Division of Neurological Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Eneas C Aguiar, 255, São Paulo, SP, Brazil.
Neurosurg Rev. 2012 Jul;35(3):437-44; discussion 444-5. doi: 10.1007/s10143-012-0379-0. Epub 2012 Mar 6.
The authors present a prospective study on the coexistence of spinal injury (SI) and severe traumatic brain injury (TBI) in patients who were involved in traffic accidents and arrived at the Emergency Department of Hospital das Clinicas of the University of Sao Paulo between September 1, 2003 and December 31, 2009. A whole-body computed tomography was the diagnostic method employed in all cases. Both lesions were observed simultaneously in 69 cases (19.4%), predominantly in males (57 individuals, 82.6%). Cranial injuries included epidural hematoma, acute subdural hematoma, brain contusion, ventricular hemorrhage and traumatic subarachnoid hemorrhage. The transverse processes were the most fragile portion of the vertebrae and were more susceptible to fractures. The seventh cervical vertebra was the most commonly affected segment, with 24 cases (34.78%). The distribution of fractures was similar among the other cervical vertebrae, the first four thoracic vertebrae and the lumbar spine. Neurological deficit secondary to SI was detected in eight individuals (11.59%) and two individuals (2.89%) died. Traumatic subarachnoid hemorrhage was the most common intracranial finding (82.6%). Spinal surgery was necessary in 24 patients (34.78%) and brain surgery in 18 (26%). Four patients (5.79%) underwent cranial and spinal surgeries. The authors conclude that it is necessary a judicious assessment of the entire spine of individuals who presented in coma after suffering a brain injury associated to multisystemic trauma and whole-body CT scan may play a major role in this scenario.
作者报告了一项关于在交通事故中受伤并于 2003 年 9 月 1 日至 2009 年 12 月 31 日期间到达圣保罗大学临床医院急诊部的患者中同时存在脊柱损伤（SI）和严重创伤性脑损伤（TBI）的前瞻性研究。所有病例均采用全身计算机断层扫描作为诊断方法。在 69 例（19.4%）患者中同时观察到两种病变，主要为男性（57 例，82.6%）。颅部损伤包括硬膜外血肿、急性硬膜下血肿、脑挫裂伤、脑室出血和创伤性蛛网膜下腔出血。横突是椎骨最脆弱的部分，更容易骨折。第七颈椎是最常受影响的节段，有 24 例（34.78%）。其他颈椎、第一至第四胸椎和腰椎的骨折分布相似。8 例（11.59%）患者出现继发于 SI 的神经功能缺损，2 例（2.89%）死亡。创伤性蛛网膜下腔出血是最常见的颅内发现（82.6%）。24 例（34.78%）患者需要脊柱手术，18 例（26%）需要脑部手术。4 例（5.79%）患者同时进行了颅骨和脊柱手术。作者得出结论，对于因多系统创伤导致脑损伤后昏迷的患者，需要对整个脊柱进行明智的评估，全身 CT 扫描可能在此类情况下发挥重要作用。
