Rush Jeremy K, Kelly Derek M, Astur Nelson, Creek Aaron, Dawkins Ross, Younas Shiraz, Warner William C, Sawyer Jeffrey R
Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN 38104, USA.
J Pediatr Orthop. 2013 Jun;33(4):393-7. doi: 10.1097/BPO.0b013e318279c7cb.
Over half of children and adolescents with spinal trauma have associated injuries, most commonly involving the appendicular skeleton, head and neck, and thorax. The incidence and characteristics of these associated injuries have been well described, but to our knowledge there has been no evaluation of the relationship between the injury characteristics and the patient age.
Data were obtained from the trauma registries of the local pediatric and adult level 1 trauma centers, and patients aged 0 to 19 years with spinal trauma were identified. For analysis, patients were divided into 3 age groups: 0 to 3, 4 to 12, and 13 to 19 years. Associated injuries were divided into 5 groups: head, thoracic, abdominal, appendicular skeletal fracture, and neurological.
Overall, 25 patients had isolated dislocations and 307 patients had 366 spinal fractures or fracture-dislocations: 36% cervical, 31% thoracic, and 51% lumbar. Most (84%) of the injuries occurred in the 13- to 19-year-old group. Sixty-two percent of patients had associated injuries, most commonly thoracic injuries (pulmonary contusion, pneumothorax, rib fracture); 45% had multilevel spinal fractures, 39% of which were noncontiguous. Nearly three fourths of the noncontiguous fractures occurred in a different spinal region; cervical fracture with concomitant thoracic fracture was the most frequent pattern.
This large series of consecutive patients highlights several important concepts concerning pediatric spinal fractures, including age-related patterns of injury, frequent associated injuries, and a high rate of multiple spinal injuries, especially noncontiguous injuries. It also emphasizes the importance of careful full-body examination and imaging of the entire spine in children and adolescents with a known spinal injury.
Level IV-case series.
超过半数的脊髓损伤儿童和青少年伴有其他损伤，最常见的是累及四肢骨骼、头颈部和胸部。这些伴发损伤的发生率和特征已有详尽描述，但据我们所知，尚未对损伤特征与患者年龄之间的关系进行评估。
数据来自当地儿科和成人一级创伤中心的创伤登记处，确定年龄在0至19岁的脊髓损伤患者。为进行分析，将患者分为3个年龄组：0至3岁、4至12岁和13至19岁。伴发损伤分为5组：头部、胸部、腹部、四肢骨骼骨折和神经损伤。
总体而言，25例患者为单纯脱位，307例患者有366处脊柱骨折或骨折脱位：颈椎骨折占36%，胸椎骨折占31%，腰椎骨折占51%。大多数（84%）损伤发生在13至19岁年龄组。62%的患者伴有其他损伤，最常见的是胸部损伤（肺挫伤、气胸、肋骨骨折）；45%的患者有多节段脊柱骨折，其中39%为非连续性骨折。近四分之三的非连续性骨折发生在不同的脊柱区域；颈椎骨折合并胸椎骨折是最常见的类型。
这一大型连续病例系列突出了有关儿童脊柱骨折的几个重要概念，包括与年龄相关的损伤模式、频繁的伴发损伤以及多节段脊柱损伤的高发生率，尤其是非连续性损伤。它还强调了对已知脊髓损伤的儿童和青少年进行仔细的全身检查和全脊柱成像的重要性。
IV级——病例系列。
