1 Allina Health Emergency Medical Services, St. Paul, Minnesota USA.
4 Minnesota Department of Health, St. Paul, Minnesota USA.
Prehosp Disaster Med. 2014 Feb;29(1):96-9. doi: 10.1017/S1049023X14000041. Epub 2014 Jan 22.
Conventional prehospital spine-assessment approaches based on low index of suspicion and mechanism of injury (MOI) result in the liberal application of spinal immobilization in trauma patients. A painful distracting injury (DI), such as a suspected hip fracture, historically has been a sufficient condition for immobilization, even in an elderly patient who suffers a simple fall from standing and exhibits no other risk factors for spinal injury. Because the elderly are at increased risk of hip fracture from low-level falls, and are also particularly susceptible to the discomfort and morbidity associated with immobilization, the prevalence of cervical spine (c-spine) fracture in this patient population was examined.
Hospital billing records were used to identify all cases of traumatic femur fracture in Minnesota (USA) in 2010-2011. Concurrent diagnosis and external cause codes were used to estimate the prevalence of c-spine fracture by age and MOI.
Among 1,394 patients with femur fracture, 23 (1.7%) had a c-spine fracture. When the MOI was a fall from standing or sitting height and the patient age was ≥ 65, the prevalence dropped to 0.4% (2/565). The prevalence was similar when the definition of hip fracture additionally included pelvis fractures (0.5%; 11/2,441). Eight of the 11 patients with c-spine fracture had diagnosis codes indicative of criteria other than the DI that likely would have resulted in immobilization (eg, head injury and compromised mental status).
C-spine fracture is extremely rare in elderly patients who sustain hip fracture as a result of a low-level fall, and appears to be accompanied frequently by other known predictors of spinal injury besides DI. More research is needed to determine whether conservative use of spinal immobilization may be warranted in elderly patients with hip fracture after low-level falls when the only criteria for immobilization is the distracting hip injury.
基于低怀疑指数和损伤机制（MOI）的传统院前脊柱评估方法导致在创伤患者中广泛应用脊柱固定。历史上，疼痛性分离损伤（DI），如疑似髋部骨折，是固定的充分条件，即使在从站立位简单跌倒且没有其他脊柱损伤危险因素的老年患者中也是如此。由于老年人因低水平跌倒而髋部骨折的风险增加，并且特别容易受到固定相关不适和发病率的影响，因此检查了该患者人群中颈椎（c 脊柱）骨折的患病率。
使用医院计费记录在 2010-2011 年期间在美国明尼苏达州识别所有创伤性股骨骨折病例。同时使用诊断和外部原因代码按年龄和 MOI 估计 c 脊柱骨折的患病率。
在 1394 例股骨骨折患者中，有 23 例（1.7%）发生 c 脊柱骨折。当 MOI 为从站立或坐高跌倒且患者年龄≥65 岁时，患病率降至 0.4%（565 例中有 2 例）。当髋部骨折的定义另外包括骨盆骨折时，患病率相似（0.5%；2441 例中有 11 例）。11 例 c 脊柱骨折患者中有 8 例有诊断代码表明有其他可能导致固定的标准，例如头部损伤和精神状态受损。
在因低水平跌倒而导致髋部骨折的老年患者中，c 脊柱骨折极为罕见，并且似乎经常伴有除 DI 以外的其他已知脊柱损伤预测因素。需要进一步研究以确定在仅固定的标准是分散性髋部损伤时，在因低水平跌倒而导致髋部骨折的老年患者中是否可以保守使用脊柱固定。
