评估钝性创伤中脊柱非连续性骨折的风险。

Evaluation of the risk of noncontiguous fractures of the spine in blunt trauma.

机构信息

Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington, USA.

出版信息

J Trauma Acute Care Surg. 2013 Jul;75(1):135-9. doi: 10.1097/ta.0b013e3182984a08.

DOI:10.1097/ta.0b013e3182984a08

PMID:23940857

Abstract

BACKGROUND

There is significant debate over the risk of additional noncontiguous (NC) fractures among blunt trauma patients with an identified spinal column injury, often prompting routine full-spine imaging. We sought to determine the incidence of NC spinal fractures and the relationship between injury pattern and mechanism.

METHODS

A review of all adult blunt trauma patients from the 2010 National Trauma Data Bank with a spine fracture. Patient demographics, mechanism of injury, and frequencies of all combinations of spinal fractures were analyzed.

RESULTS

Among 654,052 blunt trauma patients, 83,338 (13%) had a diagnosed spine fracture. The mean (SD) Injury Severity Score (ISS) was 15 (11). Of these, 7% (5,496) sustained spinal cord injury, and 17% (14,413) underwent spinal surgery during their index hospitalization. Among those with spinal column fractures, the overall incidence of NC fractures was 19% and was associated with severe truncal injuries, primarily involving the chest. The relative incidences of cervical, thoracic, and lumbar fractures were 41% (34,480), 37% (30,383), and 43% (35,778), respectively. Rates of NC fractures of the spine included 9% cervicothoracic (7,406), 4% cervicolumbar (3,415), and 10% thoracolumbar (7,929). The slight majority (57%) of patients with spinal fractures sustained high-velocity trauma compared with 43% associated with low-velocity trauma. However, NC fractures of the spine were strongly associated with high-velocity trauma.

CONCLUSION

Spine fractures are relatively common with blunt trauma, and approximately 20% of patients with a spinal column fracture will have an NC fracture. NC fractures were associated with other severe injuries and should be mainly suspected and investigated in high-velocity mechanisms.

摘要

背景

对于有脊柱损伤的钝性创伤患者，是否存在额外的非相邻（NC）骨折风险存在很大争议，这通常促使对整个脊柱进行常规成像检查。我们旨在确定 NC 脊柱骨折的发生率，以及损伤模式与机制之间的关系。

方法

回顾了 2010 年国家创伤数据库中所有有脊柱骨折的成年钝性创伤患者。分析了患者的人口统计学特征、损伤机制以及所有脊柱骨折组合的频率。

结果

在 654052 例钝性创伤患者中，有 83338 例（13%）被诊断为脊柱骨折。平均（SD）损伤严重程度评分（ISS）为 15（11）。其中，7%（5496 例）发生脊髓损伤，17%（14413 例）在住院期间接受了脊柱手术。在有脊柱骨折的患者中，NC 骨折的总体发生率为 19%，且与严重的躯干损伤相关，主要涉及胸部。颈椎、胸椎和腰椎骨折的相对发生率分别为 41%（34480 例）、37%（30483 例）和 43%（35778 例）。脊柱的 NC 骨折发生率包括 9%的颈胸（7406 例）、4%的颈腰椎（3415 例）和 10%的胸腰椎（7929 例）。与低能创伤相比，有脊柱骨折的患者中，有 57%的患者遭受了高能创伤，而 43%的患者遭受了低能创伤。然而，脊柱的 NC 骨折与高能创伤密切相关。