Bajaj Mohit, Stefanutti Giorgio, Crawford Haemish, Upadhyay Vipul
Paediatric Surgical Registrar, Starship Children's Hospital, Auckland.
Paediatric Orthopaedic Surgeon, Starship Children's Hospital, Auckland.
N Z Med J. 2018 Mar 9;131(1471):13-20.
Pelvic fractures constitute between 0.3% and 4% of all paediatric injuries, with a mortality rate up to 25%. This study aims to review the experience with pelvic fractures at Starship Children's Hospital and demonstrate its role as a marker of severe trauma.
A retrospective review of children with pelvic fractures managed at our institution in the 20-year period between July 1995 and May 2015 was performed. The search identified 179 consecutive children admitted with a pelvic fracture. Data fields collected included patient details, mechanisms of injury, investigations performed, length of hospital stay, management and complications. Data was also collected on Injury Severity Score (ISS), Glasgow coma scale (GCS), transfusion requirements and details of associated injuries (both orthopaedic and non-orthopaedic).
Median age was eight years (IQR 5-12 years) with 65% boys. The median Injury Severity Score (ISS) was 9 (IQR 4-22). Pedestrian-motor vehicle injuries were most common at 46% of cases, followed by passengers injured in motor vehicle accidents accounting for 23% (n=41). Associated injuries were present in 68% (n=122) of patients, with other orthopaedic fractures (42%, n=75) and thoracic injuries (33%, n=59) most common. Management of pelvic fractures was primarily non-operative, with only 7% (n=13) requiring operative intervention. In comparison, operative procedures for associated injuries were much more common and were required in 38% (n=68) of cases.
Pelvic fractures represent an important marker for severe trauma. Patterns of paediatric pelvic fractures reported by other studies around the world are very similar. Understanding the patterns in which pelvic fractures and their associated injuries occur and the outcome of treatment is fundamental to the establishment of effective preventative, diagnostic and therapeutic interventions.
骨盆骨折占所有儿童损伤的0.3%至4%，死亡率高达25%。本研究旨在回顾星舰儿童医院治疗骨盆骨折的经验，并证明其作为严重创伤标志的作用。
对1995年7月至2015年5月这20年间在我院接受治疗的骨盆骨折患儿进行回顾性研究。检索发现179例连续收治的骨盆骨折患儿。收集的数据字段包括患者详细信息、损伤机制、进行的检查、住院时间、治疗及并发症。还收集了损伤严重程度评分（ISS）、格拉斯哥昏迷量表（GCS）、输血需求及相关损伤（骨科和非骨科）的详细信息。
中位年龄为8岁（四分位间距5 - 12岁），男孩占65%。中位损伤严重程度评分（ISS）为9分（四分位间距4 - 22分）。行人 - 机动车损伤最为常见，占病例的46%，其次是机动车事故中的乘客受伤，占23%（n = 41）。68%（n = 122）的患者存在相关损伤，其中其他骨科骨折（42%，n = 75）和胸部损伤（33%，n = 59）最为常见。骨盆骨折的治疗主要为非手术治疗，仅7%（n = 13）需要手术干预。相比之下，相关损伤的手术治疗更为常见，38%（n = 68）的病例需要手术。
骨盆骨折是严重创伤的重要标志。世界各地其他研究报道的儿童骨盆骨折模式非常相似。了解骨盆骨折及其相关损伤的发生模式和治疗结果对于建立有效的预防、诊断和治疗干预措施至关重要。
