Platzer Patrick, Jaindl Manuela, Thalhammer Gerhild, Dittrich Stefan, Kutscha-Lissberg Florian, Vecsei Vilmos, Gaebler Christian
Department of Traumatology, University of Vienna Medical School, Vienna, Austria.
J Trauma. 2007 Feb;62(2):389-96; discussion 394-6. doi: 10.1097/01.ta.0000221802.83549.46.
Cervical spine injuries are uncommon in pediatric trauma patients. Previous studies were often limited by the small numbers of patients available for evaluation. The aim of this study was to determine the incidence and characteristics of pediatric cervical spine injuries at this Level 1 trauma center and to review the authors' experiences with documented cases.
This study retrospectively analyzed the clinical records of all pediatric trauma patients with skeletal and/or nonskeletal injuries of the spine that were admitted to this Level 1 trauma center between 1980 and 2004. Those with significant injuries of the cervical spine were identified and included in this study. Pediatric patients were defined as patients younger than the age of 17 years. In addition, they were stratified by age into two study groups: group A included patients aged 8 years or fewer and group B contained patients from the ages of 9 to 16 years.
We found 56 pediatric patients with injuries of the cervical spine that met criteria for inclusion. Thirty-one female and 25 male patients with an average age of 8.9 years (range, 1-16 years) sustained significant skeletal and/or nonskeletal injuries of the cervical spine and were entered in this study. Thirty patients (54%) were aged 8 years or fewer and entered into study group A, whereas 26 patients (46%) from the ages of 9 to 16 met criteria for inclusion in study group B. An analysis of data revealed that younger patients (group A) showed significantly more injuries of the upper cervical spine, whereas older children (group B) sustained significantly more injuries of the lower level. Spinal cord injuries without radiographic findings were only found in study group A. In addition, younger children were more likely injured by motor vehicle crashes, whereas older children more commonly sustained C-spine injuries during sports activities. Two-thirds of our patients showed neurologic deficits, and the overall mortality was 28%.
The results of our study were similar to several previous reports, underscoring a low incidence (1.2%) and age-related characteristics. Younger children had a predilection for injuries of the upper cervical spine, whereas children in the older age group sustained significantly more injuries of the lower cervical spine. Spinal cord injuries without radiographic abnormalities were only seen in the younger age group. Despite the low incidence of cervical spine injuries in pediatric patients, increased efforts at prevention are demanded because mortality rate (27%) and incidence of neurologic deficits (66%) were dreadfully high in our series.
颈椎损伤在小儿创伤患者中并不常见。以往的研究往往因可供评估的患者数量较少而受到限制。本研究的目的是确定该一级创伤中心小儿颈椎损伤的发生率和特征，并回顾作者对已记录病例的经验。
本研究回顾性分析了1980年至2004年间入住该一级创伤中心的所有患有脊柱骨骼和/或非骨骼损伤的小儿创伤患者的临床记录。确定那些颈椎有严重损伤的患者并纳入本研究。小儿患者定义为年龄小于17岁的患者。此外，他们按年龄分为两个研究组：A组包括8岁及以下的患者，B组包含9至16岁的患者。
我们发现56例小儿颈椎损伤患者符合纳入标准。31例女性和25例男性患者，平均年龄8.9岁（范围1 - 16岁），颈椎遭受了严重的骨骼和/或非骨骼损伤并纳入本研究。30例患者（54%）年龄在8岁及以下，进入研究组A，而26例年龄在9至16岁的患者符合纳入研究组B的标准。数据分析显示，年龄较小的患者（A组）上颈椎损伤明显更多，而年龄较大的儿童（B组）下颈椎损伤明显更多。无放射学异常的脊髓损伤仅在研究组A中发现。此外，年龄较小的儿童更易因机动车碰撞受伤，而年龄较大的儿童在体育活动中更常发生颈椎损伤。我们三分之二的患者有神经功能缺损，总体死亡率为28%。
我们的研究结果与之前的几份报告相似，强调了低发生率（1.2%）和与年龄相关的特征。年龄较小的儿童易患上颈椎损伤，而年龄较大的儿童下颈椎损伤明显更多。无放射学异常的脊髓损伤仅在较年轻的年龄组中出现。尽管小儿患者颈椎损伤的发生率较低，但仍需要加大预防力度，因为在我们的系列研究中死亡率（27%）和神经功能缺损的发生率（66%）非常高。
