Ruffing T, Wiehmann M, Winkler H, Muhm M
Klinik für Unfallchirurgie und Orthopädie 1, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland.
Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland.
Unfallchirurg. 2018 Jan;121(1):30-36. doi: 10.1007/s00113-016-0271-4.
Usually, conventional radiographs are appropriate for injuries in the region of the thoracic and lumbar spine (TLS) in children and adolescents. The aim of our study was to determine the incidence of trauma-associated radiographic findings in this anatomical region and to present the therapeutic consequences.
In a retrospective cohort study (2007-2015) of a level 1 trauma center all children and adolescents (0-17 years) with a TLS-trauma, in which conventional radiographs were performed anteroposterior and lateral as the initial imaging modality, were included.
In 396 children and adolescents conventional radiographs were performed, but only 5.6 % suffered a fracture. Conventional radiographs were performed in 188 cases of the thoracic spine, in 43 cases in the thoracolumbar junction and in 255 cases in the lumbar spine. On average, children and adolescents with fractures were 12.5 (5-17) years old. Fractures were classified as 38.7 % A1.1, 51.6 % A1.2, and 9.7 % were fractures of the transverse process. B and C fractures could not be detected. Of all fractures, 80 % were found in the mid-thoracic spine and the thoracolumbar junction. All fractures could be treated conservatively.
With 5.6 % TLS-injuries in children and adolescents, the study revealed a low fracture rate in a highly radiosensitive region. With regard to an expected stable fracture morphology and the absent surgical consequences, the indication for emergency radiographs should be provided restrictively.
通常，传统X线片适用于儿童和青少年胸腰椎（TLS）区域的损伤。我们研究的目的是确定该解剖区域创伤相关影像学表现的发生率，并阐述其治疗结果。
在一项对一级创伤中心（2007 - 2015年）进行的回顾性队列研究中，纳入了所有因TLS创伤而接受传统前后位和侧位X线片作为初始影像学检查的儿童和青少年（0 - 17岁）。
共对396例儿童和青少年进行了传统X线片检查，但仅有5.6%的患者发生骨折。胸椎部位进行传统X线片检查188例，胸腰段交界处43例，腰椎部位255例。骨折患儿和青少年的平均年龄为12.5岁（5 - 17岁）。骨折类型中，38.7%为A1.1型，51.6%为A1.2型，横突骨折占9.7%。未检测到B型和C型骨折。所有骨折中，80%发生在胸椎中段和胸腰段交界处。所有骨折均可行保守治疗。
该研究显示，儿童和青少年TLS损伤发生率为5.6%，在这个对辐射高度敏感的区域骨折率较低。鉴于预期骨折形态稳定且无手术相关后果，应严格掌握急诊X线片的适应证。
