Dogan Seref, Safavi-Abbasi Sam, Theodore Nicholas, Horn Eric, Rekate Harold L, Sonntag Volker K H
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Neurosurg Focus. 2006 Feb 15;20(2):E1. doi: 10.3171/foc.2006.20.2.2.
In this study the authors evaluated the mechanisms and patterns of injury and the factors affecting management and outcome of pediatric subaxial cervical spine injuries (C3-7).
Fifty-one pediatric patients (38 boys and 13 girls; mean age 12.4 years, range 10 months-16 years) with subaxial cervical spine injuries were reviewed retrospectively. Motor vehicle accidents (MVAs) were the most common cause of injury. Overall, 12% presented with a dislocation, 63% with a fracture, 19% with a fracture-dislocation, and 6% with a ligamentous injury. The most frequently injured level was C6-7 (33%); C3-4 (6%) was least frequently involved. Sixty-four percent of patients were neurologically intact, 16% had incomplete spinal cord injuries (SCIs), 14% had complete SCIs, and three patients (6%) died after admission and before assessment. Treatment was conservative in 64%: seven (13%) wore a halo vest and 26 (51%) wore a rigid cervical orthosis. Surgery was performed in the other 18 patients (36%), with the breakdown as follows: 15 (30%) underwent an anterior approach, two (4%) had posterior approaches, and one (2%) had a combined approach. Postoperatively, four patients (8% who had a neurological deficit improved. The overall mortality rate was 8%; all deaths were related to MVAs. There were no surgery-related deaths or complications.
Subaxial cervical spine injuries are common in children 9 to 16 years of age, and occur principally between C-5 and C-7. Multilevel injury is more common in children 8 years of age and older than in younger children and infants. Most patients with subaxial cervical spine injuries can be treated conservatively. Both anterior and posterior approaches are safe and effective.
在本研究中，作者评估了小儿颈椎下节段损伤（C3 - 7）的损伤机制、模式以及影响治疗和预后的因素。
回顾性分析51例颈椎下节段损伤的小儿患者（38例男孩和13例女孩；平均年龄12.4岁，范围10个月至16岁）。机动车事故（MVA）是最常见的损伤原因。总体而言，12%表现为脱位，63%为骨折，19%为骨折脱位，6%为韧带损伤。最常受伤的节段是C6 - 7（33%）；C3 - 4（6%）受累最少。64%的患者神经功能完整，16%有不完全脊髓损伤（SCI），14%有完全性SCI，3例患者（6%）在入院后至评估前死亡。64%的患者接受保守治疗：7例（13%）佩戴头环背心，26例（51%）佩戴硬质颈椎矫形器。另外18例患者（36%）接受了手术，具体情况如下：15例（30%）采用前路手术，2例（4%）采用后路手术，1例（2%）采用联合手术。术后，4例（8%）有神经功能缺损的患者病情改善。总体死亡率为8%；所有死亡均与机动车事故有关。无手术相关死亡或并发症。
颈椎下节段损伤在9至16岁儿童中常见，主要发生在C - 5和C - 7之间。8岁及以上儿童的多节段损伤比年幼儿童和婴儿更常见。大多数颈椎下节段损伤患者可采用保守治疗。前路和后路手术均安全有效。
