Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX 79920, USA.
Spine J. 2012 Sep;12(9):777-83. doi: 10.1016/j.spinee.2011.01.029. Epub 2011 Mar 9.
The epidemiology of cervical spine fractures and associated spinal cord injury (SCI) has not previously been estimated within the American population.
To determine the incidence of cervical spine fractures and associated SCI and identify potential risk factors for these injuries in a large multicultural military population.
Query of a prospectively collected military database.
The 13,813,333 military servicemembers serving in the US Armed Forces between 2000 and 2009.
The Defense Medical Epidemiology Database (DMED) was queried to identify all servicemembers diagnosed with cervical spine fractures with and without SCI during the time period under investigation. Data were used to determine the incidence of cervical spine fractures and SCI as well as identify risk factors for their development.
The DMED was queried for the years 2000 to 2009 using the International Classification of Diseases, Ninth Revision, Clinical Modification code for cervical spine fractures with and without SCI (805.0, 805.1, 806.0, and 806.1). The database was also used to determine the total number of servicemembers within the military during the same period. The incidence of cervical spine fractures and fractures associated with SCI was determined, and unadjusted incidence rates were calculated for the demographic characteristics of sex, race, military rank, branch of service, and age. Adjusted incidence rate ratios were then determined using multivariate Poisson regression analysis to control for other factors in the model and identify significant risk factors for cervical spine fractures and cervical injuries associated with SCI.
From 2000 to 2009, there were 4,048 cervical spine fractures in a population at risk of 13,813,333 servicemembers. The overall incidence of cervical spine fractures was 0.29 per 1,000 person-years, and the incidence of fracture associated SCI was 70 per 1,000,000. The cohorts at highest risk of cervical spine fracture were males, whites, Enlisted personnel, those serving in the Army, Navy, or Marine Corps, and servicemembers aged 20 to 29. Risk of fracture-associated SCI was significantly increased in males, Enlisted personnel, servicemembers in the Army, Navy, or Marines, and those aged 20 to 29.
This study is the largest population-based investigation to be conducted within the United States regarding the incidence of SCI and the only study addressing incidence and risk factors for cervical spine fractures. Male sex, white race, Enlisted military rank, service in the Army, Navy, or Marine Corps, and ages 20 to 29 were found to significantly increase the risk for cervical fractures and/or fracture associated SCI. Our findings support previously published data but also represent best available evidence based on the size and diversity of the population under study.
Prognostic; Level II.
在美国人群中，颈椎骨折和相关脊髓损伤（SCI）的流行病学尚未被评估。
确定大型多元文化军事人群中颈椎骨折和相关 SCI 的发生率，并确定这些损伤的潜在危险因素。
前瞻性收集的军事数据库查询。
2000 年至 2009 年期间在美国武装部队服役的 13813333 名军人。
通过国防部医疗流行病学数据库（DMED）查询，确定在调查期间诊断出颈椎骨折伴或不伴 SCI 的所有军人。数据用于确定颈椎骨折和 SCI 的发生率，并确定其发展的危险因素。
使用国际疾病分类，第九修订版，临床修正版，颈椎骨折伴或不伴 SCI 的代码（805.0、805.1、806.0 和 806.1）在 2000 年至 2009 年期间对 DMED 进行了查询。该数据库还用于确定同期内军队中军人的总数。确定颈椎骨折和与 SCI 相关的骨折的发生率，并计算出性别、种族、军衔、军种和年龄等人口统计学特征的未调整发病率。然后使用多变量泊松回归分析确定调整后的发病率比，以控制模型中的其他因素，并确定颈椎骨折和与 SCI 相关的颈椎损伤的显著危险因素。
2000 年至 2009 年，在 13813333 名有风险的军人中，有 4048 例颈椎骨折。颈椎骨折的总发生率为 0.29/1000 人年，骨折伴 SCI 的发生率为 70/100 万人。颈椎骨折风险最高的队列是男性、白人、 enlisted 人员、陆军、海军或海军陆战队服役人员以及 20 至 29 岁的人员。男性、 enlisted 人员、陆军、海军或海军陆战队服役人员以及 20 至 29 岁的人员，SCI 相关骨折的风险显著增加。
这项研究是在美国进行的最大规模的基于人群的 SCI 发生率调查，也是唯一一项针对颈椎骨折发生率和危险因素的研究。男性、白人、 enlisted 军衔、陆军、海军或海军陆战队服役以及 20 至 29 岁的年龄被发现显著增加了颈椎骨折和/或骨折伴 SCI 的风险。我们的发现支持以前发表的数据，但也代表了基于研究人群的规模和多样性的最佳现有证据。
预后；二级。
