Mitchell Rebecca J, Stanford Ralph, McVeigh Catherine, Bell David, Close Jacqueline C T
Falls and Injury Prevention Group, Neuroscience Research Australia,, Australia.
Injury. 2014 Jan;45(1):217-22. doi: 10.1016/j.injury.2013.02.024. Epub 2013 Apr 6.
No Australian population-based studies have examined temporal trends in the incidence of fracture of the first or second cervical vertebra (C1 or C2 fractures), their aetiology, treatment and outcome for younger (15-64 years) compared to older (65+ years) individuals. The aim of this research is to examine the circumstances, treatment and outcomes including mortality for C1 or C2 fractures without associated spinal cord injury by age group in New South Wales (NSW), Australia.
A retrospective review of C1 or C2 vertebra fractures in individuals aged 15 years and over in the NSW Admitted Patient Data Collection from 1 July 1998 to 30 June 2010. Direct age standardised admission rates were calculated by cervical fracture type and by age group. Negative binomial regression was used to examine the statistical significance of changes in trend over time of hospitalised cervical fractures by age group.
The annual rate of hospitalised C1 and C2 fractures without associated spinal cord injury for individuals aged 15 years and over in NSW was 2.3 per 100,000 population, with the rate estimated to increase by 5.3% each year. Those aged 85+ years had the highest rates of hospitalisation. For those aged 15-64 years, road trauma was the most common mechanism of injury, while for those aged 65+ years, a fall was the dominant mechanism of injury. The in-hospital mortality for individuals aged 65+ years was 11.8% compared to 0.7% for those aged 15-64 years.
This study identified an estimated increasing trend in C1 and C2 fractures over time, particularly for older individuals. While younger individuals are commonly injured in road traffic accidents, older individuals are predominantly injured following a fall. Injury prevention strategies should be targeted to the different age groups and injury mechanisms. Implementation of effective falls prevention strategies is likely to reduce these injuries in older people whilst road and vehicle safety including vehicle rollover protection standards may improve rates in younger people.
尚无基于澳大利亚人群的研究探讨第一或第二颈椎骨折（C1或C2骨折）的发病率随时间的变化趋势、其病因、治疗方法以及与老年（65岁及以上）个体相比年轻（15 - 64岁）个体的治疗结果。本研究的目的是按年龄组研究澳大利亚新南威尔士州（NSW）无脊髓损伤的C1或C2骨折的情况、治疗方法及包括死亡率在内的治疗结果。
对1998年7月1日至2010年6月30日新南威尔士州住院患者数据集中15岁及以上个体的C1或C2椎骨骨折进行回顾性研究。按颈椎骨折类型和年龄组计算直接年龄标准化入院率。采用负二项回归分析按年龄组划分的住院颈椎骨折随时间变化趋势的统计学意义。
新南威尔士州15岁及以上个体无脊髓损伤的C1和C2骨折的年住院率为每10万人2.3例，预计每年增加5.3%。85岁及以上年龄组的住院率最高。对于15 - 64岁的个体，道路创伤是最常见的损伤机制，而对于65岁及以上的个体，跌倒则是主要的损伤机制。65岁及以上个体的院内死亡率为11.8%，而15 - 64岁个体为0.7%。
本研究发现C1和C2骨折随时间呈上升趋势，尤其是老年个体。年轻个体通常在道路交通事故中受伤，而老年个体主要因跌倒受伤。伤害预防策略应针对不同年龄组和损伤机制。实施有效的预防跌倒策略可能会减少老年人的这些损伤，而道路和车辆安全，包括车辆翻滚保护标准，可能会提高年轻人的损伤发生率。
