Falavigna Asdrubal, Righesso Orlando, Guarise da Silva Pedro, Sanchez Chavez Felix Adolfo, Sfreddo Ericson, Pelegrini de Almeida Leandro, Valencia Carrasco Manuel Jose, Joaquim Andrei Fernandes
Department of Neurosurgery and Laboratory of Cellular Therapy, University of Caxias do Sul, Caxias do Sul, Brazil.
Department of Orthopedist, Clínica Verti, Bento Gonçalves, Brazil.
World Neurosurg. 2018 Feb;110:e479-e483. doi: 10.1016/j.wneu.2017.11.021. Epub 2017 Nov 14.
This retrospective study reports the epidemiology, clinical aspects, and management of spinal trauma in children and adolescents.
Multicenter study of 215 cases of spinal trauma in individuals <18 years of age. All patients were submitted to preoperative and postoperative radiologic and clinical evaluation. The fractures were classified according to the AOSpine fracture classification. Neurological evaluation was performed using the Frankel scale at admission to hospital and at the last follow-up.
Mean age was 14.7 (± 2.5) years and most of the patients were male (72.6%). Falls were responsible for 52.6% of the spinal trauma. Compression fracture was the most common type of fracture, observed in 48.4% of the cases. Most spinal fractures were located at the thoracic level (58.7%). Associated injuries were observed in 37.2% of the cases. The complication rates were 15.8%. Normal neurological examination was observed in 160 cases (74.4%) at the final follow-up. Neurological impairment was mostly observed due to shallow water diving, dislocation fractures types, and fractures located between the lower cervical spine and the thoracic spine. Surgical treatment was performed in 73.8% of the cases. Better neurological outcome was observed in fractures due to falls, fractures located in the upper cervical (C1-C2) and lower lumbar spine injuries (L3-L5).
Surgical treatment is often necessary in children and adolescents after spinal trauma. Higher incidence of spinal cord injury was observed after shallow water diving, fractures located in the lower cervical spine and thoracic spine, and type B and C fractures.
本回顾性研究报告儿童和青少年脊柱创伤的流行病学、临床特征及治疗情况。
对215例18岁以下脊柱创伤患者进行多中心研究。所有患者均接受术前和术后影像学及临床评估。骨折根据AOSpine骨折分类法进行分类。入院时及末次随访时采用Frankel量表进行神经功能评估。
平均年龄为14.7（±2.5）岁，大多数患者为男性（72.6%）。跌倒导致52.6%的脊柱创伤。压缩性骨折是最常见的骨折类型，占48.4%。大多数脊柱骨折位于胸段（58.7%）。37.2%的病例存在合并伤。并发症发生率为15.8%。末次随访时160例（74.4%）患者神经功能检查正常。神经功能损害多因浅水跳水、脱位骨折类型以及下颈椎与胸椎之间的骨折所致。73.8%的病例接受了手术治疗。因跌倒导致的骨折、上颈椎（C1-C2）骨折及下腰椎损伤（L3-L5）患者神经功能恢复较好。
儿童和青少年脊柱创伤后常需手术治疗。浅水跳水、下颈椎和胸椎骨折以及B型和C型骨折后脊髓损伤发生率较高。
