Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Center for Injury Biomechanics, Winston-Salem, NC, United States.
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, NC, United States.
Accid Anal Prev. 2019 Jan;122:1-7. doi: 10.1016/j.aap.2018.09.029. Epub 2018 Oct 5.
Side impact motor vehicle collisions (MVC) represent a significant burden of mortality and morbidity caused by automotive injury within the United States. The objective of this study was to evaluate the relationship between upper extremity (UE) injury patterns and contact sources in side impact MVC with occupant and crash variables.
Crash Injury Research and Engineering Network data obtained from 1998 to 2012 were used to evaluate UE injuries in side impact crashes. First row drivers and passengers that were at least 16 years old with complete crash information were included. Side impact crashes were defined to have an area of deformation to the side of the vehicle and a principal direction of force between 60° and 120° or 240° and 300°. Injuries were stratified by type, anatomic location, and Abbreviated Injury Scale (AIS) severity. Occupant variables included age, sex, height, weight, body mass index, and Injury Severity Score. Vehicle and crash variables included in the analysis were change in vehicle velocity at the time of impact, maximum door intrusion, maximum B-pillar intrusion, seat track position, belt use, vehicle type, impact type, and injury source. Statistical analysis of the UE injury data included descriptive statistics, linear regression analyses with occupant variables, and logistic regression analyses with vehicle and crash variables.
There were 903 UE injuries among 408 case occupants. The most common injury type was soft tissue injury (72.5%). The majority of fractures were proximal to and including the humerus (70.3%) with the clavicle being the most common fracture location (N = 89). AIS 2+ UE injuries were associated with a significantly higher mean occupant Injury Severity Score than AIS 1 UE injuries (p = 0.01). Contact with the door was the leading cause of UE injury (34.2%). The odds (OR [95% confidence interval], p-value) of an AIS 2+ UE injury due to contact with the B-pillar (5.3 [3.1, 9.1], <0.0001), door (1.9 [1.3, 2.7], 0.0006), and steering wheel/assembly (2.7 [1.1, 6.3], 0.03) were significantly higher than all other injury sources combined. Scapula fractures were significantly associated with rearward seat track positions (1.46 [1.04, 2.05], 0.03).
This study provides insight into UE injury patterns in side impact MVC. The clavicle was the most common UE fracture location. Contact with the door resulted in the highest number of UE injuries and the B-pillar resulted in the most severe injuries. Additionally, exposure to greater B-pillar intrusion was associated with increased odds of scapula and clavicle fractures in side impacts.
在美国，汽车事故造成的侧面碰撞机动车事故（MVC）导致的死亡率和发病率很高。本研究的目的是评估上肢（UE）损伤模式与接触源之间的关系在侧面碰撞 MVC 中与乘员和碰撞变量。
使用 1998 年至 2012 年获得的碰撞伤害研究和工程网络数据评估侧面碰撞中的 UE 损伤。包括至少 16 岁的前排驾驶员和乘客，并且具有完整的碰撞信息。将侧面碰撞定义为车辆侧面有变形区域，并且力的主要方向在 60°和 120°或 240°和 300°之间。根据类型、解剖部位和损伤严重程度评分（AIS）严重程度对损伤进行分层。乘员变量包括年龄、性别、身高、体重、体重指数和损伤严重程度评分。分析中包括的车辆和碰撞变量包括冲击时车辆速度的变化、最大车门侵入量、最大 B 柱侵入量、座椅轨道位置、安全带使用、车辆类型、冲击类型和损伤源。对 UE 损伤数据进行了描述性统计分析、线性回归分析（包含乘员变量）和逻辑回归分析（包含车辆和碰撞变量）。
在 408 例病例中，有 903 例 UE 损伤。最常见的损伤类型是软组织损伤（72.5%）。大多数骨折发生在肱骨近端及以上（70.3%），锁骨是最常见的骨折部位（N=89）。AIS 2+UE 损伤与显著更高的平均乘员损伤严重程度评分相关（p=0.01）。与车门接触是 UE 损伤的主要原因（34.2%）。由于与 B 柱（5.3 [3.1, 9.1], <0.0001）、车门（1.9 [1.3, 2.7], 0.0006）和方向盘/组件（2.7 [1.1, 6.3], 0.03）接触而导致 AIS 2+UE 损伤的可能性显著高于所有其他损伤源的总和。肩胛骨骨折与后排座椅轨道位置显著相关（1.46 [1.04, 2.05], 0.03）。
本研究提供了侧面碰撞 MVC 中 UE 损伤模式的见解。锁骨是最常见的 UE 骨折部位。与车门接触导致的 UE 损伤数量最多，B 柱导致的损伤最严重。此外，更大的 B 柱侵入量与侧面碰撞中肩胛骨和锁骨骨折的几率增加有关。
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