Utheim Nils Christian, Helseth Eirik, Stroem Mona, Rydning Paal, Mejlænder-Evjensvold Magnus, Glott Thomas, Hoestmaelingen Christina Teisner, Aarhus Mads, Roenning Paal Andre, Linnerud Hege
Department of Neurosurgery, Oslo University Hospital, Nydalen, P. O. Box 4956, 0424, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Inj Epidemiol. 2022 Mar 24;9(1):10. doi: 10.1186/s40621-022-00374-w.
In Western countries, the typical cervical spine fracture (CS-Fx) patient has historically been a young male injured in a road traffic accident. Recent reports and daily clinical practice clearly indicate a change in the typical patient from a young male to an elderly male or female with comorbidities. This study aimed to establish contemporary population-based epidemiological data of traumatic CS-Fx for use in health-care planning and injury prevention.
This is a population-based retrospective database study (with prospectively collected data) from the Southeast Norway health region with 3.0 million inhabitants. We included all consecutive cases diagnosed with a CS-Fx between 2015 and 2019. Information regarding demographics, preinjury comorbidities, trauma mechanisms, injury description, treatment, and level of hospital admittance is presented.
We registered 2153 consecutive cases with CS-Fx during a 5-year period, with an overall crude incidence of CS-Fx of 14.9/100,000 person-years. Age-adjusted incidences using the standard population for Europe and the World was 15.6/100,000 person-years and 10.4/100,000 person-years, respectively. The median patient age was 62 years, 68% were males, 37% had a preinjury severe systemic disease, 16% were under the influence of ethanol, 53% had multiple trauma, and 12% had concomitant cervical spinal cord injury (incomplete in 85% and complete in 15%). The most common trauma mechanisms were falls (57%), followed by bicycle injuries (12%), and four-wheel motorized vehicle accidents (10%). The most common upper CS-Fx was C2 odontoid Fx, while the most common subaxial Fx was facet joint Fx involving cervical level C6/C7. Treatment was external immobilization with a stiff neck collar alone in 65%, open surgical fixation in 26% (giving a 3.7/100,000 person-years surgery rate), and no stabilization in 9%. The overall 90-day mortality was 153/2153 (7.1%).
This study provides an overview of the extent of the issue and patient complexity necessary for planning the health-care management and injury prevention of CS-Fx. The typical CS-Fx patient was an elderly male or female with significant comorbidities injured in a low-energy trauma. The overall crude incidences of CS-Fx and surgical fixation of CS-Fx in Southeast Norway were 14.9/100,000 person-years and 3.7/100,000 person-years, respectively.
在西方国家，典型的颈椎骨折（CS-Fx）患者历来是在道路交通事故中受伤的年轻男性。最近的报告和日常临床实践清楚地表明，典型患者已从年轻男性转变为患有合并症的老年男性或女性。本研究旨在建立基于当代人群的创伤性CS-Fx流行病学数据，以用于医疗保健规划和伤害预防。
这是一项基于人群的回顾性数据库研究（数据前瞻性收集），来自挪威东南部健康地区，该地区有300万居民。我们纳入了2015年至2019年间所有连续诊断为CS-Fx的病例。呈现了有关人口统计学、伤前合并症、创伤机制、损伤描述、治疗以及医院收治水平的信息。
我们在5年期间登记了2153例连续的CS-Fx病例，CS-Fx的总体粗发病率为14.9/100,000人年。使用欧洲和世界标准人群进行年龄调整后的发病率分别为15.6/100,000人年和10.4/100,0至0人年。患者年龄中位数为62岁，68%为男性，37%有伤前严重全身性疾病，16%受乙醇影响，53%有多发伤，12%伴有颈脊髓损伤（85%为不完全性损伤，15%为完全性损伤）。最常见的创伤机制是跌倒（57%），其次是自行车伤（12%）和四轮机动车事故（10%）。最常见的上位CS-Fx是C2齿状突骨折，而最常见的下颈椎骨折是涉及颈椎C6/C7水平的小关节骨折。65%的患者仅采用硬颈托进行外部固定治疗，26%采用开放手术固定（手术率为3.7/100,000人年），9%未进行固定。90天总体死亡率为153/2153（7.1%）。
本研究概述了规划CS-Fx的医疗保健管理和伤害预防所需的问题范围和患者复杂性。典型的CS-Fx患者是在低能量创伤中受伤的患有显著合并症的老年男性或女性。挪威东南部CS-Fx的总体粗发病率和CS-Fx手术固定率分别为14.9/100,000人年和3.7/100,000人年。
