Tian Heng-Li, Guo Yan, Hu Jin, Rong Bo-Ying, Wang Gan, Gao Wen-Wei, Chen Shi-Wen, Chen Hao
Department of Neurosurgery, Shanghai 6th People Hospital, Shanghai Jiaotong University, Shanghai, China.
J Trauma. 2009 Dec;67(6):1305-10. doi: 10.1097/TA.0b013e31819db57c.
Reports on the risk factors for combined craniocervical spine injury in comatose patients are rare. The incidence of concomitant cervical injury in comatose patients with traumatic brain injury (TBI) was determined herein.
One thousand twenty-six comatose patients with TBI were examined. The clinical characteristics of combined craniocervical trauma were documented, including type and location of cervical injury, occurrence of hypotension, and dyspnea.
Seventy-one patients (6.92%) sustained cervical spine injury. The most common injury region included the upper cervical segments, demonstrated in 37 (52.11%) of 71 patients. Of the 71 patients who sustained combined craniocervical spine injury, 42 (59.15%) had hypotension, including 26 (36.62%) with dyspnea. With regard to the association between the severity of TBI and the incidence of the cervical injury, a significant difference was apparent between patients with an initial Glasgow Coma Scale (GCS) score of 3-5 and those with an initial GCS score of 9-12 (11.62% compared with 4.03%, p < 0.01). Regarding the relationship between the mechanism of injury and the occurrence of cervical spine injury, cervical spine injury was associated at a significantly higher incidence with motorcycle accident-related head trauma as compared with non motorcycle accident-related trauma (10.32% vs. 4.68%, p < 0.01).
Patients who sustained TBI as a result of motorcycle accidents and those exhibiting a lower GCS score are at the highest risk for concomitant cervical spine injury.
关于昏迷患者合并颅颈脊柱损伤危险因素的报道较少。本文确定了创伤性脑损伤（TBI）昏迷患者中颈椎损伤的发生率。
对1026例TBI昏迷患者进行检查。记录合并颅颈创伤的临床特征，包括颈椎损伤的类型和部位、低血压的发生情况及呼吸困难情况。
71例患者（6.92%）发生颈椎损伤。最常见的损伤部位包括上颈椎节段，71例患者中有37例（52.11%）表现为此处损伤。在71例合并颅颈脊柱损伤的患者中，42例（59.15%）出现低血压，其中26例（36.62%）伴有呼吸困难。关于TBI严重程度与颈椎损伤发生率之间的关联，初始格拉斯哥昏迷量表（GCS）评分为3 - 5分的患者与初始GCS评分为9 - 12分的患者之间存在显著差异（分别为11.62%和4.03%，p < 0.01）。关于损伤机制与颈椎损伤发生之间的关系，与非摩托车事故相关创伤相比，摩托车事故相关头部创伤导致颈椎损伤的发生率显著更高（10.32%对4.68%，p < 0.01）。
因摩托车事故导致TBI的患者以及GCS评分较低的患者发生颈椎损伤的风险最高。
