Buhs C, Cullen M, Klein M, Farmer D
Department of General Surgery, Beaumont Hospital, Wayne State University, Detroit, Michigan, USA.
J Pediatr Surg. 2000 Jun;35(6):994-7. doi: 10.1053/jpsu.2000.6951.
BACKGROUND/PURPOSE: The "odontoid view" is a difficult and often hazardous film to obtain in young children. The aim of this study was to determine if the transoral roentgenogram is necessary in the evaluation of the pediatric cervical spine.
A retrospective, multiinstitutional review was performed of all patients 16 years of age and under with documented cervical spine injury in a large metropolitan area during the past decade. Fifty-one children with cervical spine injury were identified from the medical records at 4 hospitals.
The 0- to 8-year-old age group had a significantly higher incidence of upper (occiput to C3) cervical injury than the 9- to 16-year-old age group (67% v 39%; P < .05). In the 0- to 8-year-old group the initial lateral/anteroposterior radiograph made the diagnosis of cervical spine injury in 13 of 15 patients (87%), and in no patients was the transoral odontoid view used to make the diagnosis of cervical spine injury. In only 1 patient in the 9- to 16-year-old age group with a type III odontoid fracture was this view deemed useful. The overall mortality rate in this series was 7.8% with all deaths secondary to associated head injury.
In the 0- to 8-year-old age group in whom the incidence of cervical spine injury is rare but frequently involves the upper cervical spine, the transoral odontoid roentgenogram may be of little value in the evaluation of the spine and should not be considered necessary in "clearing" the pediatric cervical spine. An alternative evaluation of these patients would include an initial lateral and AP radiograph, followed by computed tomography scan.
背景/目的：“齿状突视图”在幼儿中获取困难且往往具有危险性。本研究的目的是确定经口X线片在小儿颈椎评估中是否必要。
对过去十年在一个大城市地区所有记录有颈椎损伤的16岁及以下患者进行回顾性、多机构研究。从4家医院的病历中识别出51例颈椎损伤患儿。
0至8岁年龄组上颈椎（枕骨至C3）损伤的发生率明显高于9至16岁年龄组（67%对39%；P<.05）。在0至8岁组中，最初的侧位/前后位X线片在15例患者中的13例（87%）中做出了颈椎损伤的诊断，且没有患者使用经口齿状突视图来做出颈椎损伤的诊断。在9至16岁年龄组中，只有1例Ⅲ型齿状突骨折患者认为此视图有用。本系列的总死亡率为7.8%，所有死亡均继发于相关的头部损伤。
在颈椎损伤发生率低但常累及上颈椎的0至8岁年龄组中，经口齿状突X线片在脊柱评估中可能价值不大，在“排除”小儿颈椎损伤时不应认为是必要的。对这些患者的另一种评估方法包括最初的侧位和前后位X线片，随后进行计算机断层扫描。
