Department of Trauma Surgery, Medical University Vienna, Vienna, Austria. marcus.hofbauer)medunwien.ac.at
J Trauma Acute Care Surg. 2012 Jul;73(1):156-61. doi: 10.1097/TA.0b013e31824e32b5.
Spine injuries, a common component in polytrauma, are relatively rare in pediatric patients. Previous studies mainly described injuries to the cervical region, whereas information of injury patterns to the thoracic and lumbosacral region lack in the current literature. The aim of this study was to determine the incidence and characteristics of polytraumatized children and associated spine injuries in different pediatric development ages.
A cohort review of all pediatric patients with the diagnosis of polytrauma and associated spine injury, admitted to a urban Level I trauma center, was conducted over an 18-year period from January 1992 to December 2010. Patients were stratified into four developmental age groups: infants/toddlers (age 0-4 years), preschool/young children (age 5-9 years), preadolescents (age 10-14 years), and adolescents (age 15-17 years). Demographics, clinical injury data, patterns of spine injuries, associated injuries, treatment, and outcome were abstracted and analyzed.
From a database of 897 severely (Injury Severity Score ≥ 16) injured pediatric patients, 28 children met the inclusion criteria. The mean age was 12.7 years (range, 1.3-16.7 years), and there were 18 males and 10 females. Younger children (age 0-9 years) sustained more injuries to the upper spine region, whereas injuries to the lumbar region were only seen in adolescents. Nine (32%) patients received surgical treatment for spine fracture or subluxation, and 15 (54%) were treated by nonoperative means. Four patients (14%) received only palliative treatment due to medical futility. Overall, the most commonly associated injury was thoracic injury (89%) followed by traumatic brain injury (64%).
The age-related anatomy and physiology predispose younger children to upper spine injuries in contrast to lower spine injuries seen in adolescents. Predictors of mortality include pathologic pupillary light reflex, high Injury Severity Score and Abbreviated Injury Scale score, and a low Glasgow Coma Scale score at admission. Thoracic injuries were the most common associated injuries followed by traumatic brain injury.
Prognostic study, level III.
脊柱损伤是多发创伤的常见组成部分，但在儿科患者中相对较少见。既往研究主要描述了颈椎区域的损伤，而目前文献中缺乏胸腰椎区域的损伤模式信息。本研究的目的是确定不同儿科发育年龄的多发创伤儿童和相关脊柱损伤的发生率和特征。
对 1992 年 1 月至 2010 年 12 月期间在一家城市一级创伤中心收治的所有被诊断为多发创伤和相关脊柱损伤的儿科患者进行了队列回顾。患者分为四个发育年龄组：婴儿/幼儿（0-4 岁）、学龄前/儿童（5-9 岁）、青少年（10-14 岁）和青少年（15-17 岁）。提取并分析了人口统计学、临床损伤数据、脊柱损伤模式、合并损伤、治疗和结局。
从数据库中 897 例严重（损伤严重程度评分≥16）受伤的儿科患者中，有 28 例符合纳入标准。平均年龄为 12.7 岁（范围 1.3-16.7 岁），其中男 18 例，女 10 例。年幼的儿童（0-9 岁）脊柱上部区域的损伤更多，而青少年仅出现腰椎区域的损伤。9 例（32%）患者接受脊柱骨折或半脱位的手术治疗，15 例（54%）采用非手术治疗。由于医疗无效，4 例（14%）仅接受姑息治疗。总体而言，最常见的相关损伤是胸部损伤（89%），其次是创伤性脑损伤（64%）。
年龄相关的解剖和生理学使年幼的儿童易发生上脊柱损伤，而青少年则易发生下脊柱损伤。死亡率的预测因素包括病理性瞳孔光反射、高损伤严重程度评分和简明损伤评分，以及入院时格拉斯哥昏迷量表评分低。胸部损伤是最常见的相关损伤，其次是创伤性脑损伤。
预后研究，III 级。
