Hax Jakob, Teuben Michel, Halvachizadeh Sascha, Berk Till, Scherer Julian, Jensen Kai Oliver, Lefering Rolf, Pape Hans-Christoph, Sprengel Kai
Department of Trauma, University Hospital Zurich, Zurich, Switzerland.
Department of Hip and Knee Surgery, Schulthess Clinic, Zurich, Switzerland.
Global Spine J. 2025 Mar;15(2):906-915. doi: 10.1177/21925682231216082. Epub 2023 Nov 14.
Retrospective database analysis.
Polytraumatized patients with spinal injuries require tailor-made treatment plans. Severity of both spinal and concomitant injuries determine timing of spinal surgery. Aim of this study was to evaluate the role of spinal injury localization, severity and concurrent injury patterns on timing of surgery and subsequent outcome.
The TraumaRegister DGU was utilized and patients, aged ≥16 years, with an Injury Severity Score (ISS) ≥16 and diagnosed with relevant spinal injuries (abbreviated injury scale, AIS ≥ 3) were selected. Concurrent spinal and non-spinal injuries were analysed and the relation between injury severity, concurrent injury patterns and timing of spinal surgery was determined.
12.596 patients with a mean age of 50.8 years were included. 7.2% of patients had relevant multisegmental spinal injuries. Furthermore, 50% of patients with spine injuries AIS ≥3 had a more severe non-spinal injury to another body part. ICU and hospital stay were superior in patients treated within 48 hrs for lumbar and thoracic spinal injuries. In cervical injuries early intervention (<48 hrs) was associated with increased mortality rates (9.7 vs 6.3%).
The current multicentre study demonstrates that polytrauma patients frequently sustain multiple spinal injuries, and those with an index spine injury may therefore benefit from standardized whole-spine imaging. Moreover, timing of surgical spinal surgery and outcome appear to depend on the severity of concomitant injuries and spinal injury localization. Future prospective studies are needed to identify trauma characteristics that are associated with improved outcome upon early or late spinal surgery.
回顾性数据库分析。
多发伤合并脊柱损伤的患者需要量身定制的治疗方案。脊柱损伤及合并伤的严重程度决定脊柱手术的时机。本研究的目的是评估脊柱损伤的部位、严重程度及并发损伤类型对手术时机及后续结果的影响。
利用创伤注册数据库（TraumaRegister DGU），选取年龄≥16岁、损伤严重程度评分（ISS）≥16且诊断为相关脊柱损伤（简明损伤定级标准，AIS≥3）的患者。分析脊柱及非脊柱并发损伤情况，确定损伤严重程度、并发损伤类型与脊柱手术时机之间的关系。
纳入12596例患者，平均年龄50.8岁。7.2%的患者存在相关多节段脊柱损伤。此外，脊柱损伤AIS≥3的患者中有50%合并其他身体部位更严重的非脊柱损伤。腰椎和胸椎损伤患者在48小时内接受治疗，其重症监护病房（ICU）住院时间和住院总时间较短。颈椎损伤早期干预（<48小时）与死亡率增加相关（9.7%对6.3%）。
当前的多中心研究表明，多发伤患者常伴有多处脊柱损伤，因此，伴有脊柱损伤的患者可能受益于标准化全脊柱成像检查。此外，脊柱手术时机及结果似乎取决于合并伤的严重程度和脊柱损伤部位。未来需要进行前瞻性研究，以确定与早期或晚期脊柱手术后改善预后相关的创伤特征。
