Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA 90033-4525, USA.
Injury. 2012 Aug;43(8):1296-300. doi: 10.1016/j.injury.2012.04.021. Epub 2012 May 28.
Spinal injuries secondary to trauma are a major cause of patient morbidity and a source of significant health care expenditure. Increases in traffic safety standards and improved health care resources may have changed the characteristics and incidence of spinal injury. The purpose of this study was to review a single metropolitan Level I trauma centre's experience to assess the changing characteristics and incidence of traumatic spinal injuries and spinal cord injuries (SCI) over a 13-year period.
A retrospective review of patients admitted to a Level I trauma centre between 1996 and 2008 was performed. Patients with spinal fractures and SCI were identified. Demographics, mechanism of injury, level of spinal injury and Injury Severity Score (ISS) were extracted. The outcomes assessed were the incidence rate of SCI and in-hospital mortality.
Over the 13-year period, 5.8% of all trauma patients suffered spinal fractures, with 21.7% of patients with spinal injuries having SCI. Motor vehicle accidents (MVAs) were responsible for the majority of spinal injuries (32.6%). The mortality rate due to spinal injury decreased significantly over the study period despite a constant mean ISS. The incidence rate of SCI also decreased over the years, which was paralleled by a significant reduction in MVA associated SCI (from 23.5% in 1996 to 14.3% in 2001 to 6.7% in 2008). With increasing age there was an increase in spinal injuries; frequency of blunt SCI; and injuries at multiple spinal levels.
This study demonstrated a reduction in mortality attributable to spinal injury. There has been a marked reduction in SCI due to MVAs, which may be related to improvements in motor vehicle safety and traffic regulations. The elderly population was more likely to suffer SCI, especially by blunt injury, and at multiple levels. Underlying reasons may be anatomical, physiological or mechanism related.
创伤性脊柱损伤是患者发病率高的主要原因，也是医疗保健支出的主要来源。交通安全标准的提高和医疗保健资源的改善可能改变了脊柱损伤的特征和发生率。本研究的目的是回顾单一都市一级创伤中心的经验，以评估 13 年来创伤性脊柱损伤和脊髓损伤 (SCI) 的变化特征和发生率。
对 1996 年至 2008 年期间入住一级创伤中心的患者进行回顾性分析。确定有脊柱骨折和 SCI 的患者。提取人口统计学、损伤机制、脊柱损伤水平和损伤严重程度评分 (ISS)。评估的结果是 SCI 的发病率和院内死亡率。
在 13 年期间，所有创伤患者中有 5.8%发生脊柱骨折，21.7%的脊柱损伤患者有 SCI。机动车事故 (MVA) 是导致大多数脊柱损伤的原因 (32.6%)。尽管平均 ISS 保持不变，但脊柱损伤导致的死亡率在研究期间显著下降。SCI 的发病率也逐年下降，这与 MVA 相关 SCI 的显著减少相平行（从 1996 年的 23.5%降至 2001 年的 14.3%，再降至 2008 年的 6.7%）。随着年龄的增长，脊柱损伤的发生率增加；钝性 SCI 的频率增加；以及多个脊柱水平的损伤。
本研究表明，脊柱损伤导致的死亡率有所下降。由于机动车事故导致的 SCI 显著减少，这可能与机动车安全和交通法规的改进有关。老年人群更容易发生 SCI，尤其是钝性损伤，且多个水平受损。潜在原因可能与解剖、生理或机制有关。
