Wang Hongwei, Yu Hailong, Zhou Yue, Li Changqing, Liu Jun, Ou Lan, Zhao Yiwen, Song Guoli, Han Jianda, Chen Yu, Xiang Liangbi
Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning State Key Laboratory of Materials Processing and Die & Mould Technology, Huazhong University of Science and Technology, Wuhan, Hubei Department of Orthopedics, Xinqiao Hospital Department of Radiology, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China.
Medicine (Baltimore). 2017 Sep;96(37):e7879. doi: 10.1097/MD.0000000000007879.
The aim of this study is to investigate the incidence and pattern of traumatic fractures (TFs) as a result of falls in a population of children and adolescents (≤18 years old) in China.This was a cross-sectional study. We retrospectively reviewed 1412 patients who were children and adolescents with TFs as a result of falls admitted to our university-affiliated hospitals in China from 2001 to 2010. Etiologies included high fall (height ≥2) and low fall (height <2 m). The incidence and pattern were summarized with respect to different age groups, year of admission, etiologies, genders, and the neurological function.This study enrolled 1054 males (74.6%) and 358 females (25.4%) aged 10.8 ± 4.7 years. The etiologies were low fall (1059, 75.0%) and high fall (353, 25.0%). There were 2073 fractures in total and 92 patients (6.5%) presented with multiple fractures. The most common fracture sites were upper extremity fractures in 814 patients (57.6%) and lower extremity fractures in 383 patients (27.1%), followed by craniofacial fractures in 233 patients (16.5%). A total of 231 (16.4%) patients suffered a nerve injury. The frequencies of early and late complications/associated injuries were 19.5% (n = 275) and 9.2% (n = 130). The frequencies of emergency admission, nerve injury, spinal fracture, lower extremity fractures, craniofacial fracture, sternum and rib fracture, and early complications/ASOIs were significantly larger in high fall than low fall (all P <.001, respectively). The frequencies of medical insurance rate (P = .042) and upper extremity fractures (P <.001) were significantly larger in low fall than high fall. The frequencies of spinal fracture (P = .039), lower extremity fractures (P = .048), and craniofacial fracture (P = .041) were significantly larger in female than the male patients. The frequency of upper extremity fractures (P <.001) and the mean age (P <.001) was significantly larger in male than female patients. The frequencies of emergency admission, high fall, spinal fracture, and craniofacial fracture were significantly larger in patients with nerve injury than other patients without nerve injury (all P <.001, respectively).Low falls and upper extremity fractures were the most common etiologies and sites, respectively. High fall, spinal fracture and craniofacial fracture were risk factors for nerve injury. Therefore, we should focus on patients who were caused by high fall and presented with spinal and craniofacial fracture to determine the presence of a nerve injury so that we can provide early, timely diagnosis and targeted treatment to children.
本研究旨在调查中国儿童及青少年（≤18岁）因跌倒导致的创伤性骨折（TFs）的发生率及骨折类型。这是一项横断面研究。我们回顾性分析了2001年至2010年期间在中国我校附属医院收治的1412例因跌倒导致创伤性骨折的儿童及青少年患者。病因包括高处坠落（高度≥2米）和低处坠落（高度＜2米）。对不同年龄组、入院年份、病因、性别及神经功能的发生率和骨折类型进行了总结。本研究纳入了1054例男性（74.6%）和358例女性（25.4%），年龄为10.8±4.7岁。病因包括低处坠落（1059例，75.0%）和高处坠落（353例，25.0%）。总共发生了2073处骨折，92例患者（6.5%）为多发骨折。最常见的骨折部位是上肢骨折814例（57.6%），下肢骨折383例（27.1%），其次是颅面骨折233例（16.5%）。共有231例（16.4%）患者发生神经损伤。早期和晚期并发症/合并伤的发生率分别为19.5%（n = 275）和9.2%（n = 130）。高处坠落患者的急诊入院率、神经损伤、脊柱骨折、下肢骨折、颅面骨折、胸骨和肋骨骨折以及早期并发症/合并伤的发生率均显著高于低处坠落患者（所有P均＜0.001）。低处坠落患者的医疗保险率（P = 0.042）和上肢骨折发生率（P＜0.001）显著高于高处坠落患者。女性患者的脊柱骨折（P = 0.039）、下肢骨折（P = 0.048）和颅面骨折（P = 0.041）发生率显著高于男性患者。男性患者的上肢骨折发生率（P＜0.001）和平均年龄（P＜0.001）显著高于女性患者。有神经损伤的患者的急诊入院率、高处坠落、脊柱骨折和颅面骨折发生率显著高于无神经损伤的其他患者（所有P均＜0.001）。低处坠落和上肢骨折分别是最常见的病因和骨折部位。高处坠落、脊柱骨折和颅面骨折是神经损伤的危险因素。因此，我们应关注高处坠落且伴有脊柱和颅面骨折的患者，以确定是否存在神经损伤，从而能够为儿童提供早期、及时的诊断和针对性治疗。
