Poorman Gregory W, Segreto Frank A, Beaubrun Bryan M, Jalai Cyrus M, Horn Samantha R, Bortz Cole A, Diebo Bassel G, Vira Shaleen, Bono Olivia J, DE LA Garza-Ramos Rafael, Moon John Y, Wang Charles, Hirsch Brandon P, Tishelman Jared C, Zhou Peter L, Gerling Michael, Passias Peter G
Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York.
Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
Int J Spine Surg. 2019 Feb 22;13(1):68-78. doi: 10.14444/6009. eCollection 2019 Jan.
The study aimed to characterize trends in incidence, etiology, fracture types, surgical procedures, complications, and concurrent injuries associated with traumatic pediatric cervical fracture using a nationwide database.
The Kids' Inpatient Database (KID) was queried. Trauma cases from 2003 to 2012 were identified, and cervical fracture patients were isolated. Demographics, etiologies, fracture levels, procedures, complications, and concurrent injuries were assessed. The -tests elucidated significance for continuous variables, and χ for categoric values. Logistic regressions identified predictors of spinal cord injury (SCI), surgery, any complication, and mortality. Level of significance was < .05.
A total of 11 196 fracture patients were isolated (age, 16.63 years; male, 65.7%; white, 65.4%; adolescent, 55.4%). Incidence significantly increased since 2003 (2003 vs 2012, 2.39% vs 3.12%, respectively), as did Charlson Comorbidity Index (CCI; 2003 vs 2012, 0.2012 vs 0.4408, respectively). Most common etiology was motor vehicle accidents (50.5%). Infants and children frequently fractured at C2 (closed: 43.1%, 32.9%); adolescents and young adults frequently fractured at C7 (closed: 23.9%, 26.5%). Upper cervical SCI was less common (5.8%) than lower cervical SCI (10.9%). Lower cervical unspecified-SCI, anterior cord syndrome, and other specified SCIs significantly decreased since 2003. Complications were common (acute respiratory distress syndrome, 7.8%; anemia, 6.7%; shock, 3.0%; and mortality, 4.2%), with bowel complications, cauda equina, anemia, and shock rates significantly increasing since 2003. Concurrent injuries were common (15.2% ribs; 14.4% skull; 7.1% pelvis) and have significantly increased since 2003. Predictors of SCI included sports injury and CCI. Predictors of surgery included falls, sports injuries, CCI, length of stay, and SCI. CCI, SCIs, and concurrent injuries were predictors of any complication and mortality, all ( < .001).
Since 2003, incidence, complications, concurrent injuries, and fusions have increased. CCI, SCI, falls, and sports injuries were significant predictors of surgical intervention. Decreased mortality and SCI rates may indicate improving emergency medical services and management guidelines.
III.
Clinicians should be aware of increased case complexity in the onset of added perioperative complications and concurrent injuries. Cervical fractures resultant of sports injuries should be scrutinized for concurrent SCIs.
本研究旨在利用全国性数据库描述儿童创伤性颈椎骨折的发病率、病因、骨折类型、手术方式、并发症及合并伤的趋势。
查询儿童住院数据库（KID）。确定2003年至2012年的创伤病例，并分离出颈椎骨折患者。评估人口统计学、病因、骨折节段、手术方式、并发症及合并伤。t检验阐明连续变量的显著性，χ²检验用于分类变量。逻辑回归确定脊髓损伤（SCI）、手术、任何并发症及死亡率的预测因素。显著性水平为P<0.05。
共分离出11196例骨折患者（年龄16.63岁；男性65.7%；白人65.4%；青少年55.4%）。自2003年以来发病率显著增加（2003年与2012年分别为2.39%和3.12%），查尔森合并症指数（CCI）也如此（2003年与2012年分别为0.2012和0.4408）。最常见的病因是机动车事故（50.5%）。婴儿和儿童常发生C2骨折（闭合性：43.1%，32.9%）；青少年和青年常发生C7骨折（闭合性：23.9%，26.5%）。上颈椎SCI比下颈椎SCI少见（5.8%比上颈椎SCI少见（5.8%比10.9%）。自2003年以来，下颈椎未明确的SCI、前脊髓综合征及其他特定的SCIs显著减少。并发症常见（急性呼吸窘迫综合征7.8%；贫血6.7%；休克3.0%；死亡率4.2%），自2003年以来肠并发症、马尾神经损伤、贫血及休克发生率显著增加。合并伤常见（肋骨15.2%；颅骨14.4%；骨盆7.1%），自2003年以来显著增加。SCI的预测因素包括运动损伤和CCI。手术的预测因素包括跌倒、运动损伤、CCI、住院时间及SCI。CCI、SCIs及合并伤是任何并发症及死亡率的预测因素，均P<0.001。
自2003年以来，发病率、并发症、合并伤及融合均增加。CCI、SCI、跌倒及运动损伤是手术干预的重要预测因素。死亡率和SCI率的降低可能表明急诊医疗服务和管理指南有所改善。
III。
临床医生应意识到围手术期并发症和合并伤增加时病例复杂性的增加。因运动损伤导致的颈椎骨折应仔细检查是否合并SCI。
