[颈部挥鞭伤：从概念到事实]

Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, assistance publique-hôpitaux de Paris, hôpital Cochin, université René-Descartes, Paris, France.

Ann Readapt Med Phys. 2003 Apr;46(3):158-70. doi: 10.1016/s0168-6054(03)00053-9.

OBJECTIVES

To focus on a topic of traumatology and rehabilitation becoming recently a much debated public health problem.

METHOD

A references search from Medline database with whiplash as keyword was carried out. Were selected articles with abstracts in french or english and focusing on accidentology, biomechanics, demonstrated lesions, epidemiology and treatments.

RESULTS

From 1664 references found, 232 were reviewed. The usual mechanism of crash is a rear-end collision inducing in the occupants of the bumped vehicle a sudden lower cervical spine extension with upper flexion followed by a global flexion. In nearly 50% of the cases, the stress occurring in the collision is comparable to that observed in bumper cars. The velocity changes are seldom up to 15 km/h. A headrest at the level of the center of gravity of the head restrict significantly the extension of the neck. Every structure of the cervical spine could be damaged and mainly the facet joints but the lesions were only demonstrated in severes traumatisms. The discrepancies in incidence among the different countries could be related to their medicolegal system. Although subjectives, the early symptoms are rather similar among patients suggesting true anatomical or functional disorders but the chronicity seems to be mainly related to social and psychological factors. The association of: no posterior midline cervical tenderness, no intoxication, normal alertness, no focal neurological deficit and no painful distracting injuries has a good predictive value of the lack of osteo-articular lesion on X-rays. Except the grade IV of the Quebec task Force (0, no symptom; 1, pain and stiffness; 2, neck complaint and physical signs; 3, neck complaint and neurological signs; 4, fracture or dislocation) the use of a collar should be avoided and the cervical spine should be mobilized.

CONCLUSION

In most whiplash injuries, the mildness should be early stated, mobilization encouraged, and procedures of compensation shortened.

目的

关注创伤学与康复领域中一个近期备受争议的公共卫生问题。

方法

以“挥鞭伤”为关键词在Medline数据库中进行参考文献检索。选取摘要为法语或英语且聚焦于事故学、生物力学、已证实的损伤、流行病学及治疗的文章。

结果

在检索到的1664篇参考文献中，对232篇进行了综述。碰撞的常见机制是追尾碰撞，导致被撞车辆内的驾乘人员颈椎突然向下伸展并伴有上部屈曲，随后是整体屈曲。在近50%的病例中，碰撞时产生的应力与碰碰车中观察到的应力相当。速度变化很少超过15公里/小时。位于头部重心水平的头枕可显著限制颈部伸展。颈椎的每个结构都可能受损，但主要是小关节，不过这些损伤仅在严重创伤中得到证实。不同国家发病率的差异可能与其法医学体系有关。尽管症状主观，但患者之间的早期症状相当相似，提示存在真正的解剖或功能障碍，但慢性化似乎主要与社会和心理因素有关。无颈椎后正中压痛、无中毒、意识正常、无局灶性神经功能缺损且无疼痛性分散性损伤同时存在，对X线检查时无骨关节损伤具有良好的预测价值。除了魁北克工作组的IV级（0级，无症状；1级，疼痛和僵硬；2级，颈部不适和体征；3级，颈部不适和神经体征；4级，骨折或脱位）外，应避免使用颈托并应活动颈椎。