Beaunoyer M, St-Vil D, Lallier M, Blanchard H
Division of General Paediatric Surgery, Ste-Justine Hospital, Montreal, Quebec, Canada.
J Pediatr Surg. 2001 May;36(5):760-2. doi: 10.1053/jpsu.2001.22954.
The goal of the current study was to evaluate the risk of intraabdominal injury in children who sustained spinal fractures in a motor vehicle collision (MVC).
Between 1980 and 1999, 48 patients, 24 girls and 24 boys, with a mean age of 12.8 years (range, 4 to 17) were reviewed. Twenty-nine were rear seat passengers, 12 front seat, and 7 unknown. Fifty-eight percent wore a seat belt. Thirty fractures involved the lumbar spine, 12 the thoracic, and 6 combined. Computed tomography (CT) scan, abdominal ultrasound, and peritoneal lavage were used to screen for abdominal injuries.
Twenty-two of 48 patients had an intraabdominal injury. Eighteen (38%) required an early (<24 hours; n = 12) or delayed (n = 6) therapeutic laparotomy. Fourteen patients were rear seat passengers, 15 wore a seat belt, and 13 had an abdominal wall ecchymoses (AWE). They were 17 lumbar fractures (13 Chance) and one thoracic. The most common findings at laparotomy were hollow viscus injury (n = 12), mesenteric tear (n = 9), and solid organ injury (n = 8). Seventy-two percent of patients presenting with a lumbar fracture and AWE needed a therapeutic laparotomy. The overall survival rate was 98% with only 1 death. The mean hospital stay was 22.4 days. In this study, 38% of patients presenting with a spinal fracture required laparotomy, 68% of whom had simultaneous lumbar fracture and AWE.
In light of these results, the authors propose that laparoscopy or laparotomy should be strongly considered in patients sustaining lumbar fracture and AWE after MVC. J Pediatr Surg 36:760-762.
本研究的目的是评估在机动车碰撞（MVC）中发生脊柱骨折的儿童发生腹腔内损伤的风险。
回顾了1980年至1999年间的48例患者，其中24名女孩和24名男孩，平均年龄12.8岁（范围4至17岁）。29名是后排乘客，12名是前排乘客，7名情况不明。58%的患者系了安全带。30处骨折累及腰椎，12处累及胸椎，6处为联合骨折。采用计算机断层扫描（CT）、腹部超声和腹腔灌洗来筛查腹部损伤。
48例患者中有22例发生腹腔内损伤。18例（38%）需要早期（<24小时；n = 12）或延迟（n = 6）治疗性剖腹手术。14例患者是后排乘客，15例系了安全带，13例有腹壁瘀斑（AWE）。有17例腰椎骨折（13例Chance骨折）和1例胸椎骨折。剖腹手术中最常见的发现是中空脏器损伤（n = 12）、肠系膜撕裂（n = 9）和实体脏器损伤（n = 8）。出现腰椎骨折和AWE的患者中有72%需要治疗性剖腹手术。总体生存率为98%，仅1例死亡。平均住院时间为22.4天。在本研究中，38%的脊柱骨折患者需要剖腹手术，其中68%同时有腰椎骨折和AWE。
鉴于这些结果，作者建议对于MVC后发生腰椎骨折和AWE的患者应强烈考虑腹腔镜检查或剖腹手术。《小儿外科杂志》36:760 - 762。
