Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Spine J. 2010 Dec;10(12):1128-32. doi: 10.1016/j.spinee.2010.09.025.
Despite multiple reports of survivability, dissociative occipitocervical injury (OCI) is generally accepted to be fatal in most cases. The actual number of trauma victims where OCI may have made the difference between life and death is unknown because multiple studies have shown that these injuries can be missed with current diagnostic methods. An improved understanding of the relative importance of OCI in blunt trauma mortality may help to refine protocols for the assessment and treatment of patients who arrive alive to the emergency room after severe blunt trauma. One way to improve our understanding is to document the relative frequency OCI relative to brain, liver, aorta, and spleen injuries in blunt trauma fatalities.
In this study, we aimed to glean a more accurate estimate of the absolute and relative incidence of OCI after death from blunt trauma via a systematic review of data reported in the forensic literature.
Systematic literature review.
A systematic literature search and review were undertaken. The search aimed to answer three primary questions: What is the true incidence of cervical spine injuries in blunt trauma fatalities? What is the incidence of dissociative OCIs specifically? and What is the incidence of these injuries relative to other common injuries associated with blunt trauma fatalities (central nervous system, spleen, liver, etc)? For that, two search protocols were used and included postmortem studies of blunt trauma mechanism in adult population.
The mean reported incidence of cervical spine injuries was 49.7% in blunt trauma fatalities. Dissociative OCIs were found to have a mean incidence of 18.1%. The relative frequencies of injuries were 49.7% for cervical spine, 41.8% for central nervous system, 20.8% for liver, 11.2% for spleen, and 10.8% for aorta.
In this systematic literature review, cervical spine injuries were found to be the most commonly reported finding associated with blunt trauma fatalities, occurring in nearly 50% of cases with occipitocervical dissociation accounting for nearly 20%. Older pathologic studies suggested a lesser overall and relative frequency and may have underestimated their incidence. Typically, these blunt cervical spine injuries were much more commonly found to disrupt the soft tissue stabilizing restraints (ligaments, facet capsules, etc) as opposed to causing bony fractures and, accordingly, were often not detected on plain radiographs. It is likely that the frequency of this injury is underestimated in patients surviving severe blunt trauma, placing them at risk for death from an occult source in the postinjury period. Additional research is needed to determine if improved methods to diagnose OCI and improved patient management protocols to protect against secondary injuries might reduce mortality in blunt trauma victims.
尽管有多项关于生存能力的报告，但分离性枕颈损伤（OCI）在大多数情况下通常被认为是致命的。由于多项研究表明，目前的诊断方法可能会遗漏这些损伤，因此实际有多少创伤受害者的生命因 OCI 而得以挽救尚不得而知。对钝性创伤死亡率中 OCI 的相对重要性的认识的提高，可能有助于完善对严重钝性创伤后存活到急诊室的患者的评估和治疗方案。一种提高认识的方法是记录 OCI 在钝性创伤死亡中的相对频率，相对于脑、肝、主动脉和脾脏损伤。
在这项研究中，我们旨在通过对法医文献中报告的数据进行系统回顾，更准确地估计因钝性创伤死亡后的 OCI 的绝对和相对发生率。
系统文献回顾。
进行了系统的文献检索和综述。该检索旨在回答三个主要问题：在钝性创伤死亡中，颈椎损伤的真实发生率是多少？分离性 OCI 的发生率具体是多少？这些损伤的发生率与其他与钝性创伤死亡相关的常见损伤（中枢神经系统、脾脏、肝脏等）相比如何？为此，使用了两种搜索方案，包括对成人钝性创伤机制的尸检研究。
报告的颈椎损伤在钝性创伤死亡中的平均发生率为 49.7%。分离性 OCI 的平均发生率为 18.1%。损伤的相对频率分别为颈椎 49.7%、中枢神经系统 41.8%、肝 20.8%、脾 11.2%和主动脉 10.8%。
在这项系统文献综述中，颈椎损伤是与钝性创伤死亡相关的最常见的报告发现，在近 50%的病例中发现，而枕颈分离约占 20%。较旧的病理研究表明，整体和相对频率较低，可能低估了其发生率。通常，这些钝性颈椎损伤更常见于破坏软组织稳定的约束（韧带、关节囊等），而不是造成骨骨折，因此，在普通 X 光片上通常无法检测到。在严重钝性创伤后幸存的患者中，这种损伤的频率很可能被低估，使他们有因隐匿性原因在受伤后死亡的风险。需要进一步研究以确定是否可以改进诊断 OCI 的方法和改进保护患者免受继发性损伤的管理方案，以降低钝性创伤受害者的死亡率。
