Bekelis Kimon, Missios Symeon, Spinner Robert J
Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire;
Department of Neurosurgery, Louisiana State University-Health Sciences Center, Shreveport, Louisiana; and.
J Neurosurg. 2015 Nov;123(5):1223-9. doi: 10.3171/2014.11.JNS142111. Epub 2015 May 15.
Despite the growing epidemic of falls, the true incidence of peripheral nerve injuries (PNIs) in this patient population remains largely unknown.
The authors performed a retrospective cohort study of 839,210 fall-injured patients who were registered in the National Trauma Data Bank (NTDB) between 2009 and 2011 and fulfilled the inclusion criteria. Regression techniques were used to investigate the association of demographic and socioeconomic factors with the rate of PNIs in this patient population. The association of age with the incidence of PNIs was also investigated.
Overall, 3151 fall-injured patients (mean age 39.1 years, 33.3% females) sustained a PNI (0.4% of all falls). The respective incidence of PNIs was 2.7 per 1000 patients for ground-level falls, 4.9 per 1000 patients for multilevel falls, and 4.5 per 1000 patients for falls involving force. This demonstrated a rapid increase in the first 2 decades of life, with a maximum rate of 1.1% of all falls in the 3rd decade, followed by a slower decline and eventual plateau in the 7th decade. In a multivariable analysis, the association of PNIs with age followed a similar pattern with patients 20-29 years of age, demonstrating the highest association (OR 2.34 [95% CI 2.0-2.74] in comparison with the first decade of life). Falls involving force (OR 1.25 [95% CI 1.14-1.37] in comparison with multilevel falls) were associated with a higher incidence of PNIs. On the contrary, female sex (OR 0.87 [95% CI 0.80-0.84]) and ground-level falls (OR 0.79 [95% CI 0.72-0.86]) were associated with a lower rate of PNIs.
Utilizing a comprehensive national database, the authors demonstrated that PNIs are more common than previously described in fall-injured patients and identified their age distribution. These injuries are associated with young adults and falls of high kinetic energy.
尽管跌倒的流行趋势日益严重，但该患者群体中周围神经损伤（PNI）的真实发生率仍 largely 未知。
作者对2009年至2011年期间在国家创伤数据库（NTDB）登记且符合纳入标准的839,210例跌倒受伤患者进行了一项回顾性队列研究。采用回归技术调查该患者群体中人口统计学和社会经济因素与PNI发生率之间的关联。还研究了年龄与PNI发生率之间的关联。
总体而言，3151例跌倒受伤患者（平均年龄39.1岁，女性占33.3%）发生了PNI（占所有跌倒的0.4%）。地面跌倒的PNI发生率为每1000例患者2.7例，多层跌倒为每1000例患者4.9例，涉及外力的跌倒为每1000例患者4.5例。这表明在生命的前20年中迅速增加，在第三个十年中发生率最高，为所有跌倒的1.1%，随后下降较慢，在第七个十年中最终趋于平稳。在多变量分析中，PNI与年龄的关联在20至29岁的患者中遵循类似模式，显示出最高的关联（与生命的第一个十年相比，OR为2.34[95%CI 2.0 - 2.74]）。涉及外力的跌倒（与多层跌倒相比，OR为1.25[95%CI 1.14 - 1.37]）与PNI的较高发生率相关。相反，女性（OR为0.87[95%CI 0.80 - 0.84]）和地面跌倒（OR为0.79[95%CI 0.72 - 0.86]）与较低的PNI发生率相关。
利用一个全面的国家数据库，作者证明PNI在跌倒受伤患者中比以前描述的更常见，并确定了它们的年龄分布。这些损伤与年轻人和高动能跌倒有关。
