Neurosurgery Program, Louisiana State University, New Orleans, LA, USA.
Injury. 2013 Nov;44(11):1601-6. doi: 10.1016/j.injury.2013.06.021. Epub 2013 Jul 11.
Gunshot wounds (GSW) to the spine represent a major health concern within today's society. Our study assessed the epidemiologic characteristics of patients with GSW to the spine treated in New Orleans.
A retrospective chart review was performed from January 2007 through November 2011 on all the patients who were seen in the emergency room and diagnosed with a gunshot wound to the spine. Epidemiologic factors, as well as the results of admission toxicology screening, were noted. Outcome analysis was performed on patients undergoing conservative versus operative management for their injuries. Clinical outcomes were assessed using the ASIA classification system. Complications related to initial injury, neurosurgical procedures, and hospital stay were noted.
A total of 147 patients were enrolled. Of those diagnosed with a GSW to the spine, 88 (59.8%) received an admission toxicology screen. Seventy-three (83%) patients out of those tested had a positive screen, with the most common substances detected being cannabis, cocaine, and alcohol. In regards to management, 127 (87%) patients were treated conservatively and only one (0.7%) patient improved clinically from ASIA D to E. Of the 20 patients who underwent surgery, one (5%) patient had clinical improvement post-operatively from ASIA C to D.
This study evaluates the largest number of patients with GSW to the spine per year treated in a single centre, illustrating the violent nature of New Orleans. In this urban population, there was a clear correlation between drug use and suffering a GSW to the spine. Surgical intervention was seldom indicated in these patients and was predominately used for fixation of unstable fractures and decompression of compressive injuries, particularly below T11. Minimally invasive techniques were used successfully at our institution to minimize the risk of post-operative CSF leak.
脊柱枪伤（GSW）是当今社会的一个主要健康问题。我们的研究评估了新奥尔良治疗的脊柱 GSW 患者的流行病学特征。
对 2007 年 1 月至 2011 年 11 月期间所有在急诊室就诊并诊断为脊柱枪伤的患者进行了回顾性图表审查。记录了流行病学因素以及入院毒理学筛查的结果。对接受保守治疗和手术治疗的患者进行了结果分析。使用 ASIA 分类系统对患者进行临床预后评估。记录与初始损伤、神经外科手术和住院时间相关的并发症。
共纳入 147 例患者。在诊断为脊柱 GSW 的患者中，88 例（59.8%）接受了入院毒理学筛查。在接受检测的 73 例（83%）患者中，有 73 例（83%）检测结果阳性，最常见的检测物质为大麻、可卡因和酒精。在治疗方面，127 例（87%）患者接受了保守治疗，只有 1 例（0.7%）患者从 ASIA D 级改善为 E 级。在接受手术治疗的 20 例患者中，有 1 例（5%）患者从 ASIA C 级改善为 D 级。
本研究评估了每年在单个中心治疗的脊柱 GSW 患者数量最多，说明了新奥尔良的暴力性质。在这个城市人群中，药物使用与脊柱 GSW 之间存在明显的相关性。在这些患者中，手术干预很少表明，主要用于固定不稳定骨折和减压压迫性损伤，特别是 T11 以下。我们机构成功使用微创技术最大限度地降低术后 CSF 漏的风险。
