Klimek Peter Michael, Lutz Thomas, Stranzinger Enno, Zachariou Zacharias, Kessler Ulf, Berger Steffen
Department of Pediatric Surgery, Inselspital, University Hospital and University of Bern, 3010 Bern, Switzerland.
Pediatr Surg Int. 2013 Mar;29(3):269-73. doi: 10.1007/s00383-012-3227-y. Epub 2012 Dec 11.
Handlebar injuries in children may lead to severe organ lesions despite minimal initial signs and without visible skin bruise. We present our experiences applying a diagnostic and therapeutic algorithm for blunt abdominal trauma, and present the history of two selected cases.
We retrospectively assessed the charts of children below 16 years of age, only who were observed for 24 h or more in our institution due to a handlebar injury between 2004 and 2011. All children were treated according to an institutional algorithm.
40 patients with a median age of 9.5 years were included. Diagnosed lesions were: ruptures of the liver (n = 6), spleen (n = 5), kidney (n = 1), and pancreas (n = 2), small bowel perforation (n = 3), and hernias of the abdominal (n = 2) or thoracic wall (n = 1). Surgical interventions were performed in 8 patients. The outcome was favorable in all the cases. Overall median hospitalization duration was 4.5 days (range 1-19 days). The overall duration between the accident and arrival at our emergency unit was 2.75 h (median, range 1-19 h). 20 children presented directly at our emergency unit after a median of 1.7 h (range 1-19.5 h). 20 children were referred by a family physician or a primary hospital after a median of 4.0 h (range 1-46 h).
Handlebar injuries in children resulted in serious trunk lesions in half of the present patient series. The spectrum of injuries in handlebar accidents varies widely, especially injuries to the abdomen can unmask often only in the course. We advocate close observation of patients with thoracic and abdominal handlebar injuries which may be regarded as blunt stab wounds. An institutional algorithm for blunt abdominal trauma management is supportive for emergency care in patients with handlebar injuries.
儿童车把伤尽管初始症状轻微且无明显皮肤瘀伤，但可能导致严重的器官损伤。我们介绍应用钝性腹部创伤诊断和治疗方案的经验，并呈现两个选定病例的病史。
我们回顾性评估了2004年至2011年间因车把伤在本机构观察24小时及以上的16岁以下儿童的病历。所有儿童均按照机构方案进行治疗。
纳入了40例患者，中位年龄为9.5岁。诊断出的损伤包括：肝破裂（n = 6）、脾破裂（n = 5）、肾破裂（n = 1）、胰腺破裂（n = 2）、小肠穿孔（n = 3）以及腹壁疝（n = 2）或胸壁疝（n = 1）。8例患者接受了手术干预。所有病例预后良好。总体中位住院时间为4.5天（范围1 - 19天）。事故发生至抵达我们急诊单元的总体时长为2.75小时（中位值，范围1 - 19小时）。20名儿童在中位时间1.7小时（范围1 - 19.5小时）后直接来到我们的急诊单元。20名儿童由家庭医生或基层医院转诊，中位时间为4.0小时（范围1 - 46小时）。
在本系列患者中，一半的儿童车把伤导致了严重的躯干损伤。车把事故中的损伤范围差异很大，尤其是腹部损伤往往仅在病程中才会显现。我们主张对胸腹部车把伤患者进行密切观察，此类损伤可视为钝性刺伤。钝性腹部创伤管理的机构方案有助于车把伤患者的急诊护理。
