Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030.
Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX.
AJR Am J Roentgenol. 2020 Jun;214(6):1359-1368. doi: 10.2214/AJR.19.22095. Epub 2020 Mar 31.
The purpose of this study was to describe the epidemiology and imaging characteristics of cervical spine injuries in children with blunt trauma. We conducted a retrospective review of the records of all patients 16 years old or younger with a diagnosis of cervical spine injury in the trauma registry of our level 1 trauma center between July 2006 and June 2018. Two hundred thirty-five patients were included in the study: 125 with subaxial cervical spine injuries, 87 with upper cervical spine injuries, and 23 with both subaxial and upper cervical spine injuries. The frequency of isolated upper cervical spine injuries was 73% in patients younger than 3 years old, 48% in patients 3-8 years old, and 29% in patients older than 8 years old. Seventy-one percent of occipital condyle fractures were avulsions, and 26% of dens fractures were avulsions. Type II dens fractures were found only in patients older than 8 years old. Type I and III dens fractures were almost exclusively in patients 8 years old or younger. Injuries classified as AOSpine types A, B, and C comprised 65.6%, 17.2%, and 17.2% of subaxial injuries, respectively. Despite similar mechanism of injury distribution across age groups, the frequency of AOSpine type A injuries in patients older than 8 years old (70.6%) was significantly higher compared with patients younger than 3 years old (40.0%) and those who were 3-8 years old (45.0%). The frequency of AOSpine type B injuries in patients younger than 3 years old (40.0%) was slightly higher than patients who were 3-8 years old (30.0%) and almost three times higher than in patients older than 8 years old (13.8%). Pediatric patients have high rates of upper cervical spine injuries, which tend to be distraction injuries that are frequently associated with avulsion fractures. Injury patterns in pediatric patients vary significantly by age, with patients younger than 3 years old being particularly prone to distraction type injuries.
本研究旨在描述儿童钝性创伤性颈椎损伤的流行病学和影像学特征。我们对 2006 年 7 月至 2018 年 6 月期间在我们的 1 级创伤中心的创伤登记处诊断为颈椎损伤的所有 16 岁以下患者的记录进行了回顾性分析。共有 235 例患者纳入本研究：125 例下颈椎损伤，87 例上颈椎损伤，23 例下颈椎和上颈椎均损伤。3 岁以下患者单纯上颈椎损伤的频率为 73%，3-8 岁患者为 48%，8 岁以上患者为 29%。71%的枕骨髁骨折为撕脱性骨折，26%的枢椎骨折为撕脱性骨折。仅在 8 岁以上患者中发现Ⅱ型枢椎骨折。Ⅰ型和Ⅲ型枢椎骨折几乎仅见于 8 岁以下患者。AOSpine 分型 A、B 和 C 型损伤分别占下颈椎损伤的 65.6%、17.2%和 17.2%。尽管各年龄段的损伤机制分布相似，但 8 岁以上患者 AOSpine 分型 A 损伤的频率（70.6%）明显高于 3 岁以下患者（40.0%）和 3-8 岁患者（45.0%）。3 岁以下患者 AOSpine 分型 B 损伤的频率（40.0%）略高于 3-8 岁患者（30.0%），几乎是 8 岁以上患者（13.8%）的 3 倍。儿科患者上颈椎损伤发生率较高，多为牵拉伤，常伴有撕脱性骨折。儿科患者的损伤模式差异显著，3 岁以下患者特别容易发生牵拉伤。
