Subotic U, Holland-Cunz S, Bardenheuer M, Loff S, Wessel L M
Department of Pediatric Surgery, University of Berne, Switzerland.
Eur J Pediatr Surg. 2007 Jun;17(3):207-9. doi: 10.1055/s-2007-965142.
We report on a 9-year-old girl who was involved in a car accident. She suffered severe polytrauma with torn abdominal muscles, rupture of the mesenteric arteries, bowel and bladder, hematoma at the right colonic flexure and disruption of the intervertebral ligaments L2/L3, including the intervertebral disc, typical of Chance fracture. The abdominal bleeding was stopped, the bowel resected and the fracture fixed by internal fixation. The patient developed a postoperative enterocutaneous fistula in the right flank and paraplegia. She underwent three laparotomies with ileostomy and closure of the fistula. Two years later, she has normal bowel movement, the wounds are closed, the internal fixation has been removed, she is able to walk with crutches and suffers from a mild bladder dysfunction. Chance fracture is a typical fracture in adults involved in motor vehicle accidents. In the last 10 years, there have only been four case reports describing this fracture in children under the age of 10. All of these individuals were involved in a car accident and had been fixed with a lap belt. With the increasing use of lap belts, this fracture has to be considered even in young children. Mild clinical symptoms can be associated with severe intra-abdominal injuries.
我们报告一名9岁女童，她遭遇了一场车祸。她遭受了严重的多发伤，包括腹部肌肉撕裂、肠系膜动脉破裂、肠管和膀胱破裂、右结肠曲部血肿以及L2/L3椎间韧带（包括椎间盘）断裂，这是典型的Chance骨折。腹部出血得到控制，切除了肠管，并通过内固定术固定了骨折部位。患者术后出现右侧腰腹部肠皮肤瘘和截瘫。她接受了三次剖腹手术，进行了回肠造口术并关闭了瘘口。两年后，她排便正常，伤口愈合，内固定已取出，能够借助拐杖行走，并且存在轻度膀胱功能障碍。Chance骨折是成人机动车事故中的典型骨折。在过去10年中，仅有4例病例报告描述了10岁以下儿童的这种骨折。所有这些儿童都遭遇了车祸，并使用了安全带固定。随着安全带使用的增加，即使是幼儿也必须考虑到这种骨折。轻微的临床症状可能与严重的腹部内伤相关。
