Spota Andrea, Giorgi Pietro Domenico, Cioffi Stefano Piero Bernardo, Altomare Michele, Schirò Giuseppe Rosario, Legrenzi Simona, Villa Fabio Giuseppe, Chiara Osvaldo, Cimbanassi Stefania
Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy; Tissue Bank and Therapy, ASST GOM Niguarda, Milan, Italy.
Trauma and Orthopaedics, ASST GOM Niguarda, Milan, Italy.
Injury. 2023 Apr;54(4):1144-1150. doi: 10.1016/j.injury.2023.02.039. Epub 2023 Feb 22.
Traumatic spinal injuries are frequent and their management is debated, especially in major trauma patients. This study aims to describe a large population of major trauma patients with vertebral fractures to improve prevention measures and fracture management.
Retrospective analysis of 6274 trauma patients prospectively collected between October 2010 and October 2020. Collected data include demographics, mechanism of trauma, type of imaging, fracture morphology, associated injuries, injury severity score (ISS), survival, and death timing. The statistical analysis focused on mechanism of trauma and the search of predictive factors for critical fractures.
Patients showed a mean age of 47 years and 72.5% were males. Trauma included 59.9% of road accidents and 35.1% of falls. 30.7% patients had at least a severe fracture, while 17.2% had fractures in multiple spinal regions. 13.7% fractures were complicated by spinal cord injury (SCI). The mean ISS of the total population was 26.4 (SD 16.3), with 70.7% patients having an ISS≥16. There is a higher rate of severe fractures in fall cases (40.1%) compared to RA (21.9% to 26.3%). The probability of a severe fracture increased by 164% in the case of fall and by 77% in presence of AIS≥3 associated injury of head/neck while reduced by 34% in presence of extremities associated injuries. Multiple level injuries increased with ISS rise and in the case of extremities associated injuries. The probability of a severe upper cervical fracture increased by 5.95 times in the presence of facial associated injuries. The mean length of stay was 24.7 days and 9.6% of patients died.
In Italy, road accidents are still the most frequent trauma mechanism and cause more cervico-thoracic fractures, while falls cause more lumbar fractures. Spinal cord injuries represent an indicator of more severe trauma. In motorcyclists or fallers/jumpers, there is a higher risk of severe fractures. When a spinal injury is diagnosed, the probability of a second vertebral fracture is consistent. These data could help the decisional workflow in the management of major trauma patients with vertebral injury.
创伤性脊柱损伤很常见，其治疗方法存在争议，尤其是在重大创伤患者中。本研究旨在描述大量患有椎体骨折的重大创伤患者，以改进预防措施和骨折治疗方法。
对2010年10月至2020年10月前瞻性收集的6274例创伤患者进行回顾性分析。收集的数据包括人口统计学信息、创伤机制、影像学类型、骨折形态、相关损伤、损伤严重程度评分（ISS）、生存情况和死亡时间。统计分析重点关注创伤机制以及寻找严重骨折的预测因素。
患者的平均年龄为47岁，72.5%为男性。创伤包括59.9%的道路交通事故和35.1%的跌倒。30.7%的患者至少有一处严重骨折，17.2%的患者在多个脊柱区域发生骨折。13.7%的骨折并发脊髓损伤（SCI）。总体人群的平均ISS为26.4（标准差16.3），70.7%的患者ISS≥16。与道路交通事故（21.9%至26.3%）相比，跌倒病例中严重骨折的发生率更高（40.1%）。跌倒时严重骨折的概率增加164%，存在头部/颈部AIS≥3相关损伤时增加77%，而存在四肢相关损伤时降低34%。多节段损伤随ISS升高以及存在四肢相关损伤而增加。存在面部相关损伤时，严重上颈椎骨折的概率增加5.95倍。平均住院时间为24.7天，9.6%的患者死亡。
在意大利，道路交通事故仍是最常见的创伤机制，导致更多的颈胸段骨折，而跌倒导致更多的腰椎骨折。脊髓损伤是更严重创伤的一个指标。在摩托车手或跌倒者/跳跃者中，严重骨折的风险更高。当诊断出脊柱损伤时，发生第二椎体骨折的概率是一致的。这些数据有助于指导对患有椎体损伤的重大创伤患者的决策流程。
