Yoganandan Narayan, Gennarelli Thomas A, Zhang Jiangyue, Pintar Frank A, Takhounts Erik, Ridella Stephen A
Department of Neurosurgery, Medical College of Wisconsin, and VA Medical Center, Milwaukee, Wisconsin, USA.
J Trauma. 2009 Feb;66(2):309-15. doi: 10.1097/TA.0b013e3181692104.
Although studies have been conducted to analyze brain injuries from motor vehicle crashes, the association of head contact has not been fully established. This study examined the association in occupants sustaining diffuse axonal injuries (DAIs).
The 1997 to 2006 motor vehicle Crash Injury Research Engineering Network database was used. All crash modes and all changes in velocity were included; ejections and rollovers were excluded; injuries to front and rear seat occupants with and without restraint use were considered. DAI were coded in the database using Abbreviated Injury Scale 1990. Loss of consciousness was included and head contact was based on medical- and crash-related data.
Sixty-seven occupants with varying ages were coded with DAI. Forty-one adult occupants (mean, 33 years of age, 171-cm tall, 71-kg weight; 30 drivers, 11 passengers) were analyzed. Mean change in velocity was 41.2 km/h and Glasgow Coma Scale score was 4. There were 33 lateral, 6 frontal, and 2 rear crashes with 32 survivors and 9 were fatalities. Two occupants in the same crash did not sustain DAI. Although skull fractures and scalp injuries occurred in some impacts, head contact was identified in all frontal, rear, and far side, and all but one nearside crashes.
Using a large sample size of occupants sustaining DAI in 1991 to 2006 model year vehicles, DAI occurred more frequently in side than frontal crashes, is most commonly associated with impact load transfer, and is not always accompanied by skull fractures. The association of head contact in >95% of cases underscores the importance of evaluating crash-related variables and medical information for trauma analysis. It would be prudent to include contact loading in addition to angular kinematics in the analysis and characterization of DAI.
尽管已开展研究分析机动车碰撞所致脑损伤，但头部接触的关联性尚未完全明确。本研究调查了弥漫性轴索损伤（DAI）患者中头部接触的关联性。
使用1997年至2006年机动车碰撞损伤研究工程网络数据库。纳入所有碰撞模式及所有速度变化情况；排除弹射和翻滚事故；考虑了使用和未使用安全带的前后排乘客损伤情况。数据库中使用1990年简略损伤量表对DAI进行编码。纳入意识丧失情况，头部接触基于医疗和碰撞相关数据确定。
67名不同年龄的乘客被编码为DAI。对41名成年乘客（平均年龄33岁，身高171厘米，体重71千克；30名驾驶员，11名乘客）进行分析。平均速度变化为41.2千米/小时，格拉斯哥昏迷量表评分为4分。有33起侧面碰撞、6起正面碰撞和2起后部碰撞，32人幸存，9人死亡。同一碰撞事故中的两名乘客未发生DAI。尽管在某些碰撞中发生了颅骨骨折和头皮损伤，但在所有正面、后部和远侧碰撞以及除一起近侧碰撞外的所有碰撞中均发现了头部接触。
利用1991年至2006年车型中大量发生DAI的乘客样本，DAI在侧面碰撞中比正面碰撞中更频繁发生，最常与冲击载荷传递相关，且并不总是伴有颅骨骨折。超过95%的病例中头部接触的关联性强调了评估碰撞相关变量和医疗信息对创伤分析的重要性。在DAI的分析和特征描述中，除角运动学外纳入接触载荷是谨慎之举。
