.comhttps://orcid.org/0000-0002-3304-8049СидоровС. В.SidorovS. V.

Сидоров Сергей Владимирович – врач-травматолог НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Sergey V. Sidorov – traumatologist, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

orrng115@rambler.ruhttps://orcid.org/0000-0002-4627-9874УблинскийМ. В.UblinskiyM. V.

Ублинский Максим Вадимович – кандидат биологических наук, научный сотрудник НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Тел.: +7-929-620-21-77

Maxim V. Ublinskiy – Cand. of Sci. (Biol.), researcher, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

Phone: + 7-929-620-21-77

maxublinsk@mail.ruhttps://orcid.org/0000-0003-0387-7046ХусаиноваД. Н.KhusainovaD. N.

Хусаинова Дарья Николаевна – младший научный сотрудник НИИ НДХиТ.

119180 Москва, ул. Большая Полянка, д. 22.

Daria N. Khusainova – junior researcher, CRIEPST.

22, Bolshaya Polyanka str., Moscow, 119180.

dsavina@yandex.ruНИИ неотложной детской хирургии и травматологии ДЗ г. МосквыРоссияClinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST)Russian Federation202112052021254122133Copyright © Серова Н.Ю., Ахадов Т.А., Карасева О.В., Мельников И.А., Божко О.В., Никишов С.О., Дмитренко Д.М., Манжурцев А.В., Ахлебинина М.И., Костикова Т.Д., Сидоров С.В., Ублинский М.В., Хусаинова Д.Н., 20222022Серова Н.Ю., Ахадов Т.А., Карасева О.В., Мельников И.А., Божко О.В., Никишов С.О., Дмитренко Д.М., Манжурцев А.В., Ахлебинина М.И., Костикова Т.Д., Сидоров С.В., Ублинский М.В., Хусаинова Д.Н.Serova N.Y., Akhadov T.A., Karaseva O.V., Mel'nikov I.A., Bozhko O.V., Nikishov S.O., Dmitrenko D.M., Manzhurtsev A.V., Akhlebinina M.I., Kostikova T.D., Sidorov S.V., Ublinskiy M.V., Khusainova D.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/930Введение

Введение. Переломы костей таза у детей редки и составляют от 0,3 до 4% всей детской травмы, 20% детей с политравмой имеют повреждения тазового кольца. Сравнительные исследования диагностических возможностей МРТ и КТ при переломах крестца и вертлужной впадины показали, что при КТ около 37% были пропущены, поэтому авторы рекомендовали МРТ как лучший метод в визуализации переломов таза.

Цель исследования

Цель исследования: показать возможности КТ и МРТ для улучшения распознавания переломов костей таза.

Материал и методы

Материал и методы. В период 2010–2019 гг. исследовано 790 детей с переломами таза в составе политравмы. Возраст детей был от 8,5 до 17 лет, средний 10,14 ± 1,4 года. КТ с трехфазным контрастированием выполнена у всех 790 пострадавших на томографах Brilliance 16. МРТ выполнена (n = 63) на МР-томографе 3 Тл с получением мультипланарных STIR, T1-, T2- и PD взвешенных изображений (ВИ) с фактором подавления сигнала жировой ткани, а также 3D изотропных изображений.

Результаты

Результаты. По шкале тяжести политравмы (ISS) оценка состояния 790 детей колебалась от 23,54 до 27,5 (средняя 25,77) балла. Основным механизмом травмы таза были ДТП (пешеход+пассажир – 63,54% (n = 502)), кататравма была на втором месте – 32,66% (n = 258), далее следовало сдавление – 2,15% (n = 17), спортивная травма – 0,38% (n = 3), прочая травма – 3,43% (n = 27). У 73,26% (n = 578) переломы костей таза были множественными, у 20,5% (n = 162) – осложненными, у 22,3% (n = 176) – нестабильными. У 63 пациентов с повреждением переднего тазового кольца по данным КТ/МРТ в 79,36% (n = 50) обнаружены переломы заднего кольца таза.

Заключение

Заключение. Детям с политравмой обязательно необходимо провести КТ, чтобы исключить не только все немышечно-скелетные повреждения, но и сочетанные переломы таза. Мы считаем, что для обнаружения и оценки переломов костей и сопутствующих повреждений других тканей и органов таза в большинстве случаев многофазная КТ с внутривенным контрастированием является достаточным методом. МРТ важна для оценки структур мягких тканей таза, таких как сухожилия, связки, нервы и фасции, а также выявления скрытых/тонких повреждений костей.

Introduction

Introduction. Fractures of pelvic bones in children are rare and make up from 0.3 to 4% of all childhood trauma, 20% of children with polytrauma have pelvic ring injuries. Comparative studies of diagnostic capabilities of MRI and CT in sacral and acetabular fractures showed that about 37% of CT were missed, therefore the authors recommended MRI as the best method in visualizing pelvic fractures.

Aim of this study is to show the capabilities of CT and MRI to improve recognition of pelvic fractures.

Material and methods

Material and methods. In the period 2010–2019, 790 children with pelvic fractures as part of polytrauma were studied. The age of children was from 8.5 to 17 years, average 10.14 ± 1.4. Computed tomography with three-phase contrast was performed in all 790 patients on Brilliance 16 scanners. MRI was performed (n = 63) on a 3 T tomograph with obtaining multiplanar STIR, T1-, T2- and PD weighted images (VI) with signal suppression factor of adipose tissue, as well as 3D isotropic images.

Results

Results. On the polytrauma severity scale (ISS), the assessment of the condition of 790 children ranged from 23.54 to 27.5 (mean 25.77) points. The main mechanism of pelvic injury was road traffic accidents (pedestrian + passenger – 63.54% (n = 502), catatrauma was in second place – 32.66% (n = 258), followed by compression – 2.15% (n = 17) , sports injury – 0.38% (n = 3), other injury – 3.43% (n = 27). 73.26% (n = 578) had multiple pelvic fractures, 20.5% (n = 162) – complicated, – 22.3% (n = 176) unstable In 63 patients with damage to the anterior pelvic ring, according to CT, MRI revealed fractures of the posterior pelvic ring in 79.36% (n = 50).

Conclusion

Conclusion. Children with polytrauma must undergo computed tomography to exclude not only all non-muscular-skeletal injuries, but also combined pelvic fractures. We believe that for the detection and assessment of bone fractures and concomitant injuries of other tissues and organs of the pelvis, in most cases, multiphase CT with intravenous contrast is a sufficient method. MRI is important for evaluating pelvic soft tissue structures such as tendons, ligaments, nerves and fascia, as well as detecting hidden / fine bone lesions.

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The authors declare that there are no conflicts of interest present.