Achildi Olga, Betz Randal R, Grewal Harsh
Section of Pediatric Surgery, Department of Surgery, Temple University School of Medicine and Temple University Children's Medical Center, Philadelphia, Pennsylvania 19140, USA.
J Spinal Cord Med. 2007;30 Suppl 1(Suppl 1):S21-4. doi: 10.1080/10790268.2007.11753964.
BACKGROUND/OBJECTIVE: Approximately 250,000 patients are presently living with spinal cord injury (SCI) in the United States. Approximately 20% of patients with SCI are less than 20 years old, and 15% are less than 15 years old. The most common cause of pediatric SCI is a motor vehicle collision (MVC; approximately 40%); lapbelt injuries and the seatbelt syndrome are seen more often in children involved in MVCs.
A search and analysis of current literature on lapbelt injuries, seatbelt syndrome, and pediatric SCI using PubMed.
Children involved in MVCs who are improperly restrained are at higher risk of sustaining injuries. The risk of significant intra-abdominal injuries is increased almost fourfold in these children. Presence of abdominal wall ecchymosis (AWE) was associated with intra-abdominal injuries in up to 84% of children, with hollow viscus injury being the most common. Likewise, presence of AWE is associated with vertebral fractures, including Chance fractures, in up to 50% of patients. Vertebral fractures were associated with SCI in up to 11%. The presence of AWE in an improperly restrained child should warrant a thorough search for intra-abdominal injuries, vertebral fractures, and SCI.
Lapbelt injuries and the seatbelt syndrome are often associated with pediatric SCI in improperly restrained children. This injury complex and its associated abdominal injuries are difficult to diagnose unless a high index of suspicion is maintained; delay in diagnosis increases morbidity, and early surgical intervention should be considered.
背景/目的：目前美国约有25万名脊髓损伤（SCI）患者。约20%的脊髓损伤患者年龄小于20岁，15%的患者年龄小于15岁。小儿脊髓损伤最常见的原因是机动车碰撞（MVC；约40%）；安全带损伤和安全带综合征在涉及机动车碰撞的儿童中更为常见。
使用PubMed对当前关于安全带损伤、安全带综合征和小儿脊髓损伤的文献进行检索和分析。
在机动车碰撞中未得到妥善约束的儿童受伤风险更高。这些儿童发生严重腹部内损伤的风险几乎增加四倍。高达84%的儿童中，腹壁瘀斑（AWE）的出现与腹部内损伤相关，其中中空脏器损伤最为常见。同样，高达50%的患者中，AWE的出现与椎体骨折（包括Chance骨折）相关。椎体骨折与脊髓损伤的关联率高达11%。对于未得到妥善约束且出现AWE的儿童，应全面检查是否存在腹部内损伤、椎体骨折和脊髓损伤。
在未得到妥善约束的儿童中，安全带损伤和安全带综合征常与小儿脊髓损伤相关。除非保持高度怀疑指数，否则这种损伤复合体及其相关的腹部损伤很难诊断；诊断延迟会增加发病率，并应考虑早期手术干预。
