Schubl Sebastian D, Robitsek R Jonathan, Sommerhalder Christian, Wilkins Kimberly J, Klein Taylor R, Trepeta Scott, Ho Vanessa P
Department of Surgery, Jamaica Hospital Medical Center, Jamaica, NY.
Ross University School of Medicine, Portsmouth, Dominica.
Am J Emerg Med. 2016 Apr;34(4):726-9. doi: 10.1016/j.ajem.2016.01.014. Epub 2016 Jan 21.
Penetrating injuries to the head and neck may not be able to cause unstable fractures without concomitant spinal cord injury, rendering prehospital spinal immobilization (PHSI) ineffectual, and possibly harmful. However, this premise is based on reports including predominantly chest and abdominal injuries, which are unlikely to cause cervical spine (CS) injuries.
We performed a retrospective review of all patients presenting with a penetrating wound to the head or neck over a 4-year period at an urban, level 1 trauma center to determine if there was a benefit of PHSI.
One hundred seventy-two patients were identified, of which 16 (9.3%) died prior to CS evaluation. Of 156 surviving patients, mechanism was gunshot wound (GSW) in 36 (28%) and stab wound (SW) in 120 (72%). Fifty-eight patients had PHSI placed (37%), and GSW patients' odds of having PHSI were greater than SW patients (OR 2.3; CI 1.08-4.9). Eight of 156 surviving patients eventually died (5.1%), and the odds of mortality were greater among those that had PHSI than those without (OR 5.54; CI 1.08-28.4). Six (3.8%; 5 GSW, 1 SW) patients had a CS fracture. Two GSW patients (5.6%) had unstable CS fractures with a normal neurological exam at initial evaluation.
Of patients with a GSW to the head or neck that survived to be evaluated, 5.6% had unstable fractures without an initial neurologic deficit. PHSI may be appropriate in this population. Further studies are warranted prior to a determination that PHSI is unnecessary in penetrating head and neck injuries.
头颈部穿透伤若不伴有脊髓损伤，可能不会导致不稳定骨折，这使得院前脊柱固定（PHSI）无效，甚至可能有害。然而，这一前提基于主要包括胸部和腹部损伤的报告，而这些损伤不太可能导致颈椎（CS）损伤。
我们对一家城市一级创伤中心4年内所有出现头颈部穿透伤的患者进行了回顾性研究，以确定PHSI是否有益。
共确定了172例患者，其中16例（9.3%）在进行颈椎评估前死亡。在156例存活患者中，致伤机制为枪伤（GSW）的有36例（28%），刺伤（SW）的有120例（72%）。58例患者进行了PHSI（37%），GSW患者接受PHSI的几率高于SW患者（比值比2.3；可信区间1.08 - 4.9）。156例存活患者中有8例最终死亡（5.1%），接受PHSI的患者死亡率高于未接受者（比值比5.54；可信区间1.08 - 28.4）。6例（3.8%；5例GSW，1例SW）患者发生了颈椎骨折。2例GSW患者（5.6%）在初始评估时颈椎骨折不稳定，但神经检查正常。
在存活至可进行评估的头颈部GSW患者中，5.6%有不稳定骨折且初始无神经功能缺损。PHSI可能适用于这一人群。在确定头颈部穿透伤无需进行PHSI之前，有必要进行进一步研究。
