Kim Christopher, Vassilyadi Michael, Forbes Jason K, Moroz Nicholas W P, Camacho Alexandra, Moroz Paul J
From the Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ont. (Kim, Forbes, N. Moroz, Camacho); the Division of Neurosurgery, Children's Hospital of Eastern Ontario, Department of Surgery, University of Ottawa, Ottawa, Ont. (Vassilyadi); and the Division of Orthopedic Surgery, Shriners Hospitals for Children, Honolulu, HI (P. Moroz).
Can J Surg. 2016 Jun;59(3):205-12. doi: 10.1503/cjs.014515.
With a reported incidence of up to 10% compared to all spinal trauma, spinal injuries in children are less common than in adults. Children can have spine fractures with or without myelopathy, or spinal cord injuries without radiological abnormalities (SCIWORA).
We retrospectively reviewed the cases of children with spinal injuries treated at a level 1 pediatric trauma centre between 1990 and 2013.
A total of 275 children were treated during the study period. The mean age at admission was 12 ± 4.5 years, and the male:female ratio was 1.4:1. Spinal injuries were more common in children of ages 12-16 years, with most injuries among ages 15-16 years. The top 3 mechanisms of spinal injury were motor vehicle-related trauma (53%), sports (28%) and falls (13%). Myelopathy occurred in 12% and SCIWORA occurred in 6%. The most common spine levels injured were L2-sacrum, followed by O-C2. Associated injuries, including head injuries (29%), and fractures/dislocations (27%) occurred in 55% of children. Overall mortality was 3%. Surgical intervention was required in 14%.
The creation of a pediatric spinal injury database using this 23-year retrospective review helped identify important clinical concepts; we found that active adolescent boys had the highest risk of spine injury, that noncontiguous spine injuries occured at a rate higher than reported previously and that nonaccidental spine injuries in children are underreported. Our findings also emphasize the importance of maintaining a higher index of suspicion with trauma patients with multiple injuries and of conducting detailed clinical and radiographic examinations of the entire spine in children with a known spinal injury.
与所有脊柱创伤相比，儿童脊柱损伤的报告发病率高达10%，不如成人常见。儿童可发生伴有或不伴有脊髓病的脊柱骨折，或无放射学异常的脊髓损伤（SCIWORA）。
我们回顾性分析了1990年至2013年在一家一级儿科创伤中心接受治疗的儿童脊柱损伤病例。
研究期间共治疗了275名儿童。入院时的平均年龄为12±4.5岁，男女比例为1.4:1。脊柱损伤在12 - 16岁的儿童中更为常见，其中15 - 16岁年龄段的损伤最为多见。脊柱损伤的前三大机制是机动车相关创伤（53%）、运动（28%）和跌倒（13%）。脊髓病发生率为12%，SCIWORA发生率为6%。最常受伤的脊柱节段是L2 - 骶骨，其次是枕骨 - C2。55%的儿童伴有其他损伤，包括头部损伤（29%）和骨折/脱位（27%）。总体死亡率为3%。14%的患儿需要手术干预。
通过这项23年的回顾性研究建立儿科脊柱损伤数据库有助于识别重要的临床概念；我们发现活跃的青春期男孩脊柱损伤风险最高，非连续性脊柱损伤的发生率高于先前报道，儿童非意外性脊柱损伤报告不足。我们的研究结果还强调了对于多发伤创伤患者保持更高怀疑指数以及对已知脊柱损伤儿童进行全脊柱详细临床和影像学检查的重要性。
