车祸后挥鞭样损伤的生物心理社会后遗症和恢复轨迹。

Biopsychosocial sequelae and recovery trajectories from whiplash injury following a motor vehicle collision.

机构信息

Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, The Kolling Institute, 10 Westbourne St, St Leonards, New South Wales, 2065, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Chicago, IL 60611, USA.

Faculty of Health Sciences, School of Physical Therapy, Western University Canada Schulich School of Medicine and Dentistry, 1151 Richmond St, London, Ontario N6A 5C1, Canada; Department of Psychiatry, Western University Canada, 151 Richmond St, London, Ontario N6A 5C1, Canada.

出版信息

Spine J. 2023 Jul;23(7):1028-1036. doi: 10.1016/j.spinee.2023.03.005. Epub 2023 Mar 21.

DOI:10.1016/j.spinee.2023.03.005

PMID:36958668

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10330498/

Abstract

BACKGROUND CONTEXT

Five out of 10 injured in a motor vehicle collision (MVC) will develop persistent pain and disability. It is unclear if prolonged symptoms are related to peritraumatic pain/disability, psychological distress, muscle fat, lower extremity weakness.

PURPOSE

To test if widespread muscle fat infiltration (MFI) was (1) unique to those with poor recovery, (2) present in the peritraumatic stage, (3) related to known risk factors.

STUDY DESIGN/SETTING: A cohort study, single-center academic hospital.

PATIENT SAMPLES

A total of 97 men and women (age 18-65) presenting to an urban academic emergency medicine department following MVC, but not requiring inpatient hospitalization.

PRIMARY OUTCOME MEASURE

Neck disability at 12-months.

METHODS

Participants underwent magnetic resonance imaging (MRI) to quantify neck and lower extremity MFI, completed questionnaires on pain/disability and psychological distress (< 1-week, 2-weeks, 3-, and 12-months) and underwent maximum volitional torque testing of their lower extremities (2-weeks, 3-, and 12-months). Percentage score on the Neck Disability Index at 12-months was used for a model of (1) Recovered (0%-8%), (2) Mild (10%-28%), and (3) Moderate/Severe (≥ 30%). This model was adjusted for BMI and age.

RESULTS

Significant differences for neck MFI were revealed, with the Recovered group having significantly lower neck MFI than the Mild and Moderate/Severe groups at all time points. The Mild group had significantly more leg MFI at 12-months (p=.02) than the Recovered group. There were no other significant differences at any other time point. Lower extremity torques revealed no group differences. The Traumatic Injury Distress Scale (TIDS) and MFI of the neck at 1-week postinjury significantly predicted NDI score at 12-months.

CONCLUSIONS

Higher neck MFI and distress may represent a risk factor though it is unclear whether this is a pre-existing phenotype or result of the trauma.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02157038.

摘要

背景

在机动车碰撞（MVC）中，有十分之五的伤者会出现持续的疼痛和残疾。目前尚不清楚是否是迁延性疼痛/残疾、心理困扰、肌肉脂肪、下肢无力导致了长期症状。

目的

测试广泛的肌肉脂肪浸润（MFI）是否（1）仅存在于恢复不佳的患者中，（2）出现在创伤期，（3）与已知的危险因素有关。

研究设计/地点：队列研究，单中心学术医院。

患者样本

共纳入 97 名 18-65 岁的男性和女性，他们在 MVC 后前往城市学术急诊医学科就诊，但不需要住院治疗。

主要结果测量

12 个月时的颈部残疾。

方法

参与者接受颈部和下肢 MRI 以定量评估肌肉脂肪浸润，完成疼痛/残疾和心理困扰问卷（<1 周、2 周、3 个月和 12 个月），并在 2 周、3 个月和 12 个月时接受下肢最大随意扭矩测试。12 个月时的颈部残疾指数（NDI）得分用于（1）恢复（0%-8%）、（2）轻度（10%-28%）和（3）中度/重度（≥30%）模型。该模型调整了 BMI 和年龄。

结果

颈部 MFI 存在显著差异，恢复组在所有时间点的颈部 MFI 显著低于轻度和中度/重度组。轻度组在 12 个月时下肢 MFI 显著高于恢复组（p=.02）。其他时间点没有其他显著差异。下肢扭矩没有显示出组间差异。创伤损伤困扰量表（TIDS）和损伤后 1 周颈部 MFI 显著预测 12 个月时的 NDI 评分。