Curtin Patrick, Mitchell Benjamin, Patel Jay, Lansbury Jenna, Connolly Patrick, Stauff Michael
University of Massachusetts, Department of Orthopedic Surgery, Worcester MA, 01655.
N Am Spine Soc J. 2022 Mar 3;10:100109. doi: 10.1016/j.xnsj.2022.100109. eCollection 2022 Jun.
Thoracic spine fractures (TSFs) are rarely isolated injuries, and they tend to present with a characteristic set of vertebral and non-vertebral injuries based on mechanism of injury. There is limited research on the rates and distribution of injuries that occur concurrently with TSFs. The purpose of this study is to characterize the distributions of these injuries by region of the body and by mechanisms of injury, so that trauma and spine surgeons can efficiently evaluate and treat patients presenting with TSFs.
We retrospectively reviewed the trauma database records of 683 patients presenting with a TSFs at a single institution from 2015 to 2019. We recorded patient demographics, comorbidities, and associated injuries by body region. We characterized the TSFs using the AO classification system, as well as the presenting physical exam and treatment. All associated injuries among the TSF patients were classified into the following categories: head injury (HI), thoracic injury (TI), non-thoracic vertebral injury (NTVI), abdominal injury (AI), upper extremity injury (UEI), lower extremity injury (LEI), and spinal cord injury (SCI).
The three leading causes of TSFs were mechanical falls (38.4%), falls from height (24.9%), and motor vehicle crashes (MVCs) (23.4%). Patients with a TSF from MVC were statistically more likely to have concomitant injuries of TI, NTVI, AI, HI, UEI, and LEI. TSFs from fall from height were statistically more likely to have TI, NTVI, and LEI. TSFs from mechanical falls had significantly lower rates of all injury locations, but still presented with high rates of additional injury. TSFs from motorcycle crashes (MCCs) presented with TI, AI, UEI, and LEI. There were high rates of treatment for TSFs, with surgery ranging from 5.3% to 20.0% and bracing from 52.3% to 65.7% depending on mechanism of injury.
TSFs after MVCs, mechanical falls, falls from height, and MCCs presented with a predictable pattern of injuries and were rarely an isolated injury. This cross-sectional data may help spine and trauma surgeons better understand patterns of injury associated with TSFs, with the hope of preventing missed injuries and better advising patients with TSFs on severity of injuries.
胸椎骨折（TSFs）很少是孤立性损伤，根据损伤机制，它们往往伴有一系列典型的椎体和非椎体损伤。关于与胸椎骨折同时发生的损伤的发生率和分布的研究有限。本研究的目的是按身体部位和损伤机制对这些损伤的分布进行特征描述，以便创伤外科医生和脊柱外科医生能够有效地评估和治疗胸椎骨折患者。
我们回顾性分析了2015年至2019年在单一机构就诊的683例胸椎骨折患者的创伤数据库记录。我们记录了患者的人口统计学资料、合并症以及按身体部位划分的相关损伤。我们使用AO分类系统对胸椎骨折进行特征描述，以及记录患者的体格检查和治疗情况。胸椎骨折患者的所有相关损伤分为以下几类：头部损伤（HI）、胸部损伤（TI）、非胸椎椎体损伤（NTVI）、腹部损伤（AI）、上肢损伤（UEI）、下肢损伤（LEI）和脊髓损伤（SCI）。
胸椎骨折的三大主要原因是机械性跌倒（38.4%）、高处坠落（24.9%）和机动车碰撞（MVCs）（23.4%）。因机动车碰撞导致胸椎骨折的患者在统计学上更有可能伴有胸部损伤、非胸椎椎体损伤、腹部损伤、头部损伤、上肢损伤和下肢损伤。高处坠落导致的胸椎骨折在统计学上更有可能伴有胸部损伤、非胸椎椎体损伤和下肢损伤。机械性跌倒导致的胸椎骨折在所有损伤部位的发生率均显著较低，但仍有较高的额外损伤发生率。摩托车碰撞（MCCs）导致的胸椎骨折伴有胸部损伤、腹部损伤、上肢损伤和下肢损伤。胸椎骨折的治疗率较高，根据损伤机制，手术率从5.3%到20.0%不等，支具固定率从52.3%到65.7%不等。
机动车碰撞、机械性跌倒、高处坠落和摩托车碰撞后发生的胸椎骨折呈现出可预测的损伤模式，很少是孤立性损伤。这些横断面数据可能有助于脊柱外科医生和创伤外科医生更好地了解与胸椎骨折相关的损伤模式，以期防止漏诊损伤，并更好地向胸椎骨折患者告知损伤的严重程度。
