Gil C, Decq P
Department of rheumatology and rehabilitation, hôpitaux nationaux de Saint-Maurice, 12/14, rue du Val-d'Osne, 94410 Saint-Maurice, France.
Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of neurosurgery, Beaujon hospital, AP-HP, Clichy, France; Georges Charpak Human Biomecanics Institute, Arts et Métiers ParisTech, Paris, France.
Neurochirurgie. 2021 May;67(3):238-243. doi: 10.1016/j.neuchi.2021.01.016. Epub 2021 Jan 30.
Mild traumatic brain injury (mTBI) and whiplash are two pathologies which appear in the follow-up of a cranio-cervical trauma. The objective of this study is to review their definitions, to discuss each entity.
Whiplash and mTBI were defined. Then, a systematic literature review was carried out using the Pubmed database. Relevant studies after 1995 were selected, with 16 articles describing a link between whiplash and mTBI. 8 articles were analyzed after reading their abstracts.
Whiplash and mTBI have many similarities (symptoms, biomechanics, cognitive disorders, presence of diffuse axonal lesions on functional imaging) and some differences (in posture, more vestibular and balance disorders in whiplash). mTBIs result from linear accelerations between 60- 160g (gravity), studies on whiplash have shown that they can appear from 4.5g, which could explain biomechanically the frequent concomitant appearance. Cervical joint dysfunction can appear in persistent concussive syndrome, with upper cervical pain, less endurance of the cervical flexor muscles, and an increase in cervical stiffness leading to tension headache. This could explain neck pain in mTBI and headache in whiplash. An explanation to vestibular and cochlear disorders is given, and the two pathologies concomitantly could increase the symptoms.
To our knowledge, no studies define distinct boundaries between these two pathologies, which overlap on many points. An explanation is their concomitant onset, due to the biomechanics of the trauma and anatomical reasons. Larger-scale studies of rigorous scientific quality are needed to answer the question of the difference between whiplash and mTBI.
轻度创伤性脑损伤（mTBI）和挥鞭样损伤是颅颈创伤后续出现的两种病症。本研究的目的是回顾它们的定义，并对每种病症进行讨论。
对挥鞭样损伤和mTBI进行了定义。然后，使用PubMed数据库进行了系统的文献综述。选取了1995年以后的相关研究，其中16篇文章描述了挥鞭样损伤与mTBI之间的联系。阅读摘要后对8篇文章进行了分析。
挥鞭样损伤和mTBI有许多相似之处（症状、生物力学、认知障碍、功能成像上弥漫性轴索损伤的存在），也有一些差异（姿势方面，挥鞭样损伤中前庭和平衡障碍更多）。mTBI由60 - 160g（重力）的线性加速度导致，关于挥鞭样损伤的研究表明，它们可在4.5g时出现，这从生物力学角度可以解释两者经常同时出现的情况。颈椎关节功能障碍可出现在持续性脑震荡综合征中，伴有上颈部疼痛、颈屈肌耐力下降以及颈部僵硬增加导致紧张性头痛。这可以解释mTBI中的颈部疼痛和挥鞭样损伤中的头痛。对前庭和耳蜗障碍给出了解释，两种病症同时存在可能会加重症状。
据我们所知，尚无研究明确界定这两种病症之间的明显界限，它们在许多方面相互重叠。一种解释是它们同时发病，这是由于创伤的生物力学和解剖学原因。需要开展更严格科学质量的大规模研究来回答挥鞭样损伤和mTBI之间差异的问题。
