Connell Richard A, Graham Colin A, Munro Philip T
Department of Accident & Emergency Medicine, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, UK.
Injury. 2003 Dec;34(12):912-4. doi: 10.1016/s0020-1383(03)00070-6.
Previous work suggests that patients with isolated penetrating trauma rarely require spinal immobilisation. This study aimed to identify the incidence of mechanically unstable, or potentially mechanically unstable, spinal column injuries in penetrating trauma patients. The study also aimed to identify the incidence of spinal cord injury as a result of penetrating trauma in Scotland.
Retrospective analysis of prospectively collected data from the Scottish Trauma Audit Group (STAG).
Study patients were identified from the period 1992-1999. Patients coded for both penetrating trauma and spinal column or spinal cord injury were included. Case records, theatre notes and post mortem information were also examined.
34903 patients were available for study. Twenty-seven patients were coded as having had penetrating trauma and concurrent spinal injury. 15 were excluded as they also had a major blunt mechanism of injury or had no actual injury to the spinal cord or column. In the remaining 12 patients, four cervical, one combined cervical and thoracic and seven thoracic spinal cord injuries were identified. 11 were male and 11 were assaulted. One assault was due to a gunshot wound; 10 resulted from sharp weapons. Four complete cord transections and nine partial cord lesions were identified. All 12 patients with spinal cord injury associated with isolated penetrating trauma either had obvious clinical evidence of a spinal cord injury on initial assessment or were in traumatic cardiac arrest. All had spinal immobilisation.
Fully conscious patients (GCS=15) with isolated penetrating trauma and no neurological deficit do not require spinal immobilisation.
先前的研究表明，单纯穿透性创伤患者很少需要脊柱固定。本研究旨在确定穿透性创伤患者中机械性不稳定或潜在机械性不稳定脊柱损伤的发生率。该研究还旨在确定苏格兰穿透性创伤导致脊髓损伤的发生率。
对前瞻性收集的苏格兰创伤审计组（STAG）数据进行回顾性分析。
研究对象为1992年至1999年期间的患者。纳入编码为穿透性创伤和脊柱或脊髓损伤的患者。还检查了病例记录、手术记录和尸检信息。
34903名患者可供研究。27名患者被编码为有穿透性创伤并伴有脊柱损伤。15名患者被排除，因为他们还存在主要的钝性损伤机制或脊髓或脊柱无实际损伤。在其余12名患者中，发现4例颈椎损伤、1例颈胸联合损伤和7例胸椎脊髓损伤。11名男性，均为受攻击所致。1例攻击是由枪伤引起；10例是由锐器所致。发现4例脊髓完全横断和9例部分脊髓损伤。所有12例与单纯穿透性创伤相关的脊髓损伤患者在初次评估时均有明显的脊髓损伤临床证据或处于创伤性心脏骤停状态。所有患者均进行了脊柱固定。
意识完全清醒（格拉斯哥昏迷量表评分=15）、单纯穿透性创伤且无神经功能缺损的患者不需要脊柱固定。
