Ochalski Pawel G, Adamo Matthew A, Adelson P David, Okonkwo David O, Pollack Ian F
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Neurosurg Pediatr. 2011 Mar;7(3):261-7. doi: 10.3171/2010.12.PEDS10190.
Fractures of the clivus and traumatic diastases of the clival synchondroses are rare in the pediatric population. The incidence, outcome, and biomechanics associated with these fractures have been difficult to ascertain secondary to the lack of literature pertaining to their occurrence.
A Boolean search of the electronic medical record database at the Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, was performed to identify patients with fractures of the clivus that were diagnosed using CT of the head. A retrospective review of the chart and radiographic imaging was then performed to assess data regarding patient demographics, mechanism of injury, and skull and brain parenchymal injuries, as well as outcomes.
Between May 2002 and November 2007, 16 patients with fractures of the clivus were identified. The mean age of these patients was 9 years (range 1-16 years). Eleven (68.8%) of the 16 patients had an associated traumatic diastasis of the central skull base. Five (31.3%) of the 16 patients died. However, of the 11 patients who survived, all had a good outcome with a Glasgow Outcome Scale score of 4 or 5 at the time of discharge. The incidence of clival fractures among patients with head injuries was 0.33%.
Clival fractures occur with a similar incidence in both the pediatric and adult trauma population. Outcome is not correlated directly with the extent of clival fracture, but rather with the presenting Glasgow Coma Scale score and concomitant brain parenchymal injuries. The identification of traumatic diastases in patients with clival fractures suggests that static loading forces are a significant factor in the biomechanics producing these types of fractures.
斜坡骨折和斜坡软骨结合部外伤性分离在儿科人群中较为罕见。由于缺乏有关其发生情况的文献，这些骨折的发病率、预后及生物力学情况难以确定。
对匹兹堡大学医学中心匹兹堡儿童医院的电子病历数据库进行布尔检索，以识别通过头部CT诊断为斜坡骨折的患者。然后对病历和影像学资料进行回顾性分析，以评估患者人口统计学、损伤机制、颅骨和脑实质损伤以及预后等数据。
2002年5月至2007年11月期间，共识别出16例斜坡骨折患者。这些患者的平均年龄为9岁（范围1 - 16岁）。16例患者中有11例（68.8%）伴有中央颅底外伤性分离。16例患者中有5例（31.3%）死亡。然而，在存活的11例患者中，所有患者出院时格拉斯哥预后量表评分为4或5，预后良好。头部受伤患者中斜坡骨折的发生率为0.33%。
斜坡骨折在儿科和成人创伤人群中的发生率相似。预后与斜坡骨折的程度无直接相关性，而是与入院时格拉斯哥昏迷量表评分及伴随的脑实质损伤有关。斜坡骨折患者中发现外伤性分离提示静态负荷力是产生这类骨折生物力学的一个重要因素。
