运动相关性颈椎骨折和脊髓损伤：全国儿科趋势综述。
Sports-related Cervical Spine Fracture and Spinal Cord Injury: A Review of Nationwide Pediatric Trends.
机构信息
Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY.
Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY.
出版信息
Spine (Phila Pa 1976). 2021 Jan 1;46(1):22-28. doi: 10.1097/BRS.0000000000003718.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
Assess trends in sports-related cervical spine trauma using a pediatric inpatient database.
SUMMARY OF BACKGROUND DATA
Injuries sustained from sports participation may include cervical spine trauma such as fractures and spinal cord injury (SCI). Large database studies analyzing sports-related cervical trauma in the pediatric population are currently lacking.
METHODS
The Kid Inpatient Database was queried for patients with external causes of injury secondary to sports-related activities from 2003 to 2012. Patients were further grouped for cervical spine injury (CSI) type, including C1-4 and C5-7 fracture with/without spinal cord injury (SCI), dislocation, and SCI without radiographic abnormality (SCIWORA). Patients were grouped by age into children (4-9), pre-adolescents (Pre, 10-13), and adolescents (14-17). Kruskall-Wallis tests with post-hoc Mann-Whitney U's identified differences in CSI type across age groups and sport type. Logistic regression found predictors of TBI and specific cervical injuries.
RESULTS
A total of 38,539 patients were identified (12.76 years, 24.5% F). Adolescents had the highest rate of sports injuries per year (P < 0.001). Adolescents had the highest rate of any type of CSI, including C1-4 and C5-7 fracture with and without SCI, dislocation, and SCIWORA (all P < 0.001). Adolescence increased odds for C1-4 fracture w/o SCI 3.18×, C1-4 fx w/ SCI by 7.57×, C5-7 fx w/o SCI 4.11×, C5-7 w/SCI 3.63×, cervical dislocation 1.7×, and cervical SCIWORA 2.75×, all P < 0.05. Football injuries rose from 5.83% in 2009 to 9.14% in 2012 (P < 0.001), and were associated with more SCIWORA (1.6% vs. 1.0%, P = 0.012), and football injuries increased odds of SCI by 1.56×. Concurrent TBI was highest in adolescents at 58.4% (pre: 26.6%, child: 4.9%, P < 0.001), and SCIWORA was a significant predictor for concurrent TBI across all sports (odds ratio: 2.35 [1.77-3.11], P < 0.001).
CONCLUSION
Adolescent athletes had the highest rates of upper/lower cervical fracture, dislocation, and SCIWORA. Adolescence and SCIWORA were significant predictors of concurrent TBI across sports. The increased prevalence of CSI with age sheds light on the growing concern for youth sports played at a competitive level, and supports recently updated regulations aimed at decreasing youth athletic injuries.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
使用儿科住院患者数据库评估与运动相关的颈椎创伤的趋势。
背景资料概要
运动参与造成的伤害可能包括颈椎外伤，如骨折和脊髓损伤（SCI）。目前缺乏对儿科人群中与运动相关的颈椎外伤进行大数据库研究分析。
方法
从 2003 年至 2012 年，儿童住院数据库中检索到与运动相关的外部原因导致的损伤的患者。根据颈椎损伤（CSI）类型，进一步将患者分组，包括 C1-4 和 C5-7 骨折伴/不伴脊髓损伤（SCI）、脱位和无放射异常的 SCI（SCIWORA）。患者按年龄分为儿童（4-9 岁）、青春期前（Pre，10-13 岁）和青少年（14-17 岁）。采用 Kruskal-Wallis 检验和事后曼-惠特尼 U 检验，比较不同年龄组和运动类型的 CSI 类型差异。Logistic 回归分析发现 TBI 和特定颈椎损伤的预测因素。
结果
共确定了 38539 名患者（12.76 岁，24.5%女性）。青少年每年运动损伤的发生率最高（P < 0.001）。青少年的任何类型的 CSI 发生率最高，包括 C1-4 和 C5-7 骨折伴或不伴 SCI、脱位和 SCIWORA（均 P < 0.001）。青少年发生 C1-4 无 SCI 骨折的几率增加 3.18 倍，C1-4 伴 SCI 骨折的几率增加 7.57 倍，C5-7 无 SCI 骨折的几率增加 4.11 倍，C5-7 伴 SCI 骨折的几率增加 3.63 倍，颈椎脱位的几率增加 1.7 倍，颈椎 SCIWORA 的几率增加 2.75 倍，均 P < 0.05。足球受伤从 2009 年的 5.83%上升到 2012 年的 9.14%（P < 0.001），并与更多的 SCIWORA 相关（1.6% vs. 1.0%，P = 0.012），足球受伤使 SCI 的几率增加 1.56 倍。青少年并发 TBI 的比例最高，为 58.4%（青春期前：26.6%，儿童：4.9%，P < 0.001），SCIWORA 是所有运动中并发 TBI 的重要预测因素（比值比：2.35 [1.77-3.11]，P < 0.001）。
结论
青少年运动员颈椎上下部骨折、脱位和 SCIWORA 的发生率最高。青少年和 SCIWORA 是所有运动中并发 TBI 的重要预测因素。年龄与 CSI 发生率的相关性表明，人们对青少年在竞技水平上进行的体育运动的关注日益增加，这支持了最近更新的旨在减少青少年运动损伤的规定。
证据水平
3 级。
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