Kasantikul Vira, Ouellet James V, Smith T A
Silpakorn University, Nakorn-Pathom, Thailand.
Traffic Inj Prev. 2003 Sep;4(3):255-62. doi: 10.1080/15389580309878.
Detailed layer-by-layer autopsy of the head and neck was performed on a prospective series of 73 fatally injured motorcyclists in order to identify occult injuries, particularly soft tissue neck injuries such as hemorrhage of vertebral and carotid arteries. The fatal cases were gathered as part of a larger study of 1,082 on-scene in-depth motorcycle crash investigations in Thailand. Detailed neck dissection was done on nearly all fatal cases. Injuries were coded using the 1990 revision of the Abbreviated Injury Scale (AIS 90) and an Injury Severity Score (ISS) was determined for each case. Additional AIS codes are proposed for neck injuries that were often identified during the detailed autopsy procedures, but which are not listed explicitly among existing AIS codes. Helmet use was determined based on analysis of injury patterns and helmet damage with consideration also given to witness statements. Both helmeted and unhelmeted motorcyclists showed a high frequency of occult neck injuries such as hemorrhages in the carotid sheath or surrounding the vertebral arteries, phrenic nerve, or brachial plexus. These soft tissue neck injuries sometimes accompanied more obvious injuries to cervical vertebrae or spinal cord, but about one-third of riders had no obvious injury to suggest the presence of occult neck injury. Twenty-eight motorcyclists had been wearing a helmet at the start of the collision sequence, but only nine helmets remained in place through the entire collision event. Helmeted riders showed more severe somatic (below-the-neck) injuries than unhelmeted riders, suggesting helmeted riders are less likely to die in low-threat accidents with somatic injuries below AIS-3. The most significant finding of this study was the identification of serious internal neck injuries despite the absence of external physical evidence of trauma to the neck. Virtually all riders with significant head injuries showed some of these soft tissue neck injuries. Approximately one-third of the critically injured riders who survived at least a few hours before death showed serious occult soft tissue neck injuries.
对73例致命伤摩托车手进行了头颈部逐层详细尸检，以确定隐匿性损伤，特别是软组织颈部损伤，如椎动脉和颈动脉出血。这些致命病例是泰国一项对1082起摩托车事故现场深入调查的大型研究的一部分。几乎对所有致命病例都进行了详细的颈部解剖。损伤采用1990年修订的简明损伤定级标准（AIS 90）进行编码，并为每个病例确定损伤严重度评分（ISS）。针对在详细尸检过程中经常发现但现有AIS编码中未明确列出的颈部损伤，提出了额外的AIS编码。根据损伤模式分析、头盔损坏情况并参考证人陈述来确定头盔使用情况。戴头盔和未戴头盔的摩托车手隐匿性颈部损伤的发生率都很高，如颈动脉鞘内或椎动脉、膈神经或臂丛神经周围出血。这些软组织颈部损伤有时伴有颈椎或脊髓更明显的损伤，但约三分之一的骑手没有明显损伤表明存在隐匿性颈部损伤。28名摩托车手在碰撞开始时戴着头盔，但整个碰撞过程中只有9顶头盔仍在原位。戴头盔的骑手比未戴头盔的骑手躯体（颈部以下）损伤更严重，这表明在躯体损伤低于AIS-3的低威胁事故中，戴头盔的骑手死亡可能性较小。本研究最显著的发现是，尽管颈部没有外部创伤的物理证据，但仍发现了严重的颈部内部损伤。几乎所有有严重头部损伤的骑手都有一些此类软组织颈部损伤。约三分之一在死亡前至少存活数小时的重伤骑手有严重的隐匿性软组织颈部损伤。
