Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 6 East, 300 Grattan Street, Melbourne, Victoria, 3050, Australia.
Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 6 East, 300 Grattan Street, Melbourne, Victoria, 3050, Australia.
Injury. 2022 Jun;53(6):2023-2027. doi: 10.1016/j.injury.2022.03.031. Epub 2022 Mar 19.
Traumatic internal carotid artery (ICA) injuries are an uncommon complication of petrous temporal bone (PTB) fractures that can have devastating consequences of stroke, haemorrhage and death. Current guidelines suggest that all PTB fractures should be screened for blunt cerebrovascular injury, however clinical practice varies. The purpose of this study was to identify features associated with PTB fractures that increase the likelihood of ICA injury.
A retrospective cohort study was performed on all patients with PTB fractures who were investigated with computed-tomography angiography (CTA) scan admitted to a Level One Trauma Service in Melbourne, Australia from 2015-2020. Patient demographic and injury data were obtained from The Royal Melbourne Hospital Trauma Registry and medical records. Multivariate binomial logistic regression was performed to identify features associated with ICA injury.
Out of 377 patients with 419 PTB fractures, 205 received a CTA scan and were included, identifying 22 ICA injuries (9.4%). The median age of ICA injuries was 33 (IQR 23-61), median Abbreviated Injury Scale (AIS) score for the head region was 5 (IQR 5-5) and the in-hospital mortality rate was 45.5%, mainly due to unsurvivable brain injury. Five patients (22.7%) developed ICA-specific complications of stroke or carotid-cavernous fistula. We identified five factors that were significantly associated with ICA injury. These included PTB fractures involving the carotid canal (OR 6.7, 95% CI 1.9-23.9, p=0.003), presenting with an initial GCS less than nine (OR 5.7, 95% CI 1.2-26.5, p=0.025) and increasing head AIS (OR 2.4, 95% CI 1.2-4.6, p=0.009). Mechanisms of injury that were associated with ICA injury were motor vehicle crash (OR 4.4, 95% CI 1.4-14.2, p=0.012) and motorbike crash (OR 4.6, 95% CI 1.2-18, p=0.029).
Patients with PTB fractures and an additional feature of carotid canal involvement, presenting GCS less than nine, increasing head AIS indicative of severe head trauma or mechanism of injury by motor vehicle or motorbike crash, are at an increased risk of ICA injury and should be screened with a CTA scan.
外伤性颈内动脉（ICA）损伤是颅底颞骨（PTB）骨折的一种罕见并发症，可导致中风、出血和死亡等灾难性后果。目前的指南建议对所有 PTB 骨折进行钝性脑血管损伤筛查，但临床实践存在差异。本研究的目的是确定与 PTB 骨折相关的特征，这些特征增加了 ICA 损伤的可能性。
对 2015 年至 2020 年期间在澳大利亚墨尔本一家一级创伤服务中心接受计算机断层血管造影（CTA）扫描检查的所有 PTB 骨折患者进行了回顾性队列研究。患者的人口统计学和损伤数据来自皇家墨尔本医院创伤登记处和病历。采用多变量二项逻辑回归分析确定与 ICA 损伤相关的特征。
在 377 名患有 419 处 PTB 骨折的患者中，有 205 名接受了 CTA 扫描并被纳入研究，发现 22 例 ICA 损伤（9.4%）。ICA 损伤的中位年龄为 33 岁（IQR 23-61），头部损伤严重程度评分（AIS）的中位数为 5（IQR 5-5），院内死亡率为 45.5%，主要是由于无法生存的脑损伤。有 5 名患者（22.7%）发生了 ICA 特定的中风或颈动脉海绵窦瘘并发症。我们确定了五个与 ICA 损伤显著相关的因素。这些因素包括累及颈动脉管的 PTB 骨折（OR 6.7，95%CI 1.9-23.9，p=0.003）、初始格拉斯哥昏迷量表（GCS）评分小于 9 分（OR 5.7，95%CI 1.2-26.5，p=0.025）和头部 AIS 增加（OR 2.4，95%CI 1.2-4.6，p=0.009）。与 ICA 损伤相关的损伤机制是机动车事故（OR 4.4，95%CI 1.4-14.2，p=0.012）和摩托车事故（OR 4.6，95%CI 1.2-18，p=0.029）。
患有 PTB 骨折且伴有颈动脉管受累、GCS 评分小于 9 分、头部 AIS 升高提示严重头部创伤或机动车或摩托车事故导致的损伤机制的患者，ICA 损伤风险增加，应进行 CTA 扫描筛查。
