Hamilton Kimberly, Rocque Brandon, Brooks Nathaniel
Neurosurgery Department, University of Wisconsin Hospital and Clinics, Madison, Wisconsin,
University of Alabama at Birmingham.
WMJ. 2017 Nov;116(4):201-205.
Deer hunting is popular in much of the United States. In Wisconsin, use of tree stands for hunting is common. Spine surgeons at a Level 1 Trauma Center observed a high incidence of spine and spinal cord injury due to falls from tree stands while hunting. This study's purpose is to systematically characterize and classify those injuries.
We reviewed the University of Wisconsin Hospital and Clinics' trauma database for tree stand-related injuries from 1999 to 2013. We collected and analyzed data pertaining to hunters' demographics, comorbidities, type and mechanism of injury, injury severity, and management.
We identified 117 patients evaluated after a tree stand fall. Sixty-five (ages 16-76) suffered spine fractures that occurred at all levels, from occipital condyle to sacrum, with thoracolumbar compression and burst fractures being most common. Fractures occurred in the following locations: cranio-cervical junction (8.7%), cervical spine (7.6%), cervical-thoracic junction (6.5%), thoracic spine (32.6%), thoracolumbar junction (33.7%), and lumbar spine (10.9%). Twenty-one patients (32%) experienced a single spinal fracture; 44 patients (68%) suffered multiple spinal fractures. Twenty-five patients (38%) required surgical fixation; 19 patients experienced loss of neurologic function: 5 complete spinal cord injuries (SCI), 5 incomplete SCI, 2 central cord syndromes, and 8 radiculopathies. Two mortalities, both of cardiopulmonary etiology, were noted-one in a patient without a spine fracture and the other in a patient with a complete spinal cord injury at T4.
The majority of spine fractures are treated nonoperatively. However, enough patients require surgical intervention that consultation with a neurosurgical or orthopedic spine surgeon is prudent. It is more common to have multiple spine fractures from a tree stand fall, therefore, it is recommended that if 1 fracture is identified the entire spine be evaluated for additional fractures. For safety, it is recommended that hunters wear and use safety harnesses appropriately. Additionally, keeping the height of the tree stand at 10 feet or less is associated with a lower likelihood of spinal cord injury. Further study is needed to determine additional interventions such as education that might reduce the injury frequency in this population.
在美国大部分地区，猎鹿活动很受欢迎。在威斯康星州，使用树架狩猎很常见。一家一级创伤中心的脊柱外科医生观察到，狩猎时从树架上跌落导致脊柱和脊髓损伤的发生率很高。本研究的目的是系统地描述和分类这些损伤。
我们回顾了威斯康星大学医院和诊所1999年至2013年与树架相关损伤的创伤数据库。我们收集并分析了有关猎人的人口统计学、合并症、损伤类型和机制、损伤严重程度及治疗情况的数据。
我们确定了117例在从树架上跌落后来接受评估的患者。65例（年龄16 - 76岁）发生了脊柱骨折，骨折发生在从枕骨髁到骶骨的各个节段，胸腰椎压缩性骨折和爆裂性骨折最为常见。骨折发生在以下部位：颅颈交界区（8.7%）、颈椎（7.6%）、颈胸交界区（6.5%）、胸椎（32.6%）、胸腰交界区（33.7%）和腰椎（10.9%）。21例患者（32%）发生单一脊柱骨折；44例患者（68%）发生多处脊柱骨折。25例患者（38%）需要手术固定；19例患者出现神经功能丧失：5例完全性脊髓损伤（SCI）、5例不完全性SCI、2例中央脊髓综合征和8例神经根病。记录到2例死亡，均为心肺病因，1例发生在无脊柱骨折的患者，另1例发生在T4水平完全性脊髓损伤的患者。
大多数脊柱骨折采用非手术治疗。然而，有足够多的患者需要手术干预，因此谨慎起见应咨询神经外科或骨科脊柱外科医生。从树架上跌落导致多处脊柱骨折更为常见，因此，建议如果发现1处骨折，应对整个脊柱进行评估以查找其他骨折。为了安全起见，建议猎人正确佩戴和使用安全带。此外，将树架高度保持在10英尺或更低与脊髓损伤可能性较低相关。需要进一步研究以确定其他干预措施，如教育，可能会降低该人群的损伤频率。
