Zusammenfassung
Hintergrund
Thorakale und lumbale Wirbelsäulenfrakturen im Wachstumsalter machen nur 1,5–2,0% aller Frakturen bei Kindern und Jugendlichen aus. Die Behandlung ist meist konservativ. Diese Studie vergleicht die Daten des eigenen Patientenguts mit den Angaben der Literatur.
Material und Methode
In einem Zeitraum von 48 Monaten wurden alle Patienten (n=86) mit Frakturen der Brust- und Lendenwirbelsäule vor Vollendung des 16. Lebensjahres prospektiv erfasst; 67 Patienten konnten nach 3–36 Monaten nachuntersucht werden.
Ergebnisse
Das mittlere Verletzungsalter lag bei 11,9 Jahren. Häufigste Unfallursache waren Sport (53%) und Verkehrsunfälle (28%). Die Frakturklassifikation ergab 94% A-, 2% B- und 4% C-Frakturen. Verletzungsschwerpunkte waren mit 47% die mittlere Brustwirbelsäule und mit 41% der thorakolumbale Übergang. Operativ behandelt wurden 9 Fälle (10,4%). Sekundäre Alignementstörungen nach operativer und konservativer Behandlung kamen nicht vor. Neurologische Defizite (n=2) bildeten sich nur teilweise zurück.
Schlussfolgerungen
Die Mehrzahl der Brust- und Lendenwirbelsäulenfrakturen im Wachstumsalter heilt rasch und folgenlos aus. Instabile B- und C-Frakturen (ausschließlich Folge von Verkehrsunfällen) bedürfen wie im Erwachsenenalter der operativen Stabilisierung.
Abstract
Background
Only 1.5-2% of all fractures in children and adolescents are fractures of the thoracic and lumbar spine. Treatment is most often conservative. This study compares the own experience with the recent literature.
Material and methods
Over a 48 month period all patients with fractures of the thoracic and lumbar spine, younger than 16 years were included prospectively. Of the patients 67 underwent follow-up investigations after 3-36 months.
Results
The average age of the patients was 11.9 years. Sports (53%) and traffic (28%) accidents were most frequent. Fractures most often appeared in the mid-thoracic (47%) and thoracolumbar spine (41%). Operative treatment was performed in 9 cases (10.4%). Secondary loss of alignment was not observed neither after conservative nor operative treatment. Neurological deficits (n=2) did not completely improve.
Conclusions
Most fractures of the thoracic and lumbar spine heal fast and without any sequelae. Unstable fractures of type B and C (exclusively occurring as a result of traffic accidents) need operative stabilization as in adults.
Literatur
Baai AA, Uribe JS, Vale FL (2009) Open reduction and internal fixation of a lumbar Chance fracture in a child using Songer cable and lamina plates. J Neurosurg Pediatr 3:129–131
Buckley SL, Gotschall C, Robertson W et al (1994) The relationships of skeletal injuries with trauma score, injury severity score, length of hospital stay, hospital charges, and mortality in children admitted to aregional pediatric trauma center. J Pediatr Orthop 14:449–453
Crawford CH, Puno RM, Campbell MJ, Carreon LY (2008) Surgical management of severely displaced pediatric seat-belt fracture-dislocations of the lumbar spine associated with occlusion of the abdominal aorta and avulsion of the cauda equine: a report of two cases. Spine (Phila Pa) 33:325–328
Carreon LY, Glassman SD, Campbell MJ (2004) Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech 17:477–482
Gauzy JS de, Jouve JL, Violas P et al (2007) Classification of chance fracture in children using magnetic resonance imaging. Spine (Phila Pa) 32:89–92
Dogan S, Safavi-Abbasi S, Theodore N et al (2007) Thoracolumbar and sacral spinal injuries in children and adolescents: a review of 89 cases. J Neurosurg 106:426–433
Greenwald TA, Mann DC (1994) Pediatric seatbelt injuries: diagnosis and treatment of lumbar flexion-distraction injuries. Paraplegia 32:743–751
