Hall Samuel, Myers Matthew A, Sadek Ahmed-Ramadan, Baxter Mark, Griffith Colin, Dare Christopher, Shenouda Emad, Nader-Sepahi Ali
Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, United Kingdom; Division of Clinical Neurosciences, School of Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom.
Department of Medicine and Elderly Care, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, United Kingdom.
Clin Neurol Neurosurg. 2019 Feb;177:106-113. doi: 10.1016/j.clineuro.2019.01.005. Epub 2019 Jan 7.
Falls from standing are common, particularly amongst the aging population, due to declining mobility, proprioception and vision. They are often complicated by fragility fractures, including vertebral fractures, that are associated with significant morbidity and may represent a pre-terminal condition with high one-year mortality rates.
A retrospective review of the Trauma Audit and Research Network database for a major trauma centre was conducted for all patients admitted between January 2011 and December 2016. Patients with a spinal fracture and a confirmed fall from standing height were eligible for inclusion. Case notes were reviewed for demographics, Injury Severity Score, Charlson co-morbidity score, treatment, complications and outcomes.
Of 1408 patients with a spine fracture admitted during the study period, 229 (16.3%) were confirmed to be secondary to a fall from standing height. The average age of this cohort was 76.6 ± 14.5 years and 134 (58.5%) cases were female. The average ISS score was 9.7 ± 5.4. The 229 patients sustained 283 fractures with a distribution of: cervical (n = 140), thoracic (n = 65) and lumbar (n = 78) spine. Fifty-six (24.5%) patients underwent surgical intervention. Forty-three patients (18.7%) died within 6 months of admission and all-cause mortality was significantly higher in patients with increasing age and Charlson co-morbidity score.
Spinal fractures due to a fall from standing height represent one sixth of the fracture workload of the emergency spinal service at a major trauma centre. Whilst the majority of patients can be managed conservatively there are still considerable implications for hospital bed usage and patient mortality.
由于行动能力、本体感觉和视力下降，从站立姿势跌倒的情况很常见，尤其是在老年人群中。这些跌倒常常并发脆性骨折，包括椎体骨折，这与显著的发病率相关，并且可能代表一种具有高一年死亡率的临终前状况。
对一家主要创伤中心2011年1月至2016年12月期间收治的所有患者进行创伤审计与研究网络数据库的回顾性分析。有脊柱骨折且证实是从站立高度跌倒的患者符合纳入标准。查阅病历以获取人口统计学信息、损伤严重程度评分、查尔森合并症评分、治疗、并发症及结局。
在研究期间收治的1408例脊柱骨折患者中，229例（16.3%）被证实是由从站立高度跌倒所致。该队列的平均年龄为76.6±14.5岁，134例（58.5%）为女性。平均损伤严重程度评分为9.7±5.4。这229例患者共发生283处骨折，分布为：颈椎（n = 140）、胸椎（n = 65）和腰椎（n = 78）。56例（24.5%）患者接受了手术干预。43例患者（18.7%）在入院后6个月内死亡，年龄和查尔森合并症评分增加的患者全因死亡率显著更高。
从站立高度跌倒导致的脊柱骨折占主要创伤中心急诊脊柱服务骨折工作量的六分之一。虽然大多数患者可采用保守治疗，但仍对医院床位使用和患者死亡率有相当大的影响。
