Dogan Seref, Safavi-Abbasi Sam, Theodore Nicholas, Chang Steven W, Horn Eric M, Mariwalla Nittin R, Rekate Harold L, Sonntag Volker K H
Department of Neurosurgery, Uludag University Faculty of Medicine, Bursa, Turkey.
J Neurosurg. 2007 Jun;106(6 Suppl):426-33. doi: 10.3171/ped.2007.106.6.426.
The authors evaluated the mechanisms and patterns of thoracic, lumbar, and sacral spinal injuries in a pediatric population as well as factors affecting the management and outcome of these injuries.
The records of 89 patients (46 boys and 43 girls; mean age 13.2 years, range 3-16 years) with thoracic, lumbar, or sacral injuries were reviewed. Motor vehicle accidents were the most common cause of injury. Eighty-two patients (92.1%) were between 10 and 16 years old, and seven (7.9%) were between 3 and 9 years old. Patient injuries included fracture (91%), fracture and dislocation (6.7%), dislocation (1.1%), and ligamentous injury (1.1%). The L2-5 region was the most common injury site (29.8%) and the sacrum the least common injury site (5%). At the time of presentation 85.4% of the patients were neurologically intact, 4.5% had incomplete injuries, and 10.1% had complete injuries. Twenty-six percent of patients underwent surgery for their injuries whereas 76% received nonsurgical treatment. In patients treated surgically, an anterior approach was used in six patients (6.7%), a posterior approach in 16 (18%), and a combined approach in one (1.1%). Postoperatively, six patients (26.1%) with neurological deficits improved, one of whom recovered fully from an initially complete injury.
Thoracic and lumbar spine injuries were most common in children older than 9 years. Multilevel injuries were common and warranted imaging evaluation of the entire spinal column. Most patients were treated conservatively. The prognosis for neurological recovery is related to the initial severity of the neurological injuries. Some pediatric patients with devastating spinal cord injuries can recover substantial neurological function.
作者评估了小儿胸、腰和骶部脊柱损伤的机制与模式，以及影响这些损伤治疗和预后的因素。
回顾了89例胸、腰或骶部损伤患者（46例男孩和43例女孩；平均年龄13.2岁，范围3 - 16岁）的记录。机动车事故是最常见的损伤原因。82例患者（92.1%）年龄在10至16岁之间，7例（7.9%）年龄在3至9岁之间。患者损伤包括骨折（91%）、骨折并脱位（6.7%）、脱位（1.1%）和韧带损伤（1.1%）。L2 - 5区域是最常见的损伤部位（29.8%），骶骨是最不常见的损伤部位（5%）。就诊时，85.4%的患者神经功能完整，4.5%有不完全损伤，10.1%有完全损伤。26%的患者因损伤接受了手术治疗，而76%接受了非手术治疗。在接受手术治疗的患者中，6例（6.7%）采用前路手术，16例（18%）采用后路手术，1例（1.1%）采用联合手术。术后，6例（26.1%）有神经功能缺损的患者病情改善，其中1例最初为完全损伤，现已完全恢复。
胸腰椎损伤在9岁以上儿童中最为常见。多节段损伤很常见，需要对整个脊柱进行影像学评估。大多数患者采用保守治疗。神经功能恢复的预后与神经损伤的初始严重程度有关。一些患有严重脊髓损伤的小儿患者可以恢复相当程度的神经功能。