Hadley MN, Zabramski JM, Browner CM et al (1988) Pediatric spinal trauma. Review of 122 cases of spinal cord and vertebral column injuries. J Neurosurg 68:18–24
Hasler C, Jeanneret B (2002) Pediatric spinal injuries. Orthopade 31:65–73
Junkins EP, Stotts A, Santiago R, Guenther E (2008) The clinical presentation of pediatric thoracolumbar fractures: prospective study. J Trauma 65:1066–1071
Kathrein A, Huber B, Waldegger M et al (1999) Management of injuries of the thoracic and lumbar vertebrae in children. Orthopade 28:441–450
Kathrein A, Blauth M (2006) Verletzungen der Brust und Lendenwirbelsäule. In: Weinberg AM, Tscherne H (Hrsg) Unfallchirurgie im Kindesalter. Springer, Berlin Heidelberg New York, S 559–569
Knop C, Oeser M, Bastian L et al (2001) Entwicklung und Validierung des VAS-Wirbelsäulenscores. Unfallchirurg 104:488–497
Lalonde F, Letts M, Yang JP, Thomas K (2001) An analysis of burst fractures of the spine in adolescents. Am J Orthop (Belle Mead NJ) 30:115–120
Louman-Gardiner K, Mulpuri K, Perdios A et al (2008) Pediatric lumbar chance fractures in British Columbia: chart review and analysis of the use of shoulder restraints in MVAs. Accid Anal Prev 40:1424–1429
Magerl F, Aebi M, Gertzbein SD et al (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3(4):184–201
Mahan ST, Mooney DP, Karlin LI, Hresko MT (2009) Multiple level injuries in pediatric spinal trauma. J Trauma 67:537–542
Möllenhoff G, Walz M, Muhr G (1993) Compensation behavior after fractures of the thoracic and lumbar spine in children and adolescents. Chirurg 64:948–952
Mulpuri K, Reilly CW, Perdios A et al (2007) The spectrum of abdominal injuries associated with chance fractures in pediatric patients. Eur J Pediatr Surg 17:322–327
Pang D, Pollak IF (1989) Spinal cord injury without radiographic abnormality in children – the SCIWORA syndrome. J Trauma 29:654–664
Pouliquen JC, Kassis B, Glorion C, Langlais J (1997) Vertebral growth after thoracic or lumbar fracture of the spine in children. J Pediatr Orthop 17:115–120
Reddy SP, Junewick JJ, Backstrom JW (2003) Distribution of spinal fractures in children: does age, mechanism of injury, or gender play a significant role? Pediatr Radiol 33:776–781
Reid AB, Letts RM, Black GB (1990) Pediatric chance fractures: association with intra-abdominal injuries and seatbelt use. J Trauma 30:384–391
Rekate HL, Theodore N, Sonntag VK, Dickman CA (1999) Pediatric spine and spinal cord trauma. State of the art for the third millennium. Childs Nerv Syst 15:743–750
Santiago R, Guenther E, Carroll K, Junkins EP (2006) The clinical presentation of pediatric thoracolumbar fractures. J Trauma 60:187–192
Sledge JB, Allred D, Hyman J (2001) Use of magnetic resonance imaging in evaluating injuries to the padiatric thoracolumbar spine. J Pediatr Orthop 21:288–293
Slotkin JR, Lu Y, Wood KB (2007) Thoracolumbar spinal trauma in children. Neurosurg Clin North Am 18:621–630
Subotic U, Holland-Cunz S, Bardenheuer M et al (2007) Chance fracture – a rare injury in pediatric patients? Eur J Pediatr Surg 17:207–209
Swischuk LE, Jadhav SP, Chung DH (2008) Aortic injury with Chance fracture in a child. Emerg Radiol 15:285–287
Vanderhave KL, Caird MS, Gross S et al (2009) Burst fractures of the thoracic and lumbar spine in children and adolescents. J Pediatr Orthop 29:713–719
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Kraus, R., Stahl, JP., Heiss, C. et al. Frakturen der Brust- und Lendenwirbelsäule im Wachstumsalter. Unfallchirurg 116, 435–441 (2013). https://doi.org/10.1007/s00113-011-2113-8
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DOI: https://doi.org/10.1007/s00113-011-2113-8