Biomechanics of Pediatric Head Injury

头部损伤是导致儿童死亡和后天残疾的主要原因。然而，儿科颅脑损伤的生物力学机制却知之甚少，这主要是由于缺乏关于未成熟组织的力学特性及其对特定载荷的反应的特定年龄数据。拟议的跨学科研究计划旨在回答以下问题：什么机制会导致什么年龄段的儿童受到什么伤害？拟议研究计划的长期目标是确定头骨和大脑的机械特性，它们可以安全地承受的负荷，以及婴儿(不到3个月)和幼儿(1-3岁)原发脑损伤的独特机制。通过这样做，拟议的研究计划的长期影响将是为加强针对婴幼儿的创伤性头部损伤预防、检测和治疗战略开辟道路。本课程将探讨脑损伤的接触性和非接触性机制。研究计划使用综合生物工程方法，包括动物实验、人类和动物组织测试、临床研究和拟人代用品，所有这些都辅之以数学模型：A)测量急性神经、血管和血脑屏障损伤的儿科组织损伤阈值B)测量儿科头骨和脑组织的力学特性C)使用(A)和(B)D)为婴幼儿头部损伤创建计算模型(A)和(B)D)定性验证计算模型预测与目睹儿童意外头部损伤E)测量拟人代用品在跌倒、摇晃、和施加的撞击F)确定冲击力和惯性载荷在原发脑损伤病因中的相对作用G)将计算模拟与急性临床数据进行比较以推断非意外头部损伤的潜在损伤机制。拟议研究计划的总体假设是：1)颅骨骨折和组织损伤的阈值以及脑和颅骨的机械特性随着年龄的变化而变化，从而导致婴幼儿和蹒跚学步的儿童之间的原发头部损伤的差异；2)婴儿头骨的顺应性增加导致撞击伤造成更大的脑组织损伤；3)可以创建有效的计算模型来预测特定的已报告机制导致的特定的原发损伤。

Head injury is a leading cause of death and acquired disability in childhood. However, the biomechanics of pediatric head injury are poorly understood, primarily due to, the paucity of age-specific data regarding mechanical properties of immature tissue and its response to specific loads. The interdisciplinary proposed research plan is designed to answer the following question: What mechanisms cause what injuries in children of what age? The long-term objectives of the proposed research plan are to determine mechanical properties of the skull and brain, the loads they can withstand safely, and unique mechanisms for primary brain injury in infants (less than 3 months) and young children (1-3 years). In so doing, the long term impact of proposed research plan will be to open pathways for enhanced traumatic head injury prevention, detection, and treatment strategies specific to infants and toddlers. Both contact and non-contact mechanisms of brain injury will be investigated. The research plan uses an integrated bioengineering approach consisting of animal experiments, human and animal tissue tests, clinical studies, and anthropomorphic surrogates, all complemented by mathematical models to: A) measure pediatric tissue injury thresholds for acute neural, vascular, and blood-brain barrier damage B) measure pediatric skull and brain tissue mechanical properties C) create computational models for infant and toddler head injury using (A) and (B) D) qualitatively validate the computational model predictions with witnessed accidental head injuries in children E) measure loads experienced anthropomorphic surrogates during falls, shakes, and inflicted impacts F) determine the relative roles of impact forces and inertial loads in the etiology of primary brain injuries G) compare the computational simulations with acute clinical data to infer potential mechanisms of injury in non-accidental head injury. The overall hypotheses of the proposed research program are that 1) thresholds for skull fracture and tissue injury and mechanical properties of the brain and skull vary with age, such that both contribute to differences in primary head injuries between infants and toddlers, and 2) the increased compliance of the infant skull results in greater brain tissue injury from impact trauma; and 3) a valid computational model can be created to predict specific primary injuries resulting from a given reported mechanism.