Blazar P E, Dormans J P, Born C T
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, USA.
J Orthop Trauma. 1997 Feb-Mar;11(2):126-9. doi: 10.1097/00005131-199702000-00011.
To describe the pattern of injuries sustained in pediatric victims of train accidents.
Retrospective review of patients identified in a search of two trauma registries for the years 1984-1994.
Two pediatric level one trauma centers in one metropolitan area.
Between 1984 and 1994, seventeen children were identified as treated for injuries sustained in train accidents. Children pronounced dead at the scene and those injured when a car was struck by a train were excluded.
ATLS protocols were followed. All open musculoskeletal injuries were treated with multiple operative irrigation and debridement procedures and broad spectrum antibiotics.
Variables included the following: age, sex, mechanism of injury, circumstances surrounding the injuries, all injuries sustained, operations performed during the acute hospitalization, subsequent operations, level of amputation(s), complications, and cost and length of hospitalization.
Presenting injuries included eight patients with ten complete amputations and eight patients with ten near-complete amputations. The average number of operative procedures for the survivors during the initial hospitalization was 5.7 (range three to sixteen). Five patients (five extremities) required amputation revision to a more proximal level after the initial surgical intervention but prior to definitive wound closure. Secondary surgical procedures have been required in 50% of survivors to date. The financial cost of these injuries is substantial, with acute hospitalization costs averaging $61,000.
Pediatric survivors of train-pedestrian accidents are likely to suffer isolated musculoskeletal injuries, the majority of which are amputations of the lower extremity. These injuries require multiple operative debridements and frequent revision to higher levels of amputation are expected. The percentage of these injuries in children at play around railroad tracks emphasizes the need for limitation of access to railroad areas and for prevention through public education.
描述小儿火车事故受害者的损伤模式。
对1984年至1994年期间在两个创伤登记处检索到的患者进行回顾性研究。
一个大都市地区的两个一级儿科创伤中心。
1984年至1994年期间，确定有17名儿童因火车事故受伤接受治疗。排除在现场宣告死亡的儿童以及汽车被火车撞击时受伤的儿童。
遵循高级创伤生命支持（ATLS）方案。所有开放性肌肉骨骼损伤均采用多次手术冲洗和清创术，并使用广谱抗生素治疗。
变量包括以下内容：年龄、性别、损伤机制、损伤周围情况、所有损伤情况、急性住院期间进行的手术、后续手术、截肢水平、并发症以及住院费用和住院时间。
呈现的损伤包括8例患者有10处完全截肢，8例患者有10处近乎完全截肢。幸存者在初次住院期间的平均手术次数为5.7次（范围为3至16次）。5例患者（5个肢体）在初次手术干预后但在伤口最终闭合前需要将截肢部位修正到更靠近近端的水平。迄今为止，50%的幸存者需要进行二次手术。这些损伤的经济成本巨大，急性住院费用平均为61,000美元。
小儿火车行人事故幸存者可能会遭受孤立的肌肉骨骼损伤，其中大多数是下肢截肢。这些损伤需要多次手术清创，预计会频繁进行更高水平的截肢修正。在铁轨附近玩耍的儿童中这类损伤的比例强调了限制进入铁路区域以及通过公众教育进行预防的必要性。
